The concept of "doing today's work today" through open access or same-day scheduling has been well known in practice management circles for years, and most practices that have tried it can vouch that adopting this technique increases patient, employee, and physician satisfaction and decreases no-shows and wasted work.
Despite the benefits, open access can go awry if not planned and executed properly. The following are six steps to help ensure open access success:
1. Educate and obtain buy-in. Make sure you have educated your staff members and physicians on the reasons for adopting the new scheduling system, says Ingram. Start by clearing up misconceptions, particularly the idea that you'll be relinquishing control of the schedule.
"Believe it or not, you'll have a more predictable schedule, even though it's not people that you see on paper," Ingram says. "Plus, physicians more often get to see their own patients. Patients don't have to see someone who just happens to have an open emergency slot."
What many physicians and staff members may not realize is that open access is fully customizable to each practice's needs. Not all physicians need to use the system, nor do all physicians need to reserve the same amount of open access time. And it's perfectly acceptable—essential, even—to make changes throughout the year due to seasonal volume differences, as well as trial and error, Blazier says.
2. Determine the scope of open access that is right for your practice. "Do your homework first," Blazier says. This means keeping a phone log of the number of calls the practice gets each day and the type of appointments requested and watching trends develop for a few weeks, keeping in mind seasonal variability. "You're going to have to adjust, but you don't want to add 10 hours a week of open access when you only needed six," she says.
Meanwhile, take the time to conduct a quick operations check to ensure that you aren't performing redundant front-end processes, such as collecting the same information at more than one time or place. This step will automatically improve the efficiency of your practice and clear the way for a smooth transition to open access, Ingram says.
Understand that open access may not work for every physician or practice. For example, this type of scheduling is best suited to primary care or specialties that aren't heavily referral based. A doctor who does a lot of surgical consults, on the other hand, is probably not a good fit, Ingram says.
3. Simplify your scheduling codes (reasons for visit). Settle on no more than three to four standard codes, Ingram says. You may also want to standardize the length of each visit, regardless of the visit type, she adds.
4. Decrease your backlog before going live. If your practice is very busy, it may take time to reduce your patient backlog before you can add same-day slots to your schedule. Some practices hasten this process by temporarily adding physician hours and shifts. This work-intense phase is the most challenging part of the implementation for many practices, Ingram says, but it pays off once your scheduling becomes virtually stress free.
5. Be flexible but disciplined. Although you will find the need to make changes as you go along (e.g., more slots for back-to-school physicals or a slower implementation period for certain physicians), resist the urge to fill open access slots with anything but same-day calls. "The tendency is, 'Oh, this patient needs to get in for a routine visit, and here's an empty [open access] slot for tomorrow,' " Blazier says. "At first, we struggled to keep these slots off-limits, but now we don't even look at them. If we do prebook an appointment, we're always sorry. If someone wants to call the next day, we're happy to put them in, but we won't prebook appointments that are reserved for same-day."
6. Track your success. Periodically check in with physicians, staff members, and patients to gauge how the schedule is working and determine whether you need to make any tweaks. Also, monitor whether you see a drop in no-shows and patient complaints.
It can take time to find the right mix of prescheduled and open access and work out the kinks, but it's well worth the effort, Blazier says. "I've been in the practice office for over 21 years, and to me, [open access] is the best way to schedule," she says. "I would never want to go back to an environment to have to squeeze in patients and double book."
"The patients are absolutely thrilled," Blazier adds. "They're kind of trained by now that if they call in the morning, they're almost guaranteed an appointment that day. And that gives them peace of mind that they can pick up the phone and get what they want. And when we can give them what they want, it really makes for a nice relationship."
This article was adapted from one that originally appeared in the January 2010 issue of The Doctor's Office, a HealthLeaders Media publication.