7 steps to improve scheduling in your outpatient practice

Tanya Albert Henry , Contributing News Writer

Conventionally, patients are often scheduled for rigid, nonoverlapping 15- or 30-minute time blocks. 

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But physicians know that 15 to 30 minutes doesn’t match the reality of how the schedule flows throughout the day. Some patients need just five minutes with the physician, while others need more than 25 minutes. Some show up late; others are no-shows. It leads to stress and frustration for physicians and staff.

“This is predictable unpredictability and we can adapt to it if our schedules are flexible,” Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA, wrote in an article published in FPM. The publication, formerly Family Practice Management, is a subscription-based, peer-reviewed, bimonthly journal of the American Academy of Family Physicians.

The first step in revamping how the office schedules patients is to “schedule on a wave,” wrote Dr. Sinsky.

Wave scheduling allows practices” to take that unused time from shorter visits “and repurpose it for the percentage of visits that inevitably go longer than average,” says Dr. Sinsky’s article, “Riding the Wave: Seven Steps to Scheduling Success.”

One way to wave schedule: Schedule two established patients on the hour and one on the half-hour. The physician begins with the patient the staff has ready first.

Some practices find that it works best to schedule only one or two preventive visits within each hour because the evaluation and management of conditions or concerns may take longer. The same is often true of new patient visits.

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“You may want to experiment to find what works best for you,” Dr. Sinsky wrote. “The key is to break out of scheduling systems that assume each patient will be ready to be seen at precisely the scheduled time and all patients will need to be seen for the same amount of time. Give yourself more flexibility.”

Scheduling on a wave is the first step toward scheduling success. Dr. Sinsky shared her perspective on these six other steps physicians can take to create a better scheduling system for the office and help create an environment primed for higher physician satisfaction.

Use two or three exam rooms. A physician can’t work efficiently with a single exam room. Physicians need two—preferably three—exam rooms if they have a strong staff to complete pre- and post-visit work. With two rooms, the physician sees one patient while staff rooms the next patient.

Three rooms allow the physician to see one patient, while one staff member rooms the next patient and another staff member completes the previous patient’s post-visit tasks.

Build in a buffer time. Set aside about an hour a day with no appointments, time the practice staff knows is available to meet occasional same-day surges in demand. The practice’s scheduler can check the upcoming week’s schedule for warning signs of a busy day so the team can build in more buffer time if needed.

Incorporate team-based practice fundamentals. To ensure you have a fully staffed practice team, hire “float” team members who are familiar with the unit’s routines and can fill in on several roles when staff members are absent for vacation or sick days.

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Schedule follow-up visits at the conclusion of each visit. This can save significant time and keep the practice running smoothly. Patients don’t need to remember to call the office back and staff doesn’t need to call patients to remind them to schedule an appointment. Patients are also more likely to keep up with follow-up visits.

Make a plan to integrate telemedicine visits. Decide whether interspersing telemedicine visits with in-person visits on the same day or scheduling them all into dedicated blocks of time on a specific day of the week works best for the practice.

Open the schedule 13–15 months in advance. When scheduling patients’ next appointments at the end of their current visits, this allows staff to reappoint patients who only need a yearly appointment and may not be able to come back exactly 12 months after the current visit.

Access key steps, best practices and resources for the adoption and scale of time-saving solutions with the “AMA STEPS Forward® Saving Time Playbook” (PDF). Learn more.