The Waiting Game: Play and Win By Improving Schedule Management

A leading retina practice reveals its eight-step program to efficient patient processing.

By Johanna Tollefson Keys, C.O.A.

At Retina Consultants of Arizona, from left: Claudia Ramirez, Administrative Assistant to Dr. Dugel; Pravin U. Dugel, MD, Managing Partner; Johanna Tollefson Keys, COA, Administrative Clinical Operations Manager.

Unfortunately, waiting is part of a typical ophthalmic office visit. Patients wait for the technician, wait for the doctor, wait for their eyes to dilate, wait for testing, and wait for results. Wait, wait, wait — that’s just the way it is. But that doesn’t mean there isn’t room for improvement.

I spent the first nine years of my career working at a large multi-specialty ophthalmology practice in Washington State where the waiting game was an accepted part of the patient experience. Did we like it? No. Did we try and improve it? Yes. The practice recognized that the potential for long waits was not an ideal situation for patients and began actively working to make it better. Did all the recommendations from staff and patients work 100% of the time? No, but the practice continuously worked at it. As a result, we began to see significant improvements not only in wait times, but also in practice productivity and patient satisfaction.

In 2004, I moved to Arizona and began working for a retina specialty practice. I noticed right away the struggles we experienced in Washington were similar to those we were experiencing in Arizona. It turns out we are not islands unto ourselves. In fact, the issues related to wait times were even more complex, considering the additional tasks required in the retinal setting. To my chagrin, I learned that retinal patients sometimes spent up to four hours at a time in the office! Fortunately, that is no longer the case at our practice.

Elena Marcos, left, and Harpreet Kaur are Research Coordinators at Retinal Consultants of Arizona.

Common Influences and Goals

Most readers will agree, the waiting game is influenced by many factors — inefficient technicians, physicians who enjoy socializing at length with patients, patients who have complicated medical histories, and talkative patients who prefer discussing their personal lives over their eye conditions. These are just a few.

Despite the varying causes, though, most practices that tackle wait-time issues agree on the same overall goals:

■ To provide excellent care to patients without making them wait so long.

■ To increase practice productivity.

Tests still need to be administered, eyes still need to be dilated and patients still need to be examined. So what can be done?

Step-By-Step Approach

The key to reducing practice wait times is to increase practice efficiency through improved schedule management. While no magic wand will solve the problem perfectly, practices willing to embrace the following scheduling and efficiency guidelines can see a marked improvement.

Step 1: KNOW YOUR PHYSICIANS. The first step in running an efficient practice is to understand how your physicians work. What are their habits around seeing patients? What are their routines and preferences? What is each doctor’s style? The answers can help the practice to perform an honest assessment of existing schedule templates.

At top, Janay Jarvis, Referral Coordinator. Below, Nohemi Ramirez, COA, Sr. Technician.

Step 2: CREATE PHYSICIAN-TAILORED SCHEDULES. Once you have your doctor figured out, develop a scheduling template that works for him or her. No two physicians are alike. This is easy to forget, and far too often administrators and managers expect their doctors to be carbon copies of each other. While it is unrealistic to implement tailor-made schedules for each and every physician in a large practice, having a one-size-fits-all schedule may be too rigid for the occasional doctor with a unique style who operates at a different pace than the others.

Step 3: IMPLEMENT A NEW SCHEDULE AND CUSTOMIZE IT IF NECESSARY. Implementing a new schedule is not that difficult. Basically you create the template and have the patients called and moved into the new (and improved) time slots. Once everyone becomes acclimated to the new schedule, you can watch your magic work. If it doesn’t, tweak it as necessary until you achieve the results you are seeking. Nine out of 10 times you will nail it. The transition can be difficult in the beginning, but I promise the staff and physicians will adapt quickly and become grateful for the improvement.

