Improve scheduling to eliminate patient backups

Key Points

Debi Croes has heard almost every excuse in the book when it comes to patient flow problems, from having too few chairs in the waiting room to not enough exam rooms. But Croes, a practice management consultant and co-founder of The Croes Oliva Group in Lexington, MA, has yet to find a practice where a dearth of chairs is the culprit.

What does she find instead? All too often, they're parking their patients-a symptom of inefficiency, Croes says.

And being parked affects patient satisfaction, according to "Willing to wait? The influence of patient wait time on satisfaction with primary care," a 2007 survey published in BMC Health ServicesResearch. While the amount of time actually spent with their physician had the greatest impact on how satisfied patients were, the 5,000-person online survey also indicated that the more time patients spent waiting to be seen, the less contented they were likely to be.

Though most practices with significant visit bottlenecks are aware of the problem, many find it difficult to pinpoint the causes and make the changes needed to correct it. Practice management experts and physicians who have managed to find and fix the flaws in their patient flow system offer advice on detecting and eliminating the most likely culprits.

Start by mapping flow

One of the most effective ways to diagnose snags is to map patient flow to determine how much time is spent on each step of a visit. While there may be variations depending on the kind of practice and type of visit, Frank Cohen, a consultant with CPA Health Partners in Clearwater, FL, focuses on the following basic steps: (1) check-in; (2) intake paperwork; (3) insurance validation; (4) move to the exam room; (5) preclinical assessment; (6) physician encounter; (7) coding; and (8) check out.

There are various ways to map flow, according to Elizabeth Woodcock, an Atlanta-based consultant and author of Mastering Patient Flow: Using Lean Thinking to Improve Your Practice Operations. In a practice with an electronic health record system, the process can be automated by programming the computer to "time stamp" patients' steps as they're keyed into their chart. Without an EHR, you can enlist the help of patients, asking them to record their progress as they move through each phase of the visit; have a staff member follow patients and do the same; or hire a consultant or get another outsider to do the tracking. Woodcock suggests recruiting an unpaid intern from a local college to work on-site for a week and map patient flow.

When the 40-physician internal medicine group at Emory Crawford Long Hospital in Atlanta set out to do this, both staff members and physicians got involved, says Richard Gitomer, an internist and the hospital's chief quality officer. They noted the time of each step from check-in to check out on patients' charts, but didn't attempt to track every patient. "It's too onerous to do it all the time. And even if you just time two or three patients for each doctor, you get an adequate amount of data," Gitomer says.