When I am called into a practice to analyze office flow, one of the areas I investigate is why the schedule gets backed up. I start to pinpoint the suspected bottlenecks by asking the same question to both doctors and staff: “In your opinion, where do you see the problem?”
If you were to guess that the doctors blame the staff and vice-versa, you would be right. The staff might say “(The doctor) spends too much time in the room with the patient.” The doctor might say “(The staff) doesn’t schedule properly.”
Looking for someone to blame is not only irresponsible, it is not constructive. The truth is that keeping your office on schedule requires a team effort. Backups are not generally a result of just one thing or one person. Let us stop pointing fingers and concentrate on implementing some proven strategies for improvement.
Start on time. Did you know that starting late is the single biggest cause of running behind? If the first patient is scheduled at 8 a.m., doctors need to set an example and arrive before then. Allow yourself the time to do what you have to do before the day starts and be ready before that first patient comes in. By the same token, if the staff does not have that patient checked in and set up in a treatment room by 8 a.m. (or sooner), the schedule is already compromised.
Scheduling protocol. Staff should have adequate policies and protocols to follow that allow them to manage the schedule properly. That means not scheduling a new patient for 15 minutes if it really takes 30 minutes or not scheduling a postoperative redress for 15 minutes if it only takes five minutes. Scheduling should happen according to facts, not guesswork. Take your five or 10 most common procedures and assign a time to each one, based on monitoring the average time you spend with each one. Then schedule accordingly.
Reining in the “two for one” attempts. “Doctor, can you also look at little Jimmy’s foot while I have him here with me?” This is a common request from patients who have dragged their son with them, hoping to get both the parent and child visits together (in an effort to save time and/or another co-pay). You should handle this properly or it is a surefire way to throw your day off.
After having a brief dialogue about little Jimmy’s problem (while you are working) and determining it is not an emergent situation, the best response you can give your patient is, “In order for me to give Jimmy the proper attention he deserves, I suggest you ask Carol at the reception desk to schedule a separate appointment for him.” If your response is such that the patients feel it is in their best interest, they will cooperate. Of course, if it is an emergency, all cards are off the table. Realistically, how often does that happen? If it were an emergency, the mother likely would have called ahead.
Streamline your check-in process. Insist that your new patients present with their patient registration paperwork completed. The national benchmark for completing new patient paperwork is 14 minutes. How does your practice rank in this regard? If your form is very comprehensive and/or several pages long, it may lead to delays.
For example, a practice that sees four new patients a day and can shave 14+ minutes off each one of those visits can gain almost another whole hour in the day. Of course, the most efficient way to accomplish this is to have your own Web site where patients can download the form and better yet, a patient portal, where patients can complete their forms online. If patients do not have Internet access, the staff can mail the form to them or tell them their “appointment time” is 15 minutes earlier than what they have actually recorded in the schedule. This way, there is time actually “built in” to the schedule for this patient paperwork.
Addressing late arrivals and no shows. It is not unrealistic to expect that there will be times when patients legitimately arrive late for an appointment. Maybe they got lost, stuck in traffic or had an emergency that detained them. In all possible cases, we try to be fair and accommodating. However, it is important that your staff does not give up the control of these types of situations to your patients to the point that they take for granted the time you reserved for them.
For those patients who make a habit of arriving late for each appointment, staff need to professionally address their tardiness and present it in such a way that it is in their best interest, not yours, to reschedule them. If the office puts such a policy in place, it is important to support your staff’s actions and not contradict them. Of course, if the schedule permits, your staff can offer patients the option of waiting.
But remember, by bending over backwards to fit these types of patients in every time they come in late (or treat them for multiple conditions when they were scheduled for one), you are actually training them to repeat this unacceptable behavior. This is not fair to all your other compliant patients who arrive on time.
You can’t monitor it if you can’t measure it. By conducting random time and motion studies, you can pinpoint exactly when patients are waiting the longest during an encounter and where you can reduce or eliminate wasted time.
For a more accurate study (without interrupting your staff’s daily routine), get your patients involved. Give them a worksheet when they present and ask them to record specific times during their progression through the office. This includes when they entered, their scheduled visit, when staff called them into the treatment room, what time the doctor presented, how long they spent with the doctor and how long it took to be discharged. If they know they can play a small role in helping to make their future visits more time-efficient, they are happy and willing to be a part of that process.
In closing, I’d like to share some statistics I found interesting. In 2009, NCR U.S. Consumer Research conducted a study and found that:1
• Seventy-two percent of consumers were more likely to choose a healthcare provider that offered the flexibility to interact via online, mobile and kiosk self-service channels over a provider that did not.
• Seventy-six percent of consumers found waiting at a hospital or doctor’s office to be the greatest frustration they faced at a healthcare appointment.
• Sixty-one percent said they would choose one provider over another based on the appointment scheduling process.
• When it came to convenience, patients wanted to spend less time on routine tasks like scheduling appointments, paying medical bills and completing forms. A significant number looked to conduct transactions with their healthcare provider online or through a mobile device.
• Sixty-two percent of consumers expressed interest in booking or changing medical appointments online, through a mobile device or at a kiosk, and receiving text message reminders of an appointment.
• Fifty-four percent of consumers said the ability to book an appointment online would be convenient to them.
One can’t help but cringe when you hear that patients who are kept waiting 30 minutes or longer list it as the third most annoying wait, right up there with waiting at the Division of Motor Vehicles. Ouch! Patients have come to expect that doctors encounter emergencies every now and then, but it is not reasonable to expect them every time they come in for a visit.
One thing is certain. If patients are forced to wait … and wait … and wait while the office sits back and does nothing about it, nothing will ever change, except your patients may eventually get fed up and just go elsewhere. Now, would you blame them?
Ms. Homisak is the President of SOS Healthcare Management Solutions and has a Certificate in Human Resource Studies from the Cornell University School of Industry and Labor Relations. She is recognized nationwide as a speaker, writer and expert in staff and human resource management.
1. Available at www.ncr.com/documents/hc_ss_consumer_resch_wp.pdf  . Published 2009. Accessed Nov. 9, 2012.