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Reduced patient check-in times

1. Measured in minutes

2. Equation: previous average check-in time vs. check-in time after implementing scheduling change

Increase appointment scheduling accuracy

1. Measured in percentage

2. Equation: Scheduled start time (SST) compared to Actual start time (AST), measuring deviation

Decrease missed appointments

1. Measured in percentage

2. Equation: previous missed appointment average vs. current missed appointment average after the scheduling change

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Process to be approved: Scheduling Process

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Process to be approved: Scheduling Process

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The process of scheduling patients was analyzed in it's entirety. With the goal of improving the ongoing staff workflow issues (Grot et al., 2023), patient equality and satisfaction increase as well. Scheduling processes begin with the appointment request and extends throughout the patient's visit. Through streamlining these processes, patient wait times were reduced as appointment accuracy increased.

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Conventionally, patients are often scheduled for rigid, nonoverlapping 15- or 30-minute time blocks.

But physicians know that 15 to 30 minutes doesn't match the reality of how the schedule flows throughout the day. Some patients need just five minutes with the physician, while others need more than 25 minutes. Some show up late; others are no-shows. It leads to stress and frustration for physicians and staff.

"This is predictable unpredictability and we can adapt to it if our schedules are flexible," Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA, wrote in an article published in FPM. The publication, formerly Family Practice Management, is a subscription-based, peer-reviewed, bimonthly journal of the American Academy of Family Physicians.

The first step in revamping how the office schedules patients is to "schedule on a wave," wrote Dr. Sinsky.

" Wave scheduling allows practices" to take that unused time from shorter visits "and repurpose it for the percentage of visits that inevitably go longer than average," says Dr. Sinsky's article, "Riding the Wave: Seven Steps to Scheduling Success."

One way to wave schedule: Schedule two established patients on the hour and one on the half-hour. The physician begins with the patient the staff has ready first.

Some practices find that it works best to schedule only one or two preventive visits within each hour because the evaluation and management of conditions or concerns may take longer. The same is often true of new patient visits.

"You may want to experiment to find what works best for you," Dr. Sinsky wrote. "The key is to break out of scheduling systems that assume each patient will be ready to be seen at precisely the scheduled time and all patients will need to be seen for the same amount of time. Give yourself more flexibility."

Scheduling on a wave is the first step toward scheduling success. Dr. Sinsky shared her perspective on these six other steps physicians can take to create a better scheduling system for the office and help create an environment primed for higher physician satisfaction.

Use two or three exam rooms. A physician can't work efficiently with a single exam room. Physicians need two-preferably three-exam rooms if they have a strong staff to complete pre- and post-visit work. With two rooms, the physician sees one patient while staff rooms the next patient.

Three rooms allow the physician to see one patient, while one staff member rooms the next patient and another staff member completes the previous patient's post-visit tasks.

Build in a buffer time. Set aside about an hour a day with no appointments, time the practice staff knows is available to meet occasional same-day surges in demand. The practice's scheduler can check the upcoming week's schedule for warning signs of a busy day so the team can build in more buffer time if needed.

Incorporate team-based practice fundamentals. To ensure you have a fully staffed practice team, hire "float" team members who are familiar with the unit's routines and can fill in on several roles when staff members are absent for vacation or sick days.

Schedule follow-up visits at the conclusion of each visit. This can save significant time and keep the practice running smoothly. Patients don't need to remember to call the office back and staff doesn't need to call patients to remind them to schedule an appointment. Patients are also more likely to keep up with follow-up visits.

Make a plan to integrate telemedicine visits. Decide whether interspersing telemedicine visits with in-person visits on the same day or scheduling them all into dedicated blocks of time on a specific day of the week works best for the practice.

Open the schedule 13-15 months in advance. When scheduling patients' next appointments at the end of their current visits, this allows staff to reappoint patients who only need a yearly appointment and may not be able to come back exactly 12 months after the current visit.

Access key steps, best practices and resources for the adoption and scale of time-saving solutions with the " AMA STEPS Forward® Saving Time Playbook" (PDF). Learn more.

