Recently my wife required a specialty consult. The neurology department at the academic institution to which she had been referred called the following morning.
When she was offered an appointment approximately six weeks away, I saw the disappointment and fear in her eyes. Would she deteriorate rapidly? Perhaps her condition was only temporary?
We voiced our concern. The young clerk explained that the number of new consults on the neurologists schedules were limited and that many had taken Thanksgiving week off. Our situation was extraordinarily frustrating and definitely not unique.
The institution's website listed 32 neurologists in their network. As a physician department chief responsible for providing excellent access to a team of 25 clinicians, I recognized the reason for the long wait times. Demand for consult appointments was much greater than the supply.
Seems obvious, right? When appointment demand is greater than the supply, wait times become unacceptably long. Yet, it's surprising how many institutions, physician groups and departments don't monitor appointment demand and supply. Some actively resist optimizing access, believing that over utilization by patients will result. For the record, this notion has long been dispelled and well documented in the literature.
Why manage appointment access?
Simply put, providing good access for patients is the right thing to do. The emotional toll of waiting and not knowing is tremendous. We want access to healthcare for ourselves and our families when it's wanted or needed. Our patients deserve no less. So why is this basic expectation still such a challenge to deliver?
Implications of poor access are many: patient satisfaction and retention, physician satisfaction, quality care, medical legal considerations and operational costs. Improving access is not just the right thing to do for patients, but also can have a significant impact on the operations and success of a medical institution.
Optimizing access?
Matching appointment supply to patient demand is complex for institutions, networks and departments consisting of more than a few physicians. Creating physician schedules containing adequate access on the back of an envelope is no longer cutting it. Computer-based applications are necessary and must be capable of producing more than on-call schedules and vacation rosters.
On the macro level, scheduling applications must be able to fill all shifts, cover all necessary duties and account for holidays and vacations. Also, the sequencing of duties and shifts should be balanced for physician professional satisfaction purposes. For example, an ObGyn department must ensure a number of physicians are in clinic during the week, provide operating room time to accommodate surgical caseloads, fill labor and delivery shifts 24/7, and ensure vacation time is available—all at the same time.
Smart physician scheduling applications have additional capabilities that match appointment supply to demand. Appointment demand is measured as the annual, monthly, weekly and daily historical utilization for the care population. Supply is measured as the number of appointments available for each month, week and day for a department and each of its providers. Smart applications use appointment demand and supply data to generate physician schedules that automatically match demand and supply. When automatic matching isn't possible, the application creates the best matching possible and alerts the chief or access specialist to mitigate the appointment deficit.
Maintaining access requires monitoring supply and demand up-to and including same day appointments. Optimally, smart physician scheduling applications detect appointment deficits and alert authorities to take appropriate action. With this technology assist, it is possible to improve patient access to physicians without increasing the number of staff, upping work hours or taking other drastic measures that risk burning out doctors or increasing operations costs.
The neurologist was kind and thorough. We learned the diagnosis was not an emergency, but treatment was necessary to stabilize my wife's condition. She reminded me how important access is for patient satisfaction and quality care. And, how bad service can push patients to make tough choices.
I believe medical groups, departments and institutions employing software that efficiently creates physician schedules and optimizes access will be more successful. It's open enrollment season and my wife and I are considering purchasing our healthcare insurance from an organization promising excellent access.
Richard Fury, MD, is a board-certified family physician with interests in technologies that enhance access, patient engagement and affordability of healthcare. He is the former director of Kaiser Permanente's Technology Group where he led teams developing applications to enhance physician practices as well as websites for patient access and service. Currently, Dr. Fury serves on Lightning Bolt Solutions' advisory board and devotes his time to practicing urgent care and promoting technology-driven healthcare efficiencies.
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