The Nightmare Stories of Scheduling In Healthcare

Yesterday I had the fortune of reading a really good article that was posted on HealthLeaders Media entitled: Why e-Scheduling May be Healthcare’s Most Valuable App”, by Scott Mace.
I have to say that this is something that I am very hopeful for and completely agree with Scott’s insight and commentary on how scheduling is a big bottle neck within healthcare.
I know from working inside of healthcare for part of my career that most of the patient experience begins and ends with scheduling. We have all been there, either the phone rings, or we are at the doctors office, and we are asked can you do 1 pm on a Tuesday 2 weeks from now? Most of us either say yes, take the appointment card, walk away, and hope to heck that it in fact will work into our schedules. Others of us may have our phones or a planner with us that we have to rifle through until we find the right date and then can give a response.
As Scott mentioned in his article, there are online portals, but again, it is just another thing that one needs to try and manage, remember passwords, and figure out how to navigate and make it work for us, the patient, the consumer of healthcare.
One of the things that I hope will be addressed in future articles will be the point of view for patients.
I agree that a large portion of waste in healthcare is due to patients not arriving on time, not showing up to appointment, and leaving expensive equipment, exam rooms, surgical suites, or staff scheduled and then not being utilized. Lots of dollars flushed down the drain. Waste. Rising healthcare costs.
However, what about the impact of scheduling to patients? What about the number of times we are kept in waiting rooms, filling out paper work, 10, 15, 20 minutes past our scheduled appointment time? What about us, the patients, the reason why you are here? What about the impact to our pocketbooks, drive time, and work?
Why are we yet again focusing on the clinicians and not the end user, the patient?
The first thing I would like to see, and I hope the winning team of Health eTime is considering, is that not only is this a one time bi-directional integration of my calendar, but that the scheduling and interaction with my calendar is continuous throughout the entire patient experience.
For instance, if I am running late and need to make adjustments on the fly, do I have the power and ability to do so in realtime? Likewise, if the physician, department, or other scheduled aspects of the care team are running behind, can they notify me and make an adjustment on my calendar that I can either accept or not accept.
While they are working on this topic, could they also attach all necessary paperwork, forms, outside exams, and any other additional information that I may need to bring along with me to the appointment-calendar request? This way I can take time to have it all done, do it once, and not have to repeat the same work time and time again for each of the multiple appointments I may have over the course of one or many days, dependent on my episode of care. If others within the organization need the information, it is now electronic, so you figure it out for me.
Another big issue inside of the world of healthcare scheduling is how they actually schedule appointments. The majority of the time the schedule is set based on the physicians schedule, and how they like to practice. I have included a sample of a physician “block schedule.”
Trial Schedule Sheet1 (click and it will open up in another window)
The problem with physician block scheduling is that it assumes that all patients are the same, and for things such as new patient consults, or existing patient follow ups, or medication checks, that all appointments will consist of the same time frame.
However, we know that is just not the case. Now, I am a big fan of the 80/20 rule, but even with scheduling, only being right 80% of the time can mean a big cost, waste of time and resources, and inefficiency with scheduling. Both patients and  physicians will be dissatisfied.
It also usually means that the entire schedule for that physician clinic is driven entirely by the physician. This assumes that all the additional resources needed for the specific appointment, such as nurses, therapists, social workers, and other clinical staff is part of the physicians schedule.
One way to remedy this is to begin to start scheduling by the resource needed for each specific appointment, and make them independent of one another, based on the “job or task” that need(s) to be performed for the patient. In example, for a consult, perhaps the first 20-30 minutes is really necessary for the nurse to obtain information, go through the history, and take vitals. Once they have performed that task, the physician really isn’t needed until 20-30 minutes past the original appointment time, and that is when the physician should be schedule to see the patient. The last 5 minutes may be for the nurse or someone else to come in once again in order to make sure any additional appointments or instructions age given to the patient accordingly.
This alleviates a few items: Keeps physicians on time and have a ‘real’ schedule. Allows the rest of the care team to have a schedule that is specific to their work, the tasks that they need to complete, and are not relying or dependent on the overall physician calendar. It also allows expectations to be set with the patients and their families to know who on the care team they will be meeting with during their appointments, versus walking in, having it all explained, and being too anxious to remember the explanation.
The other remedy that this can impact is knowing where everyone on the team is at any given moment, knowing where they are supposed to be at a specific time, and everyone on the team knowing what their specific role and job function is for that day and time.
It is like the old adage of being on a baseball team. Not everyone can be a pitcher, someone has to catch, and others have to play the infield and outfield positions in order to have a chance to win.
The difference is that this is a game of care, that needs to be focused on the patient, the one who is in the batters box, and everyone needs to solely focus on me. It’s all about the right time, right information, and the right team.
Which leads me to one last question to ponder, “Why are most physician appointments and clinic times the same as normal operating business hours of 8-5pm, Monday Through Friday. I mean, typically when I need to use healthcare services it is later in the afternoon or in the evening, or on weekends. Children are typically in school between those times. So doesn’t it make sense to maybe consider moving the hours of operation back by about 4-6 hours? Maybe noon-9pm?
When it comes to scheduling, healthcare professionals need to remember that they need to make this simple, easy, and quick for us to use.
This is a yet another chapter on how to think about patients first, in the story of healthcare.

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