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Open Access Scheduling Decrease
waiting times and delays in the pediatric office Home | FAQs | Getting Started | Key Measures | Resources | Education
It is important to collect
baseline data prior to attempting to adapt Open Access principles to
your practice. Below are some key measures that will serve both as good
baseline data and ongoing tracking measures to assess if the changes
you are making are resulting in desired improvements. Note, a member
of your office staff who is savvy with spreadsheets (e.g., Excel) may
be able to automate many of these calculations using formulas in a spreadsheet. Appointment Demand and Supply Purpose: In order to achieve and sustain excellent access for your patients, your practice must match demand and supply. Thius, your practice must be able to measure both. This is arguably the most important measure to track for open access! How to: Demand Tool Reasonable goal: Demand =
Supply for all clinicians Appointment Delays ("3rd available appointment") Purpose: Assess the extent of delays for appointments for your patients - these delays lead to waste, inefficiency, and decreased patient satisfaction. How to: Every month, record the date of each clinician's 3rd (chronologically) available appointment for a preventive care visit (e.g., well-child visit, physical). To get the 3rd available appointment, pretend a patient calls and the first 2 chronological appointments with a clinician do not work for the patient. Record the next chronologically available appointment. Count the days between today and the date of 3rd available for every clinician and calculate the average for the practice by dividing the sum of these days by the number of clinicians. This average can be plotted on an Excel graph with months on x-axis and days until 3rd available on y-axis. Reasonable goal: 0 days In-office Waiting Times (Also called "cycle times") Purpose: Assess the extent of office visit waiting times for your patients. These delays reflect waste and inefficiency and lead to decreased patient and staff satisfaction. How to: Every month, record the time of arrival and time of departure for 5-10 consecutive patients per clinician in your practice. This can easily be done on your billing sheets by your administrative staff. Calculate the number of minutes for each visit; then, calculate the average for the practice by dividing the total number of minutes by the number of visits sampled. This average can be plotted on an Excel graph with months on x-axis and minutes of cycle time on y-axis. Reasonable goal: 25-30 minutes
Purpose: In order to match demand and supply, your practice must be able to anticipate and predict the future availability of appointments. How to: First, calculate the total number of potential appointments, which equals the number of appointment slots in the schedule that a clinician has in the next four weeks (but does not include overbooking). For example, if Dr B works 20 days in the next four weeks and he has a schedule template that allows him to see 25 patients/day, then he s 20x25=500 potential appointments). Next, calculate the number of available (open) appointments which equals the number of appointment slots in the schedule that a clinician has that are currently open in the next four weeks (i.e, they are not booked yet). So, if Dr B above already has 300 of his 500 appointments in the next four weeks scheduled with patients, he has 200 available appointments. To calculate future appointment capacity, each month or week, divide the number of available or open appointments by the total number of potential appointments for each clinician in your practice. Calculate an average for the practice by adding these percentages and dividing by the number of clinicians. This average can be plotted on an Excel graph with months or weeks on x-axis and future capacity percentage on y-axis. Note: If you cannot readily obtain the information with your office computer, you may wish to instead report the total number of potential appointments and number of available or open appointments for the one week period that is two weeks in the future (e.g, if today is 7/1/05, then report total number of potential appointments and number of available (open) appointments for the week of 7/15/05). This will be easier if you are doing this measure by hand rather than electronically. Reasonable goal: 70-80% open
Purpose: Measure no shows because they are very harmful. No shows cause many problems, including potential lost revenue, longer waiting times if practices overbook for no shows, and wasted effort and costs due to added staff work (e.g., to file and refile charts, call patients, reschedule, etc.). How to: Record the number of scheduled appointments on last week's schedule and the number of thos patients who showed for their appointment. If a walk-in or add-on patient 'replaces' a no-show, that walk-in or add-on patient should either: 1) be left out of the date entirely; or 2) be counted in both the scheduled appointments and the patients who showed for their appointment. To calculate your practice's no-show rate, divide the patients who showed by the number of scheduled appointments. This is your show rate - to get your no-show rate, subtract this number from one (e.g., 1-show rate). The no-show rate can be plotted on an Excel graph with months on the x-axis and the no show rate on the y-axis.
Purpose: To assess the degree to which we are meeting or even exceeding our patients' needs and expectations. How to: Each month, distribute
anonymous patient surveys to the first 30 consecutive patients (or parents of
a young child) seen in your office on a given day. The designated staff members
distributing the surveys should stress that surveys are to be used for quality
improvement, are anonymous, and will not affect their care at the practice.
The survey should have at least 2 questions:
2. How would you rate the quality of today's visit overall?
For continuity of care, calculate
by deviding the number of patients responding "Yes" by the
total number of patients surveyed. These averages can be plotted on an Excel graph with months on x-axis and percentages on y-axis. Reasonable goal: 80-85% of
patient visits are with primary care clinician and 80% rate overall
visit quality as "excellent."
If you need help with open access, or if you have any additional questions, we can help you. Contact Junelle Speller for more information or to provide feedback at jspeller@aap.org or 847/434-7650. |
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