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7 steps to improve scheduling in your outpatient practice

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Learn with the AMA about how to "ride the wave" to more efficiently schedule visits in your family medicine or outpatient practice.

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Steps considered in the scheduling process:

1. Appointment request (marks the beginning)

2. Appointment confirmation

3. Patient's arrival to scheduled appointment

4. Patient check-ins

5. Patient completes check-in and waits for RN

6. Patient arrives to a room and appointment begins

7. Appointment completion - further appointment requested may be ordered (may mark the end if no further appointments are necessary)

8. Patient schedules the ordered follow-up appointment (marks the end)

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How to Effectively Optimize Patient Scheduling in Your Medical Office for Efficiency and Accuracy

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The scheduling process should be approached while appreciating the complexity and impact on overall patient and staff satisfaction. Patient satisfaction relies on a multitude of factors, however, wait times and timely visits are two that improved scheduling processes can directly affect. Streamlining operations can also optimize finances and reduce organization costs (Ala et al., 2021) and benefit the clinicians’ workflow.

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We recently commissioned a study conducted by the Medical Group Management Association (MGMA) that found provider staffing challenges and burnout appear exacerbated by sub-optimal use of automation technology coupled with rising consumer expectations.

Tellingly, the survey demonstrated that a quality patient experience, leading to strong engagement and satisfaction, relies in large part on the quality of the scheduling processes, and by extension, the technology providers use. The study showed that while most provider groups leverage outbound communication technology, such as email and SMS reminders, patients still rely heavily on human-driven interactions-whether by phone or at the front desk-at a time when the overwhelming majority of executives say they are facing administrative staffing challenges.

The study identified three primary characteristics of patient scheduling and engagement that are critical to provide a high-quality healthcare consumer experience. These three areas are also prone to cause trouble if providers do not manage and monitor them carefully:

- Patient scheduling relies too heavily on human interaction. Today's providers recognize that patient scheduling is a critical part of the overall care experience. About half (47%) of provider organizations rate patient scheduling as their organization's "most important" patient experience function; 75% rate quality of patient scheduling and communication as "very important."

But in large part, patients still pick up the phone to make an appointment: 84% of providers say patients schedule appointments with the front desk, and a bit more than half (58%) say patients schedule through a call center. (The use of call centers was most common for provider groups with 100+ physicians.)

Managing provider preferences is the top scheduling challenge, according to 31% of executives surveyed. Notably, 58% rely on internal staff knowledge (vs. intelligent rules) to navigate the issue-a high-risk problem when staff turnover occurs.

Other top priorities for improvement include optimizing online scheduling for a better patient self-service experience, improving ability to fill available appointment slots, reducing no-shows and cancellations, reducing manual workflows with intelligent rules, managing provider preferences, and decreasing call center wait time.

- Patients still rely primarily on phone calls. Most provider groups are leveraging outbound automated communications (text, human call, automated call, or email). Yet even with these tools in place, 73% of patients are still calling to cancel or reschedule, which requires a human touch. Notably, those providers who do leverage automated appointment reminders report lower no-show rates.

Some 60% of organizations surveyed send mass patient messages, and about half (52%) send targeted/segmented messages. Most providers (96%) are not yet utilizing chat enablement to reduce the burden of inbound patient communications.

- Staffing shortages and labor dependencies impact the patient experience. A full 87% of executives say they've faced administrative staffing challenges over the last 12 months. Of those, over one third (35%) found those staffing challenges have had a negative impact on staff morale, and almost one in five (18%) noted it has led to longer wait times for patients.

About one in six (16%) providers add that staffing shortages have had a negative impact on the patient experience in their organization. Almost four in ten (39%) providers report it takes more than four weeks to onboard new staff.
Planning a response
Provider groups are divided about how to best address their challenges. Executives cite contact center scheduling (24%) and online patient self-scheduling (23%) as their biggest priorities.

