Patient appointment scheduling needs flexibility

The daily appointment schedule is often a sore spot in everyone’s day:

* Patients aren’t completely satisfied because they can’t get an appointment when they want one.
* Physicians feel they’ve lost control of their day when the flow is not running smoothly and they fall behind and patients complain.
* Nurses and medical assistants are frustrated at the hodgepodge of types of appointments that get scheduled seemingly without any consideration for timing or room setup and required supplies.
* Receptionists feel they are between a rock and a hard place — the nursing staff and the patients — trying to keep the patients informed and helping the nursing staff by alerting them to potentially put-off patients.
* And the manager, where the buck stops, feels the pressure to keep the patients, the staff, and the providers happy at the same time!

How can the daily schedule be managed more effectively? Is there a perfect template that will allow new patients and follow-up patients and procedures to be mapped out with efficiency equaling that of a UPS delivery truck route?

The short answer is No. The UPS truck’s route is fine-tuned for efficiency and timeliness. Every delivery is scheduled based on where it falls along the route; there no left turns that can add time to the route.

A medical practice cannot operate like that. You can’t take in requests for appointments and — after counting off a day’s worth of patients — stop the flow and plan the day’s schedule based on who is coming in for what service. Your practice is not in control of your daily route!

In fact, a practice is doomed to everlasting frustration trying to create the perfect scheduling template where a new patient slot is specified at certain times of the day and follow-up appointments are worked around those slots.

Designing a flow for appointments without consideration of the patients’ needs is like designing the UPS delivery route without knowing the street addresses for delivery of the packages.

But you can come up with a schedule that works for your needs.

First, recognize what each of the “running parts” wants out of the day:

For the patients, the perfect schedule is getting an appointment when they want to be seen.

For the physicians, the perfect schedule is consistent — without gaps and down time.

For the nurses and medical assistants, the perfect schedule is one that starts on time and flows smoothly without a lot of special needs for squeezing patients into an already too full day.

If the patients, the nurses, and the providers are happy, then the receptionists, phone operators, and manager will be happy with the schedule too.

How to get that perfect day? Go for the flexible schedule.

Basically, divide up the day into equal blocks.

To do that, start with the first appointment time for patients. Staff and providers should arrive in advance of that time. How far in advance will be determined by your type of practice and what you need to get done before patients start arriving.

Next, determine how long it takes to see a new patient and how long it takes for a follow-up patient. Generally a new patient visit takes about twice as long as an established patient visit requires. If you do tests or procedures, determine how long those take, too.

Use multiples of the shortest type of visit you have and divide the day into blocks of that length.

Then figure out what time you want everyone to go home for the day.

That’s your template!

Yes, it is that simple — a start time, an end time, and a minimal appointment time.

Many practices use 10 minutes as the minimal slot, but the key is to be realistic. If you prefer a more relaxed visit, with plenty of time for small talk with patients, make it 15 minutes. (Longer than that is probably not a cost-effective, though). Include the time the nursing staff spends with the patient and the amount of time it takes to prep the room for the next patient in determining your minimal slot.

Schedule patients for the time of day they want to be seen and assign them the amount of time (one 10-minute slot, two 10-minute slots, whatever) based on the type of care they will need (new patient visit, established patient follow-up, established patient new problem, procedure, etc.).

Be prepared to review your types of visits and how long they’ll take with your receptionists or whoever makes the appointments, so that they can book a realistic slot.

The template doesn’t have to be overly complicated with an attempt to fit the incoming demand to a preformatted visit type — that is a recipe for frustration.

The key is to have a good handle on what type of visit needs to be scheduled and to be ready to usher the first patient into the exam room at the appointment time.

Keep it simple, and patient-centered. Just like the UPS route — no left turns and it is a smooth ride most days!

Rosemarie Nelson is a principal with the MGMA Health Care Consulting Group.

Originally published in MedPage Today. Visit for more practice management news.

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  • Eli

    “You can’t take in requests for appointments and — after counting off a day’s worth of patients — stop the flow and plan the day’s schedule based on who is coming in for what service.”

    Isn’t that what happens now. If I don’t get my request in early enough in the day, the same-day appointments are gone and I am referred to the urgent care.

  • IVF-MD

    There is no limit to the creativity that can be used to come up with flexible desirable scheduling options to make patients happy. The big question is in the system as it stands (and even more so in the system that will result in coming years), how much of an incentive is there or will there be for doctors to do so?

  • stargirl65

    No one can provide good care to an established patient in 10 minutes. That is unreasonable. It is nearly impossible to get a patient with htn, dm, and chol problems seen in 10 minutes PROPERLY. Managers and management consultants say this is the way to run practices. See more patients in less time. It is NOT the way to provide effective health care.

  • rezmed09

    Hey, isn’t this the free market? How about working it like the airlines?
    Change an appointment? – sure just charge a fee!
    Want to get seen at the last minute? – sure pay extra!
    Want to bring some “carry on” complaints into the office? – sure, that’s extra?

    Where is the free market when you need it? Flexibility = cost.

  • RMore

    If you know it is going to take longer for new patient appts then set blocks of time just for those types of appts and let patients know that new patient appts are set for certain times in the day.

    Another alternative is to post work-in appts into your schedule for certain times of the day for patients who call at the last minute.

    If you cannot see a patient in the 10 min window allotted then set appt base times to be longer so that patients are not waiting. A patient may relish in getting the appt time they desire, but will that will backfire on your practice if they are not seen within a reasonable amount of time with that appt.

  • LynnB

    THis is how our scedule works and we are always behind….
    1. You can position the sack however you like but 10# of sugar don;t fit intoa 5 # sack
    2. Like most employed physicians–holes in the schedule/ Are you KIDDING? I have had a free lunch hour maybe twice since the beginnig of the year. I know because when I can’t leave my invaluable MA charges my lunch at the hospital. A quick look at my paystubs tells me this is correct.One ay for sure since the beginning of 2010 that I had lunch.
    3. If we add dementia and psych disorders (not that many patients bit lots of the visits) to htn dm cho really we are looking at 20-25 minutes at a minimum plus charting time i the evenings and weekends.

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