Executive Summary

Patient access reduced the median wait time for appointments from 25 to 13 days at Seattle Children’s Hospital. These changes were made:

• Scheduling rules were simplified.

• Senior leaders now approve all exceptions to the four-hour time block standard for physicians.

• A data analyst position was created.

 

Patient access leaders at Seattle (WA) Children’s Hospital reduced the median wait times for new patient appointments from 25 days to 13 days.

“Our goal for Fiscal Year 2015 is 11 days,” reports Jennifer Becker, vice president of ambulatory services.

In 2008, which was the first year of the project, there was a seven-day decrease. “At first, there is much more low-hanging fruit,” says Becker. “But when you get down to about 15 days, it becomes exponentially more difficult to take one day off.”

The department made these changes:

• Each week, patient access works with various service lines to open up new capacity as needed.

In some cases, this change means adding nurse practitioners, physician assistants, or faculty physicians. Service lines aren’t always able to respond to the demand for more capacity, however.

“That’s a challenge we are working through,” says Becker. “We’re working on a model of flexible physician deployment.” This model allows clinics to meet changes in demand, such as by physicians extending their hours on a given day.

• The process for making appointments is simpler, with fewer scheduling rules.

“We had a very complex set of scheduling rules, to match the patient with the perfect appointment. That was problematic for many reasons,” says Becker.

Slots were left unused when providers had cancellations, if the provider wasn’t the exact type of specialist a patient needed to see. In some cases, patients would have been happy to get a quicker appointment with the provider, but schedulers couldn’t book the appointment according to rigid rules.

“Most would rather get in and get started quickly, rather than wait for a certain subspecialist,” says Becker. With fewer scheduling rules, these slots are now available.

• Primary care physicians now refer patients immediately.

Providers were required to fully “package” patients before referring them.

“The physicians did not want to do that,” says Becker. “They preferred to have families call and schedule right away.”

Previously, families waited up to seven additional days for an appointment, depending on how long the provider’s office took to refer them. “We typically think about access wait times as starting from when the patient first contacts us,” says Becker. In fact, families had lengthy waits before they were even able to call for the appointment. Patients are now able to schedule right away, “and we do the prep afterward,” says Becker.

• “No shows” were reduced by sending reminders closer to the family’s appointment time.

“The lead time for reminder calls was reduced from four days to three days,” says Sarah Thomas, director of patient access. “We also reduced the lead time for reminder letters from two weeks to one week.”

• Families were surveyed to determine demand for same-day access.

The general surgery team offers same-day access, but the median wait is still about six days. “It’s not because they don’t have capacity. It’s because that’s what some families are choosing,” says Becker.

Patient access surveyed families and learned that 24% preferred to schedule appointments more than 14 days out.

“Some need more time to plan because they need to travel here. Or they may need to coordinate with their work schedule. We don’t have evening hours for every specialty,” Becker explains.

Patient access leaders contacted representatives from AmazonFresh and learned that in order to meet same-day delivery commitments for groceries, a certain amount of capacity is left open every day. “It’s the same in healthcare,” says Becker. “We know we need to leave some capacity open. We are trying to understand how to balance this with cost.”

• Senior leaders now approve all exceptions to the four-hour time block standard for physicians.

Previously, individual physicians sometimes requested shorter blocks of time. Office managers had to attempt to enforce the four-hour standard. “It’s a challenging place to put your middle management,” says Becker. “We needed to take them out of it.” 

 

SOURCES

Jennifer Becker, Vice President, Ambulatory Services, Seattle (WA) Children’s Hospital. Email: jennifer.becker@seattlechildrens.org.

Sarah Thomas, Director, Patient Access, Seattle (WA) Children’s Hospital. Email: Sarah.Thomas@seattlechildrens.org.