patient access to careNobody said it would be easy to upset tradition and office culture in order to dramatically re-invent the often-frustrating system of patient appointments. Pediatric Rheumatologist Dr. Paul Rosen spells out how faster, better, easier patient access produces business, personal and clinical advantages.

I was talking to a friend last week about a recent experience she had while seeking medical care. She had developed a skin condition and was very worried that it might be an autoimmune disease. Luckily, a friend referred her to an excellent dermatologist. She called to schedule an appointment and was anxious to get a diagnosis and treatment plan.

When she called, however, she was told the next available appointment was…in three months.

She was in the city the following week and stopped at the office to see if an earlier appointment time had come open. The receptionist told her that she could get an appointment…in three months.

My friend is a senior business consultant, and typically a levelheaded, polite person. But, when she thought about her upcoming travel schedule and her worry about her symptoms, she decided not to accept three months as a reasonable option.

She told the office staff that she would not be leaving until she saw the doctor.

The office staff called the office manager.

The office manager called the doctor.

My friend was seen by the doctor and received a diagnosis and treatment plan. She was able to resume her busy travel schedule and stop worrying.

In talking to her about her experience, she lamented about resorting to guerilla tactics to receive the care she needed, but felt that a three-month wait was completely unacceptable. Unfortunately, being told to wait several months for health care is not a unique experience.

Long waits are typical…

In 2010, the Wall Street Journal published an article describing the crisis in patient access across the pediatric subspecialties. Patients seeking appointments for their children for almost every subspecialty typically had long waits to get an appointment.

In my field, pediatric rheumatology, there are little more than 300 doctors in the field in North America. Wait times for appointments can run up to four months.

Fortunately, some health systems are now prioritizing patient access as a top-down, leadership priority. Modern schedule-templating techniques enable a practice to work down their backlog and schedule patients in a timely fashion. The Institute of Health Care Improvement describes many of these techniques.

In 2007, the health system I worked for mandated a maximum three-day wait time for all new patient appointments for all areas. At the time, our patients had a wait time of one month for a new appointment, better than a four-month wait, but a far cry from 72 hours. We had work to do.

We managed to come up with a plan so that over the next four years, every single new patient who called for an appointment was offered one within three business days…every day…four years running. How did we achieve this? The team pulled together to figure it out:

  • Each physician agreed to make patient access a priority.
  • We looked at our past data regarding supply and demand.
  • We made a new schedule based on the number of new patients calling.
  • We worked with our office manager to change our scheduling templates so that we had more slots for new patients so our supply could match our demand.
  • We planned the vacation and conference schedules so that more new slots were added for the physicians who stayed in the office while others were away.
  • Our secretaries checked the schedule daily and let us know how many new slots were open in the next 72 hours. If we were low on new slots, we would open up appointments during lunch or later in the day.

We basically shifted from a static schedule with a first-come-first-served mentality to an actively managed template where adjustments were made daily. Supply-and-demand was continuously monitored. It was a true team effort to achieve success in this area. And the patients greatly appreciated this effort.

Achieving a steady-state, patient-centric schedule…

Perhaps, your practice is currently like ours was: a backlog of patients to see, busy waiting room, and no shortage of patients: all the signs of a busy and “successful “practice. But is this what success looks like? What is the critical need to work down the backlog and achieve a steady state where the supply for appointments matches the patient demand?

There are three main imperatives driving patient access:

The Medical Imperative: Better access offers a faster time to diagnosis, treatment, and recovery. Many diseases can worsen if there is a delay in treatment. Early diagnosis and treatment can facilitate better medical management of many diseases.

The Humanistic Imperative: waiting for care can induce suffering. Having symptoms or abnormal blood work without an explanation can raise anxiety, disrupt sleep, affect concentration, and reduce overall quality of life. This unnecessary suffering can be relieved with an expedient meeting with the doctor to allay fear and worry.

The Business Imperative: practices that offer great access gain market share. No longer are patients just looking for a doctor with a great reputation and high quality care, but are also looking for accessibility.

Many health care systems are now addressing the imperative for access to care. Cleveland Clinic’s ad on the front page of the The New York Times in 2014 announced that in one year they delivered same day appointments to 1-million patients (20 percent of total visits).

Health systems are realizing that patients have more choice than ever before. They understand that access is part of the equation for attracting and keeping patients coming back. Like my friend, many patients are standing up and refusing to accept a long wait for care.

Nowadays, when I see patients in my office, I often ask, “What brought you in to see me?” The typical answer is not “We heard you are a great doctor,” but rather, “We called all the children’s hospitals in the area and your office could get us in the fastest.”

Like Jeff Bezos, we in the health care industry need to think how we can deliver what customers want: faster, better, easier.

Paul Rosen, MD

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Paul Rosen

Paul Rosen

Pediatric Rheumatologist Paul Rosen, MD, is Clinical Director of Service and Operational Excellence at Nemours. He received a Masters of Public Health degree from Harvard University and a Masters of Medical Management degree from Carnegie Mellon University. Dr. Rosen’s interests include patient-physician communication, family-centered care, and the patient experience. He teaches medical students about improving the patient experience, and he serves as the faculty mentor for the physician executive leadership program for medical students at Sidney Kimmel Medical College at Thomas Jefferson University. Twitter @PaulRsn1


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