Divergent Paths to Better Patient Scheduling, Greater Access

Improved scheduling processes cost little and can open up pathways to better access to healthcare, researchers say.

Access to healthcare is wildly variable throughout the US, but one obstacle to access—patient wait times—can be reduced by the implementation of systems-based approaches in scheduling, research from the Institute of Medicine suggests.

"We saw [this report] as an opportunity to improve upon what we see as a huge problem, which is waits and delays in our system," says Gary Kaplan, MD, Chairman and CEO at Virginia Mason Medical Center in Seattle. He was lead author of Transforming Healthcare Scheduling and Access: Getting to Now, published by the Institute of Medicine. 

Gary Kaplan, MD Chairman and CEO Virginia Mason Medical Center

Wide variations exist in wait times for care; wait times can range from hours to months. And no single factor determines how long a patient is made to wait. Variables include location, services required, and provider demand.

Delays are not predictable, and neither are they limited to primary care or a particular specialty, nor region of the country, says Kaplan. They are endemic to healthcare as a whole.  And "there are quite a few consequences, including negative outcomes and poor patient satisfaction [scores]."

Healthcare on Demand
The primary question Kaplan and his coauthors sought to answer was which practices would allow greater access to care and remedy the inefficiencies that cause delays in access. "How do we actually see patients when they want and when they need to be seen? How do we look at this from their perspective?"

The study found that the greatest cause of scheduling problems was "mismatched supply and demand," says Kaplan. Other factors: provider-focused approach to scheduling, an outdated care supply model, and priority-based queues.

Process Refinement
Kaplan is an advocate of Lean process improvement. "Our care system needs to be designed with systems that lend themselves to improvement in mind. We need processes and policies in place that allow you to create flow." He also believes that healthcare administrators should be learning best practices from other industries, such as the hospitality industry.

The report also suggested that using telemedicine and "non-physician clinicians," such as nurse practitioners could help create more appointment times for patients, leading to expanded access to care and improved efficiencies in scheduling.

A Different Approach
Nick Fabrizio, PhD, FACMPE, FACHE, a principal consultant at the Medical Group Management Association, warns that Lean process improvement is a buzzword so overused, its original meaning has been long lost. "Lean can be 100 different things to 100 different people."

"I don't get too excited when I hear someone say that they're a Lean organization," he says. His advice for improving scheduling efficiency is to re-evaluate each organization's scheduling process and ensure uniformity within each system.

"Let's say we are both specialists, and I tell my administrator that I want to see new patients every hour, while you tell your admin that you only want to see them every hour and a half. My follow-ups are every 30 minutes or 20 minutes, while you want them every 15 minutes. By design, we've already limited patient access to care, as you'll be fitting in more bodies daily than I am, even though we're working the same hours and same number of days."

This sort of arrangement creates a major inefficiency, says Fabrizio, especially when it occurs within the same specialty. These inefficiencies are common, says Fabrizio, noting that about 90% of practices he consults could improve their scheduling processes.

He does agree with Kaplan, however, that healthcare would benefit from best practices gleaned from other industries.  "Healthcare could benefit from almost every single industry out there. If we spent enough time with… leaders in other industries, we could learn a lot."

Fabrizio points to both banking and air travel as industries that have securely improved access to vulnerable account information and streamlined scheduling, creating user-friendly systems despite heavy regulation.

Kaplan says he will remain a steadfast believer in Lean improvement processes. "Manufacturing is where some of the systems engineering approaches are most evident… I would say that [doubters in healthcare] ought to open their minds. We owe it to our patients we serve to do everything we can to improve their care experience."