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12-Scheduling patients
– how to manage appointments efficiently
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"Time is the
coin of your life. It is the only coin you have,
and only you can determine how it will be spent.
Be careful lest you let other people spend it for
you. "
- Carl Sandburg.
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When you first start practice, you may see only a few patients
each day , and you may decide not to bother with having an
appointment system at all. In fact, you are likely to be so
glad to see any patient at all, that you will see them at
their convenience. However, it’s important to get into
the habit of planning efficiently right from the beginning,
and if there are just a few patients, give them appointments
close together, so that one patient leaves as another arrives.
It will then appear to your patients that you have a busy,
thriving practice ! Of course, as you become busier, an appointment
system is essential to help you plan your day.
The appointment system you choose will affect your entire
practice management. Appointment books or diaries can be bought
with timed appointments already set out, and the following
guidelines may help you run your practice more smoothly and
efficiently:
1. Be on time. If you are always late, the patient will go
elsewhere.
2. Allow additional time for elderly or disabled patients,
who may take a long time to get dressed or undressed, and
for those who are very talkative.
3. Patients attending for the first time will take longer
as their history must be recorded, an assessment made and
treatment may be necessary.
4. Emergency patients will derail your scheduling, and you
need to factor this into your appointment system.
5. Check the appointment book regularly to make sure a helpful
member of staff or enthusiastic receptionist has not overbooked
your time.
Even if you have an excellent appointment system,
the sad reality is that staying on schedule has
never been easy. An emergency hospital admission
, a traffic jam, or a family crisis can all wreak
havoc with your appointments. One of the commonest
complaints patients have about their doctors is
the long waits they are forced to endure –
and many patients refuse to put up with this delay,
and are quite prepared to find another doctor who
is more respectful of their time.
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Managing appointments is especially hard in India. Indians
are notoriously unpunctual, and Indian standard time means
anywhere from 10 – 60 minutes late, depending upon the
part of the country you practise in . This often sets up a
vicious cycle, because when the doctor is always late, patients
too start showing up late for their appointments, making a
bad problem even worse.
Of course, many patients don’t even bother to take an
appointment, and dealing with unscheduled “walk-ins”
can be tricky. Others will take an appointment, and then not
bother to turn up ( “ no-shows”) , so that the
doctor sits twiddling his thumbs, and wasting valuable time.
In order to prevent this, and protect their time ( after all,
a doctor is a daily wages earner !), many doctors will “overbook”
– and if all the patients turn up, then everyone gets
upset !
We need to respect both the physicians' and patients' time.
No one likes to be kept waiting. It is very expensive for
you to sit and have no patients to see. It can be even more
expensive when your patients, faced with unreasonably long
times to see you, decide to find a new doctor.
While most doctors would be only to happy to be in the happy
position of having a long waiting list of patients to see
them, and an appointment book which is fill weeks in advance,
having too many patients can be as difficult to manage as
having too few. Having few patients is easy to manage –
you just see them when they want to see you. However, when
starting practice, many doctors adopt a very disorganised
approach , with the result that as their practice grows and
they become busier, they remain as disorganised as ever !
But as the volume of patients you must work with grows, the
result is predictable: chaos leading to reduced efficiency
and increased stress on you and your staff, not to mention
angry patients. If you have an efficient system, you will
help yourself – and your patients to make more effective
use of your time.
Waiting patients get stressed out and angry –
and this can be stressful for the doctor too. An
overfull clinic can be difficult for the staff to
manage as well – and tempers can easily get
frayed. While some busy doctors take pride in the
fact that patients need to wait for weeks before
they can get to see them, I think this is a symptom
of poor appointment management practices. Remember
that patients can get fed up and easily go to your
competitor. It is useful to develop techniques to
ensure that patients can get an appointment to see
you when they want to.
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Remember that not all problems need a face to face visit –
and many can be resolved on the phone or by email. Try to
reduce the number of visits your patients actually need to
make to your visit. Not only will this free up your time for
more productive activities, your patients will also appreciate
the fact that you have saved them the hassle of coming to
see you.
What if you deal with a class of patients who do not take appointments
? It is possible to teach them to follow a system. Thus, you
can schedule a time slot for pre-booked appointments, and leave
the rest of the time for “walk-in” patients, who
can be seen on a
first come-first served basis. What about emergencies ? You
should keep a few slots every day for same-day appointments.
Exactly how many depends on your previous experience, but two
in the morning and two in the afternoon is a useful starting
point. That may sound like it will cut into your productivity,
but if you plan for same-day visits — and you will get
them — you’ll handle them and the rest of your workload
more efficiently.
Physicians can easily evaluate the efficiency of their practices
by conducting a time-and-motion study, which involves placing
a sheet on the front of every patient’s chart for about
10 days. Record the time of each patient’s appointment,
the time each one is directed to the exam room, the time the
patient leaves the clinic, and the time the patient spends with
the doctor. You may be surprised to find that some of your patients
may be spending 60 to 120 minutes in the clinic but only about
five to 10 minutes with you. This simple technique allows physicians
to identify problems and find solutions to them. Track your
appointment activity for a month, and pay attention to fluctuations
in days of the week, so that you can tailor your clinic hours
for your patients’ convenience. Thus, if you find that
you are very busy on Saturday evenings, you can start your clinic
at 3 pm ( instead of the routine 5 pm for example). And if you
find that few patients come in on Wednesday mornings, you can
use this time for another activity, without affecting your productivity
!
If you have many poor patients, it may be a good idea to run
a free clinic once a week. You can then see a lot of patients
at this time- leaving you with more time for demanding patients,
who do not mind spending more money to spend quality time with
you.
Dealing with patients who take appointments and
then do not bother to show up can be very frustrating.
Practices that remind their patients of their upcoming
appointment will generally have fewer no-shows and
have less need to overbook. Each patient should
be contacted by phone a day or two in advance of
the appointment. You may also choose to mail them
postcards as a reminder service, It’s a good
idea to request them patients themselves to fill
up their reminder post cards at the end of each
visit , to reduce the administrative burden on your
staff.
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It is also helpful to have specialty clinics on a particular
day of the week – for example, immunization clinics every
Saturday at 10 am, rather than give vaccinations whenever the
patient turns up. This is much more efficient , since everything
( staff, supplies vaccines, doctors and patients) are geared
up for this . Similarly, gynecologists can have a menopause
clinic at a specific day. Since patients with similar concerns
are seen together this encourages interaction amongst patients
with similar problems while they wait in your clinic.
A clever trick to avoid empty "holes" during a typical
day, is to schedule morning appointments from noon backward
and afternoon appointments from noon forward, thereby filling
in late morning and early afternoon appointments first and gradually
booking early and late slots. This way, if a day is not fully
booked, early morning hours can be used productively for a staff
meeting or permit the doctor to come in later. An empty slot
in the middle of the day is generally wasted time.
When the doctor is faced with emergencies or is running significantly
behind schedule, take the opportunity to partner with the patient.
Patients already in the office as well as those scheduled for
later in the day should be told of the approximate wait time
and offered options. If the physician appears unable to see
all of the scheduled patients, start calling immediately to
reschedule those who likely have not yet left for their appointment.
To make the wait less onerous for patients, many
practices are implementing innovative amenities.
In addition to the reception room staple of magazines
(current, please!) consider adding these: library
of relevant medical information ; health-related
videos ; internet access ; a telephone for local
calls ; coffee, tea, water ; television ; piped-in
music. An efficient appointment system will ensure
that your clinic runs smoothly and well –
and will keep you, your staff and your patients
happy and smiling !
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