Staying on Schedule

Last month, I discussed the complaint patients make most often: waiting too long to see the doctor.

I suggested ways to help you stay on time, but ultimately, your success in staying on schedule depends in large part on your schedule.

No practice can run on schedule every day. There are simply too many uncontrollable variables inherent in the practice of medicine. And no single scheduling system is perfect for every practice.

The most traditional and probably the most popular scheduling system is continuous scheduling. Patients are booked at regular intervals throughout the hour; for example, the first at 9 a.m., the next at 9:15, the next at 9:30, and so on. (In the interests of clarity and simplicity, I am assuming a rate of one patient per 15 minutes. If you schedule two or even three per 15 minutes, adjust the numbers accordingly.)

Continuous scheduling is popular with patients, but it is far less than ideal for most dermatologists running high-volume practices. If the 9-a.m. patient arrives late, your entire half-day is delayed before you even start. Similarly, a single visit that takes longer than anticipated, or one unplanned patient who needs urgent care, will throw off the entire schedule.

Even without late patients or work-ins, continuous scheduling can be inefficient in high-volume offices because the workload tends to pile up toward the end of each hour as new patients arrive and you struggle to keep up.

For many offices, a better system is wave scheduling. Instead of one patient per 15 minutes, you would schedule two or three per half-hour, or three on the hour, two at 20 minutes past, and one at 40 minutes past, so that patients arrive in waves, rather than continuously. In that way, variations in time needed per patient, as well as problems created by the inevitable disruptions, will average out over each hour during the day.

Also, those end-of-hour pileups are minimized because most patients come in early in each hour.

A third, relatively new scheduling option, called open-access scheduling, is gradually gaining in popularity. More about that next month.

No appointment system, though, no matter how efficient, will eliminate the problems created by common disruptions—no-shows, tardy patients, tardy doctors, and “work-ins”—and each must be addressed individually.

Dealing with no-shows is a column in itself—particularly in dermatology, where the no-show rate is much higher than average. That column ran in the December 2004 issue.

To briefly summarize, you can eliminate one of the major reasons patients miss appointments—simple forgetfulness—by calling them the day before. Reasonably priced phone software is available from a variety of vendors to automate this process. You could also hire a teenager to do it after school each day.

Document each missed appointment in the patient's chart; it's important clinical and medicolegal information. A second missed appointment should prompt a warning, either verbal or written, that measures will be taken if it happens again. Such measures might include a charge before future appointments will be accepted, a nonrefundable advance deposit (for surgical procedures), or outright dismissal from the practice. Habitual no-shows should be dismissed. You cannot afford them.

Late-arriving patients need to be politely advised by a staffer that the efficient flow of the office depends on their punctuality. Anyone arriving more than half an hour late should be rescheduled. Treat habitually tardy patients the same way you deal with no-shows.

Of course, patients aren't the only culprits when schedules run late; all too often, it's the physician's fault.

Most patients understand unavoidable delays, but they resent being kept waiting without an explanation. You should never take shortcuts with a patient's care to see the next patient on time, but when it becomes clear that unforeseen issues will cause delays, make sure your staff explains that to patients who will be affected by it. Offer to reschedule them if the delay will be significant.

Unscheduled visits should be permitted only in situations that are truly urgent. As I mentioned last month, work-ins should be inserted as late in the schedule as possible to minimize inconvenience to patients with appointments. And once again, when a work-in does put you behind schedule, make sure the patients who are affected receive a prompt explanation.

To respond to this column, e-mail Dr. Eastern at [email protected]

Last month, I discussed the complaint patients make most often: waiting too long to see the doctor.

I suggested ways to help you stay on time, but ultimately, your success in staying on schedule depends in large part on your schedule.

No practice can run on schedule every day. There are simply too many uncontrollable variables inherent in the practice of medicine. And no single scheduling system is perfect for every practice.

The most traditional and probably the most popular scheduling system is continuous scheduling. Patients are booked at regular intervals throughout the hour; for example, the first at 9 a.m., the next at 9:15, the next at 9:30, and so on. (In the interests of clarity and simplicity, I am assuming a rate of one patient per 15 minutes. If you schedule two or even three per 15 minutes, adjust the numbers accordingly.)

Continuous scheduling is popular with patients, but it is far less than ideal for most dermatologists running high-volume practices. If the 9-a.m. patient arrives late, your entire half-day is delayed before you even start. Similarly, a single visit that takes longer than anticipated, or one unplanned patient who needs urgent care, will throw off the entire schedule.

Even without late patients or work-ins, continuous scheduling can be inefficient in high-volume offices because the workload tends to pile up toward the end of each hour as new patients arrive and you struggle to keep up.

For many offices, a better system is wave scheduling. Instead of one patient per 15 minutes, you would schedule two or three per half-hour, or three on the hour, two at 20 minutes past, and one at 40 minutes past, so that patients arrive in waves, rather than continuously. In that way, variations in time needed per patient, as well as problems created by the inevitable disruptions, will average out over each hour during the day.

Also, those end-of-hour pileups are minimized because most patients come in early in each hour.

A third, relatively new scheduling option, called open-access scheduling, is gradually gaining in popularity. More about that next month.

