Patient Centered Scheduling Collaborative

We designed this program to improve patient access, increase continuity of care, and decrease days to third next available appointment. This is not the usual data-analysis-crazed IT-driven program, but rather a methodology born from our well-respected and highly successful Patient Visit Redesign™ training that gets dramatic results for clinics struggling to create access with current staff and schedules. We work with and not against providers and patient care teams in order to create the best system of access for all patients—both scheduled and walk-in, routine or acute.

National statistics indicate that seventy-five percent of patients want appointments on the same day they call. While this "demand" percentage may vary among individual clinics, the point is that when clinics are functioning at their best, patients can get in to see their providers when they want to. Patient Centered Scheduling (PCS) is about balancing the demand and supply for same-day appointments at your clinic.

The objective of Patient Centered Scheduling is to improve patient access. By focusing aggressively on reducing no-show rates, Simplified Patient Scheduling, and increasing capacity, this methodology works to accommodate a patient's request an appointment on the day of the patient's choosing with her/his primary care provider or provider team.

Twenty-five ambulatory care clinics from New York City's Health and Hospitals Corporation have completed Patient Centered Scheduling. By following the PCS methodology, these clinics have:

• Decreased no-show rates by an average of 74%, with one-half of the teams achieving no-show rates of less than 10%.
• Created at least 25% more same day access (with their own provider) for those patients who want it. Forty percent of the PCS teams reached a PCS third next available goal of 5 days by the final collaborative Learning Session.

The Case for Change

Traditional patient scheduling systems create more problems than they solve. The key problems include:

• Patient complaints about the difficulty of getting appointments when they want them (access)
• High no-show rates (because patients are often not given immediate access to care when they experience episodic acute problems)
• Unimpressive productivity (because of high no-show rates)
• High patient walk-in rates (because patients know this is the most effective way for them to deal with a flawed patient appointment system)
• Poor staff morale (because of the siege mentality generated by high walk-in rates)

It makes sense that traditional scheduling systems don't work well: rather than being engineered to satisfy patients, they are designed by staff and managers to govern—unsuccessfully—the flow of the day. Consequently, there are often too many appointment types with each type (like "Physical" or "PAP Smear") having a unique time allotment (i.e., 20, 30, or 45 minutes).

Magnify these problems by double-booking patients and the result will be lengthy appointment cycle times, dissatisfied patients, and highly stressed staff. Finally, combine these elements with a staff schedule that is out of alignment with patient demand and you have roller-coaster days that exhaust staff and frustrate patients.

The objectives of any modern scheduling system are to:

• Provide patients (who want them) with same-day appointments to ensure high patient satisfaction with access and low no-show rates
• Improve the continuity of care by eliminating urgent care and walk-in clinics
• Improve productivity via a more reliable and steady flow of patients into the clinic
• Reduce no-show rates (because patients get the appointment times they want).
• Improve patient loyalty (by improving patient satisfaction with access).

Our Training Approach

Each collaborative consists of five learning sessions and four action periods spread over an eight-month period. The key milestones for each Collaborative are:

• Learning Session One. Focus: Reducing No-show Rates, and Implementing Simplified Patient Scheduling (SPS), Principles of Teamwork, Introduction to Capacity and Demand. Action Period One. Implement no-show reduction and SPS
• Learning Session Two. Focus: Forming Patient Care Teams (PCTs), Reducing Demand to Reduce Third Next Available Appointment (TNAA), Using Hidden Capacity to reduce TNAAAction Period Two. Teams begin spreading the model to two additional Patient Care Teams, evaluate Third Next Available Appointment (industry standard for metric on availability).
• Learning Session Three. Teams learn how to roll out PCS across the entire clinic, Training and Coaching PCTs, Public availability of data and Scoreboarding, Troubleshooting problemsAction Period Three. Finalize Implementation of PCS across the clinic.
• Learning Session Four. Teams learn to troubleshooting Problems and Barriers, Understanding Continuity, Final Backlog reduction, Continue Reducing Third Next Available Appointment or "TNAA" (i.e., adequate same-day appointment slots)Action Period Four. Teams continue to follow the program as they watch the third next available appointment data fall through diligence and anchor PCS changes.
• Learning Session Five. Sustaining and Anchoring PCS, Capstone sharing

The PCS program structure encourages the integration of Patient Visit Redesign™ and Patient Centered Scheduling, which is natural and synergistic combination.

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