Put a stop to inconsistency!
Standardize registration processes
If a patient continually encounters different processes throughout your organization for scheduling, registration and check-in, he or she is very likely to become frustrated.
"It can give the appearance of lack of cohesion and communication," says Lori S. Bruelheide, assistant director of enterprise patient access services at University of Kentucky (UK) Healthcare in Lexington.
While some specialty clinics permit patient self-referrals, others require that the patient’s primary care physician refer the patient and coordinate the initial appointment. "Similarly, there may be nuances related to pre-visit testing for a specific clinic that may appear to the patient to be a delay in care," says Bruelheide.
Variations such as these can cause the patient to have a very different experience scheduling with clinic A than with clinic B, which makes the healthcare organization difficult for the patient to navigate. "To overcome this perception of disparity, we have worked to identify areas where standardization can be achieved," says Bruelheide. These changes were made:
• Staff use standard phone greetings and phrases for all clinics to improve the appearance of consistency between clinics.
All patients are now greeted with, "Thank you for calling UKHealthCare, Department of __________. How may I help you?"
"We also request patient identification in a standard way, which helps repeat callers know what to expect when calling," says Bruelheide.
Previously some departments always requested the patient’s Social Security number as the primary identifier, but all staff now ask callers for their name and date of birth for identification.
• The appointment reminder letter was standardized, so that each clinic’s letter contains the same information in the same order.
"We have moved from a paragraph format letter to one that looks more like an invitation," says Bruelheide. This format provides a separate line for each piece of information: clinic name, clinic address, physician name, and date/time of appointment.
• All clinic front desk personnel wear the same uniform of a blue shirt with a UKHealthCare logo and khaki, blue, or black pants.
"This provides a more interrelated appearance within our clinic areas," says Bruelheide. "They may also choose to wear an approved UKHealthCare logo jacket, sweater, or neck tie, but those items are optional."
Get physician buy-in for change
Explain what centralized scheduling will do for them
When switching to centralized scheduling, it quickly became apparent to patient access leaders that buy-in "from the top down" was needed to pave the way.
"Most physicians were not familiar with a centralized scheduling concept and showed some apprehension," says Chris Korneffel, director of scheduling center operations at Cincinnati (OH) Children’s Hospital Medical Center.
To quickly gain physician buy-in, patient access leaders personally met with department leaders. They explain that these benefits would be possible with centralized scheduling:
- that the entire scheduling process would be taken out of their hands;
- that there would be less wait time for their patients;
- that there would be fewer mistakes, because patients are more likely to be scheduled correctly due to detailed scheduling questionnaires within the scheduling system;
- that quality would be improved, due to formalized call monitoring and auditing.
In addition, leaders in the scheduling center visited each department separately to learn special circumstances or cases encountered, nuances, processes, and policies. "This allowed the team to build relationships with each division’s leadership, as well as the first line staff, resulting in a trusting partnership," Korneffel says.
By spending time with the division staff and with each provider, a concise template for scheduling rules for each department was created and implemented. "During this process, we attempted to standardize rules and processes as much as possible," says Korneffel. "This was important for standardization and finding efficient workflows."
You can achieve timelier appointments
Like most large healthcare organizations University of Kentucky (UK) Healthcare in Lexington struggles with access to timely appointments, especially for some of its advanced specialties.
"In many of our specialty areas, patient demand for appointments outpaces the supply of available physician time considerably," says Lori S. Bruelheide, assistant director of enterprise patient access services.
In 2011, patient access leaders began closely monitoring the third next available appointment at its main scheduling locations. "This analysis has led to significant improvement of appointment availability in many areas," says Bruelheide. These steps were taken by patient access managers:
• They began by looking at all areas with anecdotally poor appointment access.
• They worked with each clinic to determine if the access problem was a demand/supply issue, or if there were other physician scheduling preferences constricting the schedules.
"For example, are there simply more dermatology requests than we have appointments? Or are we attempting to throttle the demand by booking certain diagnoses on certain days?" asks Bruelheide. "We found a bit of both in our research."
• They established a goal of 10 days and started publishing their data.
"Once we did that, we found a large number of our clinics were very interested in being a top performer for this metric," she says. "They found creative ways to increase capacity for new patients."
Eighty percent of the evaluated clinical areas are now meeting the goal of scheduling a new patient appointment within 10 business days or less.
Strategies to increase capacity included physician recruitment, fully utilized clinic sessions, improved scheduling templates, and a focus on make-up clinic sessions, when sessions need to be cancelled or bumped. "We have added quite a few physicians in the last few years, allowing us to add appointment slots," adds Bruelheide.
Managers also worked with established physicians and mid-level extenders to make sure that the most efficient appointment durations were used for each clinic. For example, if a new patient appointment can be done in 45 minutes instead of 60 minutes, that change adds 1.25 slots to each four-hour clinic session.
"We also had great support from our executive leadership and our medical directors to ensure that clinic sessions are fully utilized — specifically, that a session begins at 8 a.m. and runs until 12 p.m., instead of 8:30 a.m. until 11:30 a.m.," says Bruelheide.
Wait lists were added to keep up with new patient demand in primary care departments. "This allows us to fill cancelled slots quickly," says Bruelheide. "This preserves the flow of the clinic and avoids a no-show or a gap in the physician’s productive clinic time."
