Chapter 12: Scheduling patients – how to manage appointments efficiently
|"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.
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.
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.
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.
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 !