Same-day Scheduling Off to Good Start in Primary Care
September 2003
Imagine calling for a routine doctor's appointment and being told that you can be seen that day by your own physician. The concept sounds radical, but PAMF's primary care departments are working to make it the norm.
The new appointment scheduling model, known as Advanced Access, is catching on at practices around the country. It's based on the simple rule of doing today's work today, without allowing a backlog of appointments to build. The initiative is intended to improve patient access and satisfaction, health outcomes and efficiency of care.
PAMF began implementing Advanced Access in primary care departments (internal medicine, family practice and pediatrics) at all its locations in February. Once the new system is fully operational, patients will be offered a same-day appointment every time they call. In some cases, patients may be referred first to an advice nurse to determine if their question can be handled even more immediately over the telephone.
Early results indicate that the initiative is working: the average time between when patients call for an appointment and when they are seen dropped from 20 days before implementation to 10 in June. (The number includes patients who chose to schedule future appointments, as well as physician vacations and other factors.) PAMF hopes to halve this number again in the coming year.
As access has increased, so has patient satisfaction. "On patient surveys, when we look specifically at how happy they are with access, scores have improved dramatically," said Jenny Buchanan, senior director of clinical services.
Implementing the Advanced Access system required significant preparation at all levels of the organization, from administration to medical and support staff. Physicians and staff members added hours to their days and days to their weeks to complete existing appointments and create time for daily requests. Computer systems were revamped and patient services representatives were retrained. All in all, working down the backlog of previously scheduled appointments took about four months, said Susan Smith, M.D., a family practice physician who serves as division head for the primary care departments.
Natural variability in patient demand means primary care physicians and support staff now work some longer days and some shorter. But despite the uncertainty, most physicians are happy with life under Advanced Access, Dr. Smith said. That's mainly because the system allows them to see more of their own patients, getting a better understanding of each person's medical issues.
"It makes the day so much better for them, because they went into medicine in order to take care of their patients and have those relationships," Buchanan added.
It's also expected that the ability to "see your own" will ultimately translate into better health outcomes and more efficient care for patients. "Since we are doing more for the patient when possible to update health maintenance such as Pap smears, lab orders and routine immunizations the need to make an appointment for an 'annual' physical really should diminish," said Joann Falkenburg, M.D., a family practitioner in PAMF's Fremont Center.
Up next is the implementation of Advanced Access in specialty departments, with planning groups expected to begin work later this year. Specialty departments pose different challenges, such as scheduling around limited operating room availability for surgeons or unpredictable deliveries in OB/Gyn.
As a result, full implementation may take longer for specialty departments than it did for primary care. Still, lessons learned from the primary care roll-out will help. On a basic level, for example, planners now know the importance of tactics such as simplifying appointment types and how to collect appropriate data, Dr. Smith said.
More broadly, the early successes in primary care show "there's a different way to do things that we can achieve if we work together," Buchanan said.
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