The price of a solution is cited by most organizations (44%) as having the most significant impact when making a buying decision. After cost, the most significant impact on provider purchasing decisions is the ability to integrate with practice management solutions or an EMR (25%).

Forward-thinking providers are exploring comprehensive scheduling and engagement solutions that use the same configurable automation rules and logic to support both patient self-scheduling and contact center scheduling, as well as the associated patient communication (confirmations, reminders, follow-ups, recalls, etc.).

The good news is there are modern technologies designed to both improve patient engagement and operational efficiency. These solutions can help ensure patient appointment volumes remain high even amidst an economic downturn.
A note on methodology
The survey was designed to discover three things about patient scheduling and communication: first, identify the top challenges providers face; second, assess common strategies used to meet these challenges; and finally, better understand current technology adoption.

The survey took place in August 2022. A total of 359 individuals in C-suite, executive, and other senior positions were invited to take this survey, and 217 of them responded with completed questionnaires.
Looking forward
We can expect providers to continue to focus on doing more with less. Economic concerns prevail: 82% of executives cited economic pressure as having the highest impact on their operations related to patient scheduling and communication, while 76% cited consumerism.

Since many respondents indicate scheduling is the top factor in establishing a positive patient experience, solutions such as intelligent online self-scheduling, connected contact center scheduling, and chat-assisted scheduling are poised for significant market adoption in 2023.

Provider groups will also continue to leverage automated outbound communications, such as appointment reminders. In doing so, provider groups should evaluate better ways for patients to ask questions, cancel, or reschedule appointments in an automated channel to reduce staff burden.
Source: Nuthawut Somsuk, Getty Images

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Quality Scheduling is Critical to a Positive Patient Experience

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We recently commissioned a survey that found that a majority of providers say the quality of scheduling is an important factor in delivering a positive patient experience, and nearly half say it's the most important factor.

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Internal customers:

Efficient workflows

Decrease workloads

Appropriate resource allocation

Satisfaction

External Customers:

Decreased wait times

Fair healthcare access

Increased and improved resources

Satisfaction

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Project Manager/Team Leader: Erica Garces

Responsible for team and project operations

Streamlines project to ensure timely and careful completion

Data Analyzation: Justin Martinez

Literature search

Focus on the current workflow

Provide project improvement suggestions

Clinical Support: Megan Pike

Ongoing observation of processes

Streamlining "go-live" and providing staff support

Serves as the staff's "voice"

Project Improvement: Nancy Alexis

Evaluation and analyzation of processes

Educates staff and validates concerns

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Project Management: Team Role Definitions

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Start: Identification of a scheduling issue or necessity for change

1 month after start: Current scheduling processes analyzation and development of current state workflow map

2 months after start: Choose improvement process and develop future state workflow map

3 months after start: Project approval and planning for implementation

~6 months after start: Project objectives are met and metrics improved

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Appointment barriers were analyzed, considering factors that are controllable and need improvement.

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Partnering with SDOH-related agencies and allocating resources, addresses barriers contributing to missed appointments. Improved technology processes also contributes to this, as well as the appointment accuracy and individualization of care using data analytics.

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Clinician cooperation (physicians, nurses, patient support specialists, etc.)

IT staff assistance

Various discipline staff management

Operations

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Assess process efficacy, consistency, authenticity, and ethicality (McBride & Tietze, 2022).

Multi-disciplinary evaluation using programs like TigerConnect (Jen at al., 2023).

Monte Carlo and Computer simulation strategies (Pisharody et al., 2023).

Fishbone diagram

Real-time audits

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What is workflow? | Digital Healthcare Research

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Read the frequently asked questions on workflow. What is workflow? Workflow is the sequence of physical and mental tasks performed by various people within and between work environments. It can occur at several levels (one person, between people, across organizations) and can occur sequentially or simultaneously.

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Shadowing templates

Staff conferences

Online modules

Live computer simulations

Transtheoretical Model usage to assist with compliance

Diffusion of Innovation Model usage to assist with acceptance (Davis & Rawson, 2024).

