Pinpoint and correct glitches in patient flow process

Question: The patient flow situation in my office seems to be getting worse. My patients are constantly complaining about having to wait to see me. More often than not, I have downtime while the medical assistants are rooming my patients. I believe that we are adequately staffed but don't know what to do.

Answer: Efficient patient flow (or lack of it) can often make or break your practice. When patients aren't being seen on a timely basis, they become irritable and/or leave. If they choose to wait it out, it places the physician and staff in an adversarial position, which may impact the perceived quality of patient care. Many times, patients who walk out before their appointment never return, or if they do, they may start coming late and exacerbating the problem.

The way to approach this problem is to track the patient flow process, analyze it, then implement and monitor change. Several practice management and electronic medical record systems provide the ability to track patient flow via specific screens or data entry fields. If the automated system does not provide this capability (or just a portion of it), then this project will have to be done manually.

Develop a tracking form that identifies the key points within the patient flow process -- patient arrival time, appointment time, check-in time, patient rooming time, physician visit time and checkout time. There may be other times to monitor depending on the practice specialty.

Create a form for each physician for each day. We recommend doing this for a two-week period or more.

When the patient arrives, begin tracking the specific patient flow times on the form. We recommend that a third party (not the employees involved in the process) track the times. This provides the opportunity to ensure more accurate and objective data.

Use the data collected from the tracking forms to analyze the process. Look for bottlenecks. Typical findings include: Patients are double- or triple-booked into one time slot; patients arrive more than 15 minutes before their appointment; patients arrive more than 15 minutes late to their appointment; the chart is not ready for the medical assistant to room the patient; the medical assistants do not keep the rooms filled; and the physician is not ready when the room is filled.

Once the findings are documented, the next step is to determine causes. For example, are patients told what time to arrive? Is there a policy about seeing patients who arrive late for appointments? Who prepares the patient's chart for the visit and when is it done? Are there enough exam rooms?

When problems and causes are identified, the practice may start identifying and implementing solutions to streamline the patient flow process.

Creating a better flow

Implementing changes in patient flow doesn't have to be an expensive proposition. But those changes must be accepted by everyone in the office.

If the problem stems from patients arriving too early or too late, then the focus would likely be on improving communications. If there are not enough exam rooms, then physician schedules may have to be rearranged. If medical assistants are slowing down the process, then their tasks and how they do them need to be reviewed and revised.

Finally, if physicians are one of the reasons for the delays, then the way in which they perform tasks might also have to change.

For example, many physicians will take phone calls from patients or others throughout the day. Most appointment slots are adjacent to one another and do not provide much, if any, opportunity for the physician to make a phone call in between.

If this is the case, then the practice could either lengthen the appointment time slots to allow the physician extra time between appointments, or all phone calls could be held until pre-established times during the day.

Once everyone understands the new policies and procedures, it will probably require someone to supervise the process on a full-time basis for the first two weeks of implementation. The purpose of this is to ensure that the new policies and procedures are being adhered to, and to identify those that may need tweaking in order to make the process as efficient and effective as possible.

The supervision process should be tracked using the same form that was used during the data collection process.

After two weeks, the data should be analyzed and compared to the initial findings. Improvements should be celebrated, and areas that have not improved should be reviewed and reworked.

You will know when the new process is working because patients, physicians and staff will stop complaining about long wait times. However, it is always a good idea to back up this subjective feedback with objective data.

The average wait time is 19 minutes, and the average time a patient spends in the office is 60 to 90 minutes, depending on the specialty. Compare the practice's patient wait times to regional and national benchmarks for your specialty.

Even