What if there were one, relatively simple way to tackle a slate of problems in clinical practice, concerns including physician burnout, patient wait times and quality of care?
Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA, says there’s no magic bullet, but that “wave scheduling” can help on all of those fronts.
“There's predictable unpredictability in our schedules; different patients have different needs,” she said. “We have to build in microflexibility.”
With that in mind, Dr. Sinsky worked with AMA Senior Physician Adviser Kevin Hopkins, MD, to construct an AMA STEPS Forward® toolkit on wave scheduling. The toolkit describes how wave scheduling can help prevent backlog and burnout and details how physicians can successfully use it.
The traditional practice scheduling model can lead to delays and backlogs, Dr. Sinsky noted. Patients may have to take more time away from work or family for their medical appointments, and a physician’s valuable time can be wasted.
“If your first person doesn't show, or your first person only takes half the time that you expected them to take, you can't recapture that time,” Dr. Sinsky noted.
It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.
The roots of wave scheduling
Dr. Sinsky also wrote an article about wave scheduling in FPM, the peer-reviewed journal formerly known as Family Practice Management. She said the idea behind wave scheduling came from queueing theory, a field of study related to wait times.
The wave model schedules more patients at the beginning of a wave (two at the start of an hour, for example) and then fewer at the wave’s trough (one at the half-hour) instead of scheduling patients in set time blocks (one for each 15 minutes, say).
Dr. Sinsky also recommends using multiple exam rooms so that patients can more rapidly be seen by support staff or other care team members before and after their visits. She said buffer time should be built into schedules, and, future appointments should be scheduled at the end of a visit. The combination can result in a better experience for everyone involved.
“You can close the loop of care at that appointment,” she said, which in turn will “reduce a lot of the cognitive load.”
Total scheduling overhaul isn’t needed
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Dr. Sinsky said practices don’t need to hire new schedulers or completely retrain current employees.
“You can do wave scheduling without upskilled schedulers,” she said. “A scheduler in the traditional mode could continue to fill appointments that are in that [wave scheduling] template. That said, you can advance the quality of the scheduling ... if that scheduler is more integrated into the core team.”
She said the benefits to integrating schedulers deeper into the practice are multifold, and such integration is facilitated by proximity.
“The scheduler gets to know the patients, gets to know the doctors. They can just turn and ask the nurse, ‘Would it work to put them at this time?’” she said. “All of those small communications reduce so much waste in the day-to-day work and they are systematically supported by having the same people working together. If the scheduler is in an office 20 minutes away, you will never get that high-functioning team.”
Not a one-size-fits-all approach
Physicians shouldn’t approach wave scheduling as another rigid model to supplant traditional scheduling, but one that can be expanded upon or altered as needed. Dr. Sinsky said it’s one way of achieving the kind of flexibility and physician autonomy that’s crucial for managing a practice.
“This isn't meant to be a cookie-cutter, just ‘take this and do exactly what is said here.’ It's meant to stimulate conversation,” she said.
Find out more about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.
