One challenge HBI has been hearing from our members is making it easy for their patients to schedule appointments. When organizations get a handle on patient scheduling, it provides several benefits. For one thing, the community is better served when patients have easy access to healthcare. For another, the financial health of providers is better when they can fill their open appointment slots.
That said, optimizing scheduling may be easier said than done, particularly for organizations where scheduling lacks standardization – a fairly common scenario in a healthcare market with frequent mergers and acquisitions. HBI has done a fair amount of research on organizations that have successfully optimized scheduling practices, and these are some of our findings.
Standardize Scheduling Templates
One thing that comes up in HBI’s conversations with members is not just standardizing scheduling per se, but standardizing actual scheduling templates. The best example from recent HBI research comes from Texas Children’s Hospital’s efforts to expand timely access to specialty care for its patients.
After doing some research, Texas Children’s leaders found that providers conducted clinic sessions at varying times, with many sessions running less than four hours. They also found that there were more than 900 different provider scheduling templates. The Texas Children’s team went through all the scheduling templates manually and set the expectation with providers that two four-hour clinic sessions would equate to a full clinic day: one between 8:00 am and noon, and one between 1:00 pm and 5:00 pm. They also established the expectation with providers that if a subspecialty appointment slot was not filled 72 hours in advance, it would be opened for a more general patient visit within that specialty.
As a result of these efforts, 53,000 new appointments were added within a year, 44% of which represented new patients. This translated to $8.3 million in gross patient revenue opportunity. Additionally, the available master templates were reduced from 400 to only seven, only a handful of people have admin permission adjust those schedules, and there is an electronic approval process for template change requests.
Ramzey Ibrahim, manager of business process transformation at Texas Children‘s Hospital, presented on this project at HBI’s 2019 Spring Member Retreat. His presentation slides and audio are available here for HBI members.
Self-Service and Patient Experience
HBI also recommends that leaders consider self-service for patients scheduling themselves or filling in open or canceled appointments. One example from HBI research is The MetroHealth System, which enabled self-scheduling for certain services and procedures through its patient portal. In the portal, patients can view all available appointment slots and choose one that works for them. They can also sign up for a FastPass waiting list that lets them know when an appointment slot opens up. (Full case study here for HBI members.)
Review Referral Procedures
Another recommendation based on HBI research is to review referral forms. Are they too complex or asking for too much information? It could be beneficial to bring in a few key physicians or clinical administration staff in to look at your current referral form and assess what is taking the longest to fill out, what is necessary information and what is not, and if the information is duplicated. Through this effort, you may be able to streamline and standardize forms going forward. In going through this initiative, Texas Children’s Hospital reduced the time to fill out these forms from two minutes to 30 seconds.
Also, evaluate if there are multiple submission routes for referral forms versus one and whether a centralized group overlooks the referral process. It could prove to be very difficult to sustain improvement if not.
Another potential process improvement to consider is clarifying and separating workstreams for referrals versus specialty consults. If there is limited specialist bandwidth, it is important to be clear about which cases truly need a referral for a specialist appointment versus cases that could be managed by primary care with some guidance or input from the specialist.
For more on this topic, HBI co-hosted a webinar with Zuckerburg San Francisco General Hospital and Trauma Center regarding its electronic referral and consultation system. The presentation slides and playback of that webinar is available here for HBI members.
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