Getting and maintaining control
of the medical practice schedule has a bigger positive impact on resource
utilization, profitability, and the general satisfaction of patients,
physicians, and staff than almost anything else. Here are five elements of
effective scheduling.
- Be realistic :
Industry standards for
appointments and procedures can be very useful in identifying areas in which
one medical practice is different from others. Arbitrarily scheduling according
to industry standards, however, is not productive. For the purpose of
scheduling a particular practitioner's day, industry guidelines are no more
than interesting information. The germane question for scheduling Dr. Jones'
day is "How long does a particular type of exam or procedure take Dr.
Jones?"
Something similar is true
relative to structuring schedules to produce a certain amount of gross revenue.
All things being equal, increasing time-related capacity requires lengthening
the clinic day. Shortening appointment allotments produces a schedule that only
appears to be more productive. The day gets longer in an ad hoc manner, with
all the frustration associated with consistently running behind.
The bottom line is that the work
takes the time it takes. It is possible to decrease the time required by
redesigning tasks and work flow, but scheduling to a more efficient environment
needs to wait until the more efficient environment is more than a fond hope.
- Build in lead times :
Even if he is on time, or a
little early, a patient with an 8:30 a.m. appointment will not be in an exam
room waiting to be seen at 8:30 a.m. Depending upon practice processes, he may
not be ready to be examined until 8:45 a.m. or 9 a.m. Knowing the lead times
relative to different types of appointments allows the physician to correctly
interpret the real appointment time.
- Plan on work-ins :
It can feel good to look at the
next day's schedule and see it booked solid because the promise is one of
maximized resource utilization. Unfortunately, if all practice resources are
committed, there is no slack available to respond to the unexpected. Protect
specific times for same-day appointments. If the practice seldom has the need
to work in a patient, the specific appointment times can be outside of the
regular schedule, at the beginning of the lunch break or after the last
appointment of the day. Other practices will find that one or two
"work-in" slots within the regular schedule are almost always
utilized.
- Acknowledge variability :
If an analysis of practice
activity reveals that an annual physical takes 28 minutes on average,
scheduling appointments at 28-minute intervals is both intuitive and
ill-advised. The problem is with the nature of the measure. Widely divergent
data points produce an average that is between the two measures, but far from
each. Variance is the statistical value that measures the disbursement of
observations from the mean or average.
Depending upon your tolerance for
running behind and your tolerance for waiting on patients, schedule appointments at the average time required plus one standard deviation to
predictably finish two-thirds of exams within the allotted time, or the average
time required plus two standard deviations to complete 95 percent of exams
within the allotted period.
- As much as possible, stay on time :
Patients will adjust their
appointment times to match what they expect from the practice. If a physician
is often an hour late, the patient will consider herself on time if she arrives
within an hour or so of the appointed time. If the physician's timeliness is
sufficiently erratic, she'll consider herself timely if she appears on the
scheduled day. The result is that the physician, on those occasions when he is
running close to on time, will find himself waiting for patients to arrive. An
added benefit to consistently running close to schedule is that providers and
staff have to deal with fewer angry patients.
Getting and maintaining control
of a clinic schedule pays huge dividends. What has worked for you? What seems
to be an intractable challenge?
source from physicians practice :
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