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Eight tips for converting to open-access scheduling

Patients hate waiting to get an appointment, and in many practices the wait for an appointment is, from their viewpoint, outlandish. In recent years many practices have successfully reduced patient frustration through "open access" scheduling, which makes it possible for a medical practice to provide appointments immediately or on the same day.

The results: No long waits or delays in care, no triage, no deflecting patients to another-day appointment or another provider, and no stress from dealing with upset patients. The model has been proven time and time again to allow for faster attention to people's health issues, increased efficiency, and dramatic improvements in the patient experience, as patients no longer endure frustration about waiting for an appointment.

Sound like a panacea? In a way, it is, but note that there is no easy recipe for converting to open-access scheduling. Practice leaders need to tailor this kind of system to their unique circumstances.

The key is to ground your plan in a set of tested principles:

  1. Measure, analyze, and understand your supply and demand. These need to be balanced; you will not be able to sustain open access scheduling if demand for appointments typically exceeds supply. If you accept more patients than you can handle in a timely fashion, you must turn down appointments, which plays havoc with the patient experience.
  2. Develop a short-term strategy to reduce your backlog to zero, so you can begin your new scheduling system on a date certain. There's no getting around the fact that you will have to work harder than usual in the short-run to make the transition to your new system on your conversion date. But of course, after that, both patients and physicians reap ongoing benefits.
  3. Decrease the number of queues by shrinking the variety of appointment types and durations available. A single appointment length works best. It's easier for staff to manage, simpler for patients, and physicians find themselves getting into a rhythm that helps them stay on time. Also, staff who schedule appointments don't have to say no to patients who need a certain appointment type because the right-size slots are full. When longer appointments are critical, staff can combine two of the generic appointment slots.
  4. Develop contingency plans for those occasions when you have more demand than expected or less capacity than anticipated.
  5. Fine-tune the demand by matching patients to their own physician, maximizing what is accomplished in a single visit, and adjusting the interval between visit and return visits.
  6. Allow some prescheduling of appointments for clinical follow-up. That way, you keep control of the follow-up appointment instead of risking that the patient will not follow through. You can also load these appointments into the lower-volume times of the day and week, so there will be less demand for such appointment times.
  7. Address the bottlenecks and constraints that tie up physician time. For instance, shift as much work as possible from the physician to other members of the team.
  8. Develop an education strategy for patients and staff. Clarify the approach, emphasizing its benefits for them. If some patients still insist (and few do) on prescheduling an appointment, honor the patient's preference, selecting time slots in the early morning or latter part of the week-whenever your volume tends to be lowest.

This article was adapted from Physician Entrepreneurs: The Quality Patient Experience, a new book published by HealthLeaders Media. For more information or to order a copy, visit HealthLeaders Media online.