Practice Management

Build a more efficient schedule

Clear communication and data are tools that can help you build and implement an effective, patient-friendly schedule.

BY MAUREEN WADDLE AND ELIZABETH HOLLOWAY, COE, CPSS, PHR

Every patient dreads the statement, “The doctor is running behind.” While there will always be extenuating circumstances, a well-built schedule coupled with good communication between the clinical and scheduling staff will not only reduce patient dissatisfaction due to wait times, but may also allow a practice to see more patients in a day. This article provides tips for building a more efficient schedule.

Start with the end in mind

Too often, practices build schedule templates thinking about the patient’s arrival time. Instead, base schedules on how the provider will move from exam room to exam room. In an ideal ophthalmic clinic flow, the doctor moves from one room to the next without having to wait for the technician to finish a patient work-up. Figure 1 (page 35) is a diagram that one practice used to build its cataract evaluation clinic. Notice that the doctor will see the patient who arrived at 8:15 a.m. for a short visit before he sees the cataract evaluation patient who arrived at 7:45 a.m. The cataract patient does not have any wait in the process because of the required work-up. To build a template this way, complete a time and motion study to determine average times for the doctors and technicians during the various stages of an exam and diagnostic testing.

Figure 1: Doctor-motion diagram (sample) — The red boxes track the doctor’s motion through a morning cataract clinic. This is from a practice with four exam lanes, an open work-up area, and a dilating area. Four technicians (one is always scribing) work with the doctor, and they can comfortably see 48 patients in a day on time.

Perform a time and motion study

Many of today’s electronic health record (EHR) systems time-stamp the medical record when a patient moves from the reception area to work-up area, from the work-up area to the dilating area, and so forth. For practices with EHR systems that track time, it should be fairly easy to generate a report indicating the average minutes it takes for each exam component. If not, conduct a manual study. Picking a “typical” two-week period and having a time-tracking form (see Figure 2, page 36) that “moves” with the patient is recommended. Fill in the times as patients begin and complete each step, and then later enter the minutes into an Excel workbook to calculate the averages. At minimum, collect the following data to build scheduling templates:

Figure 2: Time-tracking form (sample). Use a time-capture form to conduct manual time and motion studies for documenting times as the patient moves through the examination.

• Average doctor minutes for short exams

• Average doctor minutes for long exams

• Average tech time for patient history and chief complaint

• Average tech time for refraction (including autorefraction)

• Average tech time for diagnostic tests (i.e., automated visual fields, OCT, and IOL Master/A-scan)

• Average dilation time (or the amount of time one estimates it should take)

• Average time from patient check in until patient is ready (chart up)

Most practices classify appointments as short/brief and long/comprehensive. Many also use an intermediate level classification. Interestingly enough, these classifications depend more on technician time requirements rather than the doctor’s time. According to most time studies, an ophthalmologist’s average patient interaction is around seven minutes. This is for ophthalmologists who delegate patient work-up and refraction to well-trained technicians. Brief exams might be closer to five to six minutes and long exams eight to nine minutes. However, since the majority of the doctor’s time is going through the findings and treatment plan with the patient, the physician time does not have wide variance.

The technician time, on the other hand, varies from a short five-minute recap on a follow-up visit to 25 minutes for a full patient history, chief complaint, and comprehensive testing including a manifest refraction. The ASOA offers a work-up benchmark report to compare the results of a practice’s time and motion study to that of other ophthalmic practices.

Conduct a needs assessment for appointment types

Intuitively, it would be easy to see more patients if they all required “short” visits. However, if a template is built for short visits and the patient demand is for comprehensive exams, then such a template frustrates everyone on the team. Staff members frequently work hard to accommodate patient demand by taking two short-exam slots to schedule a patient who needs a long-exam slot (when no long-exam slots are available). This type of mis-scheduling quickly causes bottlenecks. Therefore, it is important to understand patient demand for certain appointment types.

Needs assessments have two primary components. The first is a historic look at the types of exams completed by each doctor (comprehensive vs. shorter visit). The second is to look at that doctor’s availability for future exams. The longer into the future it takes to find a time slot for a certain type of exam indicates a higher demand for that type than the schedule has available. As a rule of thumb, patients should not wait more than two weeks for an appointment. If you have a demand for more comprehensive exams, build those into the template. This may mean a decrease in total visits per day. However, if you do not build a schedule according to need, staff members will quickly deviate from the template in an attempt to meet patient demand.

Team talk

With results of the time and motion study and the needs assessment, put together a scheduling team. Include on the team people who schedule appointments (phone and checkout individuals), technicians, scribes, and the manager responsible for improving practice efficiency. Give this team free rein to make recommendations, which may include changing appointment-type definitions, adding specific appointment types, and creating special clinic schedules depending on the doctor’s specialty.

Best practices

While many items need evaluation (such as the layout of the space), here are several general tips that efficient practices have found helpful when building and successfully implementing new schedules:

• Put emergency patients at the end-of-morning or end-of-afternoon schedules. In larger practices, a specific doctor may be designated as the triage physician on a given day, and all emergencies are directed first to the provider who does not have routine exams that suffer because of “work-ins.”

• Build “clinic” schedules. In a clinic schedule, like-appointments are all grouped together. One-day postop patients are those most commonly in a “grouped” clinic schedule. “Batching” work has proven to be the most efficient work method for any industry. Having a glaucoma clinic once a month for the short, IOP-check patients is another example of a clinic schedule whereby you can see more patients than normal in an efficient manner.

• Stagger doctor start-times to avoid overwhelming the check-in process.

• Verify insurance and required authorization before a patient checks in.

• Give doctors a set time for phone calls and administrative work so they are not tempted to leave the clinic floor to work on something else.

• Minimize patient “hand-offs” to avoid bottlenecks. This requires thorough training to make sure all staff members can perform all tests or prepare a patient for any type of exam.

• Schedule testing that the technician administers using the technician’s own schedule or the resource schedule so that diagnostic equipment is not overbooked.

Be patient and never stop improving

A final habit of efficient practices is to have a regular pattern for re-evaluation and updates to scheduling templates. This could be every six months, or annually for more established providers. Changing services and work-up protocols and adding new diagnostic testing requires an immediate review of schedules. Planning regular reviews and selecting appropriate future dates for implementation of new schedules minimizes rescheduling of patients. However, this means practices must patiently wait to realize the impact of the new scheduling template. Patients will be grateful for the effort. OP

Maureen Waddle is a partner and senior consultant with BSM consulting in Clearwater, FL

Elizabeth Holloway is a senior consultant with BSM Consulting in Clearwater, FL. Her current certifications include Professional in Human Resources (PHR) and Certified Patient Service Specialist (CPSS).