Effective Scheduling Using Sacred Time

According to Tom Peters, the guru of excellence,(1) there are two secrets for success:

1. Find out what the patient wants and give him or her more of it; and

2. Find out what the patient doesn’t want and avoid it.

Patients’ number one complaint regarding healthcare is the delays they experience waiting to be seen by their physician. Languishing in the waiting room has been reported to cause more patient dissatisfaction than any other aspect of medical care, including fees.

One of the easiest ways to manage your schedule is look at what is currently taking place in your practice. This can be easily accomplished using a time and motion study (Figure 1). I suggest you conduct this study for just a few days once or twice a year. The time and motion sheet can be placed on the paper chart or added as a template to the electronic medical record. Doctors will be amazed at how much time patients are spending in their offices and how little of that time is spent with physicians. Sometimes patients are in the office for two hours and only get to spend five minutes with the physician. This most definitely does not leave them with a warm fuzzy feeling when they leave the office. This disparity between time spent in the office and time spent with the physician does not result in a positive experience for the patient and has the end result of tarnishing the reputation of the entire profession.

Figure 1. Time and motion study.

Sacred Time

What are some solutions for dealing with the inevitable delays that will take place in any office? Nearly every medical practice has one or two urgent situations or emergencies that must be worked in every day. Most of the time, patients with an emergency are just told to come to the office and that they will be worked into the schedule. This wreaks havoc with the schedule and delays patients who have designated appointments at the end of the day, because when the worked-in patient is fit in ahead of them, they often experience a significant delay in seeing the doctor. Another scenario occurs when a referring doctor calls a specialist and asks if his or her patient can be seen on the same day. Again, these patients often are told to just come to the office and that they will be worked into the schedule. There also are times when the need to see additional patients quickly can be anticipated: for example, flu season; back-to-school physicals at a pediatrician’s office; or end-of-year requests for appointments so patients won’t have to pay deductibles so quickly in January. Finally, most doctors can anticipate additional patients on a Monday morning when patients who developed problems over the weekend and went to the emergency department are requesting follow-up appointments on Monday morning.

To avoid the problems that arise with emergencies, urgencies, or work-ins, you can create a few 15-minute time slots. In my practice these slots are at 10:30 AM and 2:45 PM. Patients with urgencies or emergencies are told to come at those designated times or at the very end of the day. These slots are referred to as “sacred time” and cannot be filled until after 8:30 AM on that day. I have yet to encounter a patient or referring doctor who won’t accept that scheduling option. Now the patient with a scheduled late morning or late afternoon appointment can be seen in a timely fashion.

Make an effort to be an on-time physician.

I rarely have a day that those sacred time slots are not filled with urgencies or emergencies. On the odd occasion where the time slots are not used, the time can be spent returning phone calls to patients, completing patient charts, or dictating notes.

Finally, if you want to make your schedule effective, make an effort to be an on-time physician. This means starting every day on time, not arriving 10 to 15 minutes late for the office clinic and hoping to catch up later in the morning. So many physicians arrive a few minutes late, look at their e-mail, or do a few minutes of paper work, and as a result start 15 or 20 minutes late. This is the surest way to have significant delays in the office from which you can never recover. If you want to see patients on time, then you also have to be on time for your staff.

Bottom Line: The reality is that few physicians have the ability to make changes to healthcare policy. However all of us have the ability to be an on-time physician and solve the problem of patients waiting to see the physician. One solution is to provide sacred time slots time each day to see urgencies and emergencies.

Reference

1. Peters TJ, Waterman RH. In Search of Excellence: Lessons from America’s Best-run Companies. New York: Harper Collins; 2004.