A Chapter Out of My Pediatricians Playbook
The other day my 9 month old daughter had an ear infection. As with anyone who has visited the pediatrician’s office before, I wasn’t sure which to dread more, the ear infection or waiting for more than an hour to be seen. I prepared for the joy of a long wait and consoling a crying baby by pacing back and forth in the waiting room. When I arrived, something completely unexpected happened. Other than the dismay of knowing that my wife left me with a $150 balance for the last ear infection because our cut rate insurance didn’t cover the visit, I was taken back to the exam room almost immediately after my check-in.
Being the self-respecting efficiency consultant that I am, I began to dive into what was different about this visit than all the other visits. I soon learned, that the office had adopted a new scheduling procedure after receiving numerous complaints from unhappy parents about the waiting time. I dug a little deeper to try to get to the bottom of what this magical change was all about.
Traditionally, patients would get scheduled with a specific provider in the practice. Certain providers naturally were more popular than others based on tenure in the practice, or personality traits that the parents preferred over others. This would cause an in balance in provider load. Some providers would have a very full schedule while others were less busy throughout the day. If you were schedule to be seen by the more popular provider by choice or routine scheduling, get ready to wait a long time.
Furthermore, because of the nature of being a pediatrician’s office, a large percentage of the visiting patients had acute issues (colds, fevers, ear infections etc.). In fact, up to 40% of the schedule was typically acute in nature. These patients normally call and try to schedule an appointment for that day or at the latest the next day. Seasonally, the acute patient volume would increase or decrease fairly dramatically as well, making it difficult to determine how much volume the practice should prepare for from one week to another. Many of these acute patients would get “squeezed” in or double booked on a provider’s schedule, creating an even bigger backup because of the traditional method of assigning patients to their usual provider when they requested an appointment.
In an effort to improve patient experience and online reviews, the providers made a very simple yet powerful change to how they were being scheduled. Each provider would only be assigned routine care patients. When parents of acute care patients would call to schedule an immediate appointment, they would be provided an appointment time for the day of visit but instead of being placed on a provider’s schedule, they would be placed on an “unassigned” schedule.
The “unassigned” patient would be brought back to the exam room and “Worked up” by the medical assistant or nurse and would be told that a doctor would be with them shortly. The medical assistant or nurse would return to their station which was located within direct line of sight of the exam room corridor. At the station, the medical assistant would review the doctor schedules and make a decision about which doctor would be assigned the patient based on schedule availability and how long the doctor had been in the exam room with the current patient. This particular office had 6 or 7 providers seeing patients on any given day so the medical assistant had options as to who to assign the patient to in order to keep the flow going smoothly. As doctors completed their previous patient visit, they would stop by the station and look at their schedule to determine where they had to go next.
Naturally, some parents didn’t necessarily feel comfortable with the change because they were used to seeing a certain provider. The practice worked towards building the appropriate script for the schedulers and the front desk to help explain to patients why this change was going to ultimately be better for them. Over a short period of time, the parents became accustomed to this change and ultimately learned to embrace it. Of course, there will always be some patients that will not be willing to embrace the change made in any practice. In those situations, exceptions can be made and those patients can be assigned to specific providers.
The moral of the story is, don’t be afraid to make a change and try something new. It takes a certain level of courage to do something that you aren’t used to but often times, you will be pleasantly surprised by the results. In today’s world of ever changing conditions, medical practices need to make non-traditional changes to manage non-traditional situations. Good luck and keep the positive changes coming.
About the Author
Tony Milian is a Managing Partner at Practice CoPilot, which provides real time location systems and lean consulting services designed to manage patient flow in medical practices.