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Ensuring staff acceptance would occur prior to the "go-live" phase of implementation. With the assistance of the multi-disciplinary support team and a PDSA cycle, real-time solutions will be prepared and implemented as issues arise. Leadership among these disciplines is necessary, as their role is continuous empowerment, education, empathy, etc. Finally, active participation of nursing informatics specialists throughout the process to analyze processes and provide almost immediate solutions and improvements.

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Go-live is both an end and a beginning, exciting and stressful, longed-for and dreaded. It is the culmination of months of preparation, data cleansing, system design and testing, and training. The actual go-live date may have been enforced by another event, such as a new financial year or the withdrawal of support for the old system, but triggering go-live just because the calendar says so is not always a good idea.

Before going live with the new system, some things are essential and non-negotiable:

All data must have been entered, checked, and verified.

There must have been a successful conference room pilot, in which all software, hardware, documentation, and people performed faultlessly. Going live with the belief that 'everything will be OK on the night' is a serious gamble.

All department heads must have visibly and loudly nailed their colors to the new system mast. Any hesitation, equivocation, or caveats will weaken the resolve of their staff to persevere if teething troubles occur. If they are not prepared to give unequivocal support, then, regardless of the upheaval it will create, the go-live must be paused because turning around a failed go-live is an enormous task, even when it is possible.

Following that, everyone must be told that teething problems will indeed occur. People will make mistakes, checked data will turn out not to have been checked properly, and, at some point, Murphy's Law will kick in. People must be told this and be told what contingency plans are in place to cope (reverting to the old system is not a contingency plan and should be explicitly ruled out).

Some things are not mandatory but can be useful:

If customer and supplier-facing documents such as purchase orders, invoices, etc, are dramatically changing, it can be a good idea to let key trading partners see examples (clearly marked 'SAMPLE'!) in advance.

Likewise, it can be helpful to write to both customers and suppliers, advising them that the company is moving to a new system and requesting their patience and forbearance should anything go wrong and they be affected.

Lastly, there will be go-live nerves amongst the users. Giving them simple instruction sheets, that walk them through the things they will be doing, greatly increases their confidence in being able to cope. (Such documents are also very useful later when people are off ill or on holiday).

It is worth remembering that, when things go wrong, the system will be blamed and, by inference, the implementation team. It is useful to remind all staff that the users have had training and that the data both belong to them and have been checked by them.

The vast majority of problems at go-live are user problems and, though the implementation team is essential to resolving problems, they are not responsible for those problems, only for helping to resolve them. This also means that, when problems occur, the reasons for them must be communicated to everyone.

If it genuinely is a system problem, then everyone should be told. But, if is a people problem, everyone must also be told. When trying to assuage people's feelings, 'the system' will take the blame for their failings and, when companies allow that to happen, they shouldn't be surprised when people lose faith and revert to notepads and spreadsheets.

Everyone should also be aware that, at go-live, it takes longer to correct mistakes than to make mistakes. For that reason, companies need as many hands on deck as they can get, and that includes the consultants, from their system supplier.

Some companies try to save money by avoiding this, and it is undeniably painful to see expensive consultants sitting around drinking coffee with nothing to do (surely you can find them something?) but, if there are times in life when companies can do without insurance, this is not one of them.

Post-go-live

The system has successfully gone live and any initial teething problems have been overcome. But the team still has vital roles to play. Firstly, following the go-live, the users should be encouraged to write down all niggles and problems they are having with the new system.

The implementation team will be capable of resolving a lot of these quickly but, after one month, three months, and twelve months, external consultants should be invited back to discuss any that are outstanding. If companies try to avoid the 'expense' of these reviews they will find themselves limping along with problems and irritants that often take just minutes to fix.

The users must, of course, be told that not all of their problems can be resolved but they can be told that, whilst there is no guarantee that all problems they report will get fixed, there is a guarantee that any problem that doesn't get reported will not be. In the original justification for the new system, measurable targets will have been set for things such as inventory reduction, service level improvement, reduction in debtor days, etc.

