What Do Patients Want?
If you’ve ever been a patient, and most of us have, how familiar is this scenario? You’re not feeling well so you call to get an appointment with your clinician and you’re told there’s nothing available for 2 weeks. You were really hoping to be seen sooner—today, actually—but the schedule is full. Maybe they’ll call you if they get a cancellation. Maybe you can convince the person making the appointment that it’s really urgent, but maybe not. If you’re desperate enough, you’ll just show up hoping they’ll fit you in somehow. If you’re really desperate, you’ll go to the emergency room or urgent care center.
Patients want to be seen at a time of their own choosing, by their own provider. Let me tell you about Patient Centered Scheduling.
Patient Centered Scheduling
Patient Centered Scheduling (PCS) is the Coleman Associates methodology for improving the ability of patients to see their doctor when they want to. In a PCS clinic, patients get appointments for the date and time that works for them—even the same day. No more working around complex scheduling systems, or seeing a clinician that you don’t know, and no more waiting to get in!
The no show rate can vary from 10-60% in ambulatory clinics. New York City’s Health and Hospitals Corporation (HHC) is the largest municipal hospital and health care system in the United States, serving over a million New Yorkers, forty percent of whom are uninsured. Starting in 2003, Coleman Associates has worked with HHC to transform the patient experience through a series of Patient Visit Redesign collaboratives. In 2006, HHC embarked upon an ambitious program with Coleman Associates to dramatically increase access to care in more than fifty of its ambulatory clinics. In four different collaboratives we trained physicians, managers, nurses, medical assistants and clerical staff in techniques which dramatically lowered no show rates and added increased capacity to see patients.
Decreasing the Number of Patients Who “No Show”
Decreasing the number of patients who don’t show up for their appointments is critical to increasing capacity. One HHC team, the “PediTimettes” from the Pediatrics Clinic at Coney Island Hospital brought down their no show rate from 28% to 3% just by trying multiple tactics taken from our No Show Playbook. (And for another article on reducing no shows, see Reducing Those Darn No Shows on this website.)
One tactic which all teams adopt is to call patients a day or two in advance to confirm their appointments. But savvy teams take this concept much further: they get as much work done ahead of time by pre-registering patients, updating insurance and demographic information, finding out what prescriptions need to be refilled—and if it makes sense, rescheduling the appointment if there’s a better time for the patient. Not infrequently on these calls, some patients will say they no longer even need to be seen, and the appointment will be canceled, opening up a slot for someone else who does need to be seen.
It was only by testing and fine tuning multiple techniques in fast succession that the Peditimettes were able to develop processes that worked for their clinic. And they’re still maintaining a no show rate of 0-5%, two years after having been through the PCS training!
Using Teams to Get Results
One of the reasons PCS is so successful is that we train clinic personnel to test new ideas using Patient Care Teams (PCT). PCTs are made up of a clinician and all the support staff necessary to provide for the needs of a panel of patients. With coaching from Coleman Associates, teams use easy-to-collect data to monitor the results of the changes they make in how they see patients. Techniques that don’t work (based on the data that is collected) are thrown out, and new ideas are tried until no show rates are lowered, and patients’ ability to get an appointment when they want is dramatically increased.
The Pediatrics Department of Bellevue Hospital has a large residency program with a lot of part time clinicians. They took the team concept and adapted it to their own needs, creating primary care teams for all patients. If a patient’s doctor works only once a week, the patient is easily seen on other days by another doctor on that team (one who has been briefed on the history of all complex patients). In each of these teams, there is a stable group of support staff that controls the schedule and works every day on the same team. Stability of patients, providers, and staff is an important part of their success. Care doesn’t feel compromised and patients and staff love this model. (For more information about teams, see Teams That Work on this website.)
How Does PCS Differ from Other Open Access Programs?
Patient Centered Scheduling is just that—patient-centered. We begin by driving down no show rates so a clinic will know what their true capacity is. Once the no show rates have been lowered, we use a standard measure of capacity and access called the “third next available appointment”, or how long it takes to get to the third next open appointment. The industry standard is 0-3 days.
In Patient Centered Scheduling, patients simply get appointments that work for them, and the schedule is created based on their needs.
Team Phoenix Queen’s Medical Center had been involved in an Advanced Access initiative and had failed miserably. When Health and Hospitals Corporation signed them up for another “access” collaborative (this time Patient Centered Scheduling with Coleman Associates), they were skeptical at best. But their drive and determination not to fail were reflected in their team name—a phoenix arising from the ashes of the failed Advanced Access.
This time around they were resoundingly successful. They were data-driven, creating a simple data collection process that was handled by each Patient Care Team. Each PCT took charge of its own schedule—no more centralized scheduling. They were so in charge of their schedule, they bought cordless phones so their patients could call in directly to the PCT to cancel or reschedule appointments, or just call in to say they were running late. That gave the PCTs tremendous latitude to keep the patient flow moving smoothly, including taking walk-in patients and still staying on time with patients with appointments. Over the course of the collaborative, Team Phoenix trained more than 60 clinicians and residents, and went from a third next available appointment of 30 days to just 2 days.
During the four PCS Collaboratives that Coleman Associates conducted for Health and Hospitals Corporation, participating clinics reduced their no show rates an average of 70%, with top quartile teams seeing a reduction of greater than 90%. The third next available appointment was reduced more than 60% to less than five days, which was the Corporate goal. These reductions have been successfully sustained more than one and a half years after the end of the collaborative. See additional data on Commonwealth report.
According to a 2007 Commonwealth report on international healthcare, only 30% of patients in the US who needed care were able to get a same day appointment with their provider. With the implementation of a Patient Centered Scheduling system, that number can be increased to almost 100% of your patients getting in to see their provider while doctors simultaneously feel a newfound sense of control of their day. Are the patients and staff pleased with these changes? You bet! As a patient from Queens Medicine commented once PCS was instituted, “Wow, I got an appointment right away and didn’t have to go to the ER. Keep up the good work—appointments are easier to make and staff is friendlier!” Now, isn’t that the kind of message you’d like to be getting consistently from your patients?
Written by Melissa Stratman, Coleman Associates