The Agency for Healthcare Research and Quality outlined implementation steps for Open Access Scheduling in their “CAHPS Ambulatory Care Improvement Guide” (July 2015). These steps include:
- Measure supply and demand as precisely as possible
- Establish a test team of providers who are willing to try the system out
- Reduce the backlog of appointments. This may take 6 to 8 weeks of extra work. To facilitate this difficult task, practices may want to set a target date and agree that visits will not be pre-scheduled beyond that date. Another useful recommendation is to apply the concept of “max packing.” The idea is to reduce the demand for future visits by taking care of any upcoming preventive or screening needs whenever the patient comes in for a necessary visit regardless of the reason for that visit. Simplify the appointment types and make them all roughly the same length. One recommended tactic is to minimize complexity by limiting the practice to three appointment types: (1) personal, where the patient is seeing his or her physician; (2) Team, where the patient is seeing someone else on the clinical team; and (3) unestablished, where the patient does not yet have a specific physician. Appointment times can also be specified as either short or long, where the long appointment is roughly equivalent to two short ones.
- Develop a contingency plan for days (or parts of the day) when demand far outstrips the availability of physicians. This plan should identify who can supplement or substitute for each physician, if and when needed. Also, the group should be proactive about planning for those times when they can predict increases in demand, such as visits for school physicals or flu shots.
- Reduce demand for one-on-one visits with patients. One helpful tactic is to identify and address sources of unnecessary visits based on outdated clinical protocols, such as routine follow-up for urinary tract infections. Another approach is to implement group visits to better manage care for patients with the same chronic condition. Finally, clinicians can use the phone and email effectively to address concerns that do not require a visit.
- Once the practice is able to offer same-day appointments, it should assess its effectiveness by measuring appointment availability on a daily basis (e.g., third next available appointment).