The team should continually monitor performance against these targets. If expectations are not being met, the team must, perhaps with the assistance of the external consultants, find out what areas of the system are underperforming and must deliver plans for remedial action.

On the other hand, if the system is meeting or surpassing expectations, everyone in the company must be told. The more they are told that the system is working, the more they will have confidence in it, and the more they have confidence in it, the better they will use it.

The company should also get details of any user groups from their system supplier and the team should maintain contact with such groups so that the company can benefit from other people's experiences. Lastly, they should try to maintain informal contact with the implementation consultants.

Giving away free consultancy will not be in their remit but most will be happy to answer brief questions over the phone or via e-mail.

And finally

There is now a team of people who know the company and its systems better than could ever have been imagined. They can be used. They can be used to monitor changes in the company and the way that it operates so that the system can be continuously re-tuned to meet developing business requirements.

They can be used to review radical changes, such as acquisitions or new product lines, so that effects on the system, or ways in which the system might help, can be evaluated. And they can be used to continually look at new and potentially better ways of doing things.

The company has invested time and money in its new system: now is the time for it to reap the rewards.

ERP Focus

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Don't leave the big day to chance! Learn more about what you and your team need to do before, during, and after your go-live here.

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Continued computer simulations: insight into operability and potential workflow disruptions

Data extraction: paired with shared governance approach aids in collection of relevant analytics

Designs Thinking: further information collection

End-user feedback

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Focusing on patient-centric scheduling and check-in workflow designs and possible improvements optimizes clinic visits through decreased wait times, thus increasing patient and staff satisfaction. These prominent benefits are just a few of many as incorporation of various approaches like Designs Thinking, only increase efficiency and project success.

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1. As an informatics nurse developing a patient-centric scheduling and pre-check in mobile app, what features, and layout would you utilize to ensure a human factor design and human-technology interface that engages the end user and guarantees overall utility? (McBride & Tietze, 2022).

2. Consider the healthcare system or EHR at your facility, and rate it in the realms of possession, form, place, time, actualization, and goal utility. Where can your facilities’ healthcare system be more useful, reliable, viable, and ethical in helping you complete your nursing responsibilities and patient care interventions? (McBride & Tietze, 2022).

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Ala, A., Alsaadi, F. E., Ahmadi, M., & Mirjalili, S. (2021). Optimization of an appointment scheduling problem for healthcare systems based on the quality of fairness service using whale optimization algorithm and NSGA-II. Scientific reports, ₁₁(1), 19816. https://doi.org/10.1038/s41598-021-98851-7

Davis, M. A., & Rawson, J. V. (2024). JRCERT update. Change management: An overview of 3 models of change. Radiologic Technology, 95(3), 228–234.

Grot, M., Kugai, S., Degen, L., Wiemer, I., Werners, B., & Weltermann, B. M. (2023). Small changes in patient arrival and consultation times have large effects on patients' waiting times: Simulation analyses for primary care. International Journal of Environmental Research and Public Health, ₂₀(3), 1767. https://doi.org/10.3390/ijerph20031767

Jen, W. Y., Chan, Z. Y., Lee, Y. M., Ng, N., Tan, B., Teo, C., Wong, Y. P., Chee, C. E., Chee, Y. L. (2023). Reducing chemotherapy waiting times in the ambulatory setting of a tertiary cancer centre using a Design Thinking approach. Cancers, 15(18), 4625. https://doi-org.ju.idm.oclc.org/10.3390/cancers15184625

McBride, S., & Tietze, M. (2022). Nursing Informatics for the Advanced Practice Nurse (3rd ed.). New York, NY: Springer Publishing.

Pisharody, V. A., Yarmohammadi, H., Ziv, E., Sotirchos, V. S., Alexander, E., Sofocleous, S., & Erinjeri, J. P. (2023) Reducing wait times for radiology exams around holiday periods: A Monte Carlo simulation. Journal of Digital Imaging, 36(1), 29-37. https://doi-org.ju.idm.oclc.org/10.1007/s10278-022-00728-2