Unfortunately, I can’t provide managers with one specific template and say, ‘use this one, it’s awesome and all of your doctors will love it.’ You must consider what works best for each of your doctors and customize the schedule accordingly. For example, you may need to abandon the idea of 5- to 10-minute appointment slots for the talkative physician that loves to know the names of all his patients’ grandchildren and the colleges they attend. A schedule with 10- to 20-minute appointments might be more appropriate.

Step 4: UNDERSTAND STAFFING NEEDS. It is important to know how many technicians you need to make the physician’s schedule run smoothly. If you are scheduling 60 patients in an eight hour workday for one physician, don’t schedule just one or two techs with that doctor. No one likes to be set up for failure. The algorithm I have come up with seems to work very well in our practice. Is it perfect? No, but it does work 90%–95% of the time.

The algorithm is as follows: Schedule one workup tech per every 12–18 patients in a half-day (three hours). This allows for a 10- to 15-minute work-up and leaves wiggle room for patients who may only take 5-7 minutes and those who may take 20–30 minutes. This formula translates into the following staffing arrangement for our schedule: 20–30 patients in a half day equals two work-up techs, two photographers, one procedure tech and one scribe — six technicians total.

Keep in mind, this formula is for a retina practice where we administer a large volume of intravitreal injections and perform a lot of OCTs and FAs for patients who have age-related macular degeneration. If you are in a general ophthalmology practice, you probably do not need a procedure tech or photographers. The better number would be three or four techs, depending on their responsibilities for performing specialized tasks such as refractions, visual fields or pre-cataract work-ups.

Step 5: EDUCATE THE STAFF. Make sure your technicians (and photographers, if applicable) know the practice’s expectations in regards to work-ups and photography. Give them a detailed list of what they are expected to complete within a specified timeframe for each type of exam. These may differ, but techs might not know if you do not tell them. For example, techs should spend less time on a post-operative exam than a new-patient exam. Spell out expectations in writing and give them to each tech. Never assume they know what you expect.

Step 6: SET GOALS. Set a realistic goal for a reasonable amount of time patients should spend in the office. For example, in a retina office it would be 90-120 minutes. That said, the goal at our clinic is to have the patient checking out within 90 minutes or less of their appointment time. Do we always meet our goal? No, but that is the reality of life. Do we meet it most of the time? Yes, and that feels good! At times we even beat it. On some days the total time patients spend in our clinic is 45 minutes or less.

Step 7: OBTAIN STAFF BUY-IN. The only way to meet practice goals is to achieve maximum staff buy-in. If your entire staff — including doctors, techs and front office team — are not on-board with getting the patient in, taken care of and out the door in the most efficient manner possible, meaningful change has little chance. Everyone has to be on the same page. Involving staff in the goalsetting process and providing frequent progress updates at staff meetings can help, as will forming groups to analyze related processes that may be contributing to the wait problem. Involving staff reinforces the fact that reducing wait times is a team effort.

Step 8: SET PATIENT EXPECTATIONS. When scheduling appointments for new patients, let them know how long they should expect to be in the office. For example, you can say, “Mrs. Jones, so that we are able to get your paperwork completed, dilate your eyes, and do an exam, plan on spending one full hour with us.” If patients have an idea of how long they will be in your office, they are less likely to become irritated during the wait and are freed up to plan the remainder of their day. They can also plan accordingly for a ride. It is important to educate your staff on what to say to patients in terms of setting patient expectations. A laminated phone script might be helpful. We have used scripts for many things in our practice. They help make sure all staff members are saying the same thing and what the practice wants them to say on its behalf.

Make a Difference

Managing clinic schedules could be the most important thing an ophthalmic professional does. It can make or break a practice. However, the process need not be daunting. By utilizing the simple guidelines in this article, you can make a difference in wait-times and in the process improve patient efficiency and flow and customer satisfaction, and relieve staff tensions. OP

Ms. Keys is an administrative clinical operations manager at Retinal Consultants of Arizona in Phoenix. She can be reached at jkeys@retinalconsultantsaz.com.