No appointment system, though, no matter how efficient, will eliminate the problems created by common disruptions—no-shows, tardy patients, tardy doctors, and “work-ins”—and each must be addressed individually.

Dealing with no-shows is a column in itself—particularly in dermatology, where the no-show rate is much higher than average. That column ran in the December 2004 issue.

To briefly summarize, you can eliminate one of the major reasons patients miss appointments—simple forgetfulness—by calling them the day before. Reasonably priced phone software is available from a variety of vendors to automate this process. You could also hire a teenager to do it after school each day.

Document each missed appointment in the patient's chart; it's important clinical and medicolegal information. A second missed appointment should prompt a warning, either verbal or written, that measures will be taken if it happens again. Such measures might include a charge before future appointments will be accepted, a nonrefundable advance deposit (for surgical procedures), or outright dismissal from the practice. Habitual no-shows should be dismissed. You cannot afford them.

Late-arriving patients need to be politely advised by a staffer that the efficient flow of the office depends on their punctuality. Anyone arriving more than half an hour late should be rescheduled. Treat habitually tardy patients the same way you deal with no-shows.

Of course, patients aren't the only culprits when schedules run late; all too often, it's the physician's fault.

Most patients understand unavoidable delays, but they resent being kept waiting without an explanation. You should never take shortcuts with a patient's care to see the next patient on time, but when it becomes clear that unforeseen issues will cause delays, make sure your staff explains that to patients who will be affected by it. Offer to reschedule them if the delay will be significant.

Unscheduled visits should be permitted only in situations that are truly urgent. As I mentioned last month, work-ins should be inserted as late in the schedule as possible to minimize inconvenience to patients with appointments. And once again, when a work-in does put you behind schedule, make sure the patients who are affected receive a prompt explanation.

To respond to this column, e-mail Dr. Eastern at [email protected]

Last month, I discussed the complaint patients make most often: waiting too long to see the doctor.

I suggested ways to help you stay on time, but ultimately, your success in staying on schedule depends in large part on your schedule.

No practice can run on schedule every day. There are simply too many uncontrollable variables inherent in the practice of medicine. And no single scheduling system is perfect for every practice.

The most traditional and probably the most popular scheduling system is continuous scheduling. Patients are booked at regular intervals throughout the hour; for example, the first at 9 a.m., the next at 9:15, the next at 9:30, and so on. (In the interests of clarity and simplicity, I am assuming a rate of one patient per 15 minutes. If you schedule two or even three per 15 minutes, adjust the numbers accordingly.)

Continuous scheduling is popular with patients, but it is far less than ideal for most dermatologists running high-volume practices. If the 9-a.m. patient arrives late, your entire half-day is delayed before you even start. Similarly, a single visit that takes longer than anticipated, or one unplanned patient who needs urgent care, will throw off the entire schedule.

Even without late patients or work-ins, continuous scheduling can be inefficient in high-volume offices because the workload tends to pile up toward the end of each hour as new patients arrive and you struggle to keep up.

For many offices, a better system is wave scheduling. Instead of one patient per 15 minutes, you would schedule two or three per half-hour, or three on the hour, two at 20 minutes past, and one at 40 minutes past, so that patients arrive in waves, rather than continuously. In that way, variations in time needed per patient, as well as problems created by the inevitable disruptions, will average out over each hour during the day.

Also, those end-of-hour pileups are minimized because most patients come in early in each hour.

A third, relatively new scheduling option, called open-access scheduling, is gradually gaining in popularity. More about that next month.

No appointment system, though, no matter how efficient, will eliminate the problems created by common disruptions—no-shows, tardy patients, tardy doctors, and “work-ins”—and each must be addressed individually.

Dealing with no-shows is a column in itself—particularly in dermatology, where the no-show rate is much higher than average. That column ran in the December 2004 issue.

To briefly summarize, you can eliminate one of the major reasons patients miss appointments—simple forgetfulness—by calling them the day before. Reasonably priced phone software is available from a variety of vendors to automate this process. You could also hire a teenager to do it after school each day.

Document each missed appointment in the patient's chart; it's important clinical and medicolegal information. A second missed appointment should prompt a warning, either verbal or written, that measures will be taken if it happens again. Such measures might include a charge before future appointments will be accepted, a nonrefundable advance deposit (for surgical procedures), or outright dismissal from the practice. Habitual no-shows should be dismissed. You cannot afford them.

Late-arriving patients need to be politely advised by a staffer that the efficient flow of the office depends on their punctuality. Anyone arriving more than half an hour late should be rescheduled. Treat habitually tardy patients the same way you deal with no-shows.

Of course, patients aren't the only culprits when schedules run late; all too often, it's the physician's fault.

Most patients understand unavoidable delays, but they resent being kept waiting without an explanation. You should never take shortcuts with a patient's care to see the next patient on time, but when it becomes clear that unforeseen issues will cause delays, make sure your staff explains that to patients who will be affected by it. Offer to reschedule them if the delay will be significant.

Unscheduled visits should be permitted only in situations that are truly urgent. As I mentioned last month, work-ins should be inserted as late in the schedule as possible to minimize inconvenience to patients with appointments. And once again, when a work-in does put you behind schedule, make sure the patients who are affected receive a prompt explanation.

To respond to this column, e-mail Dr. Eastern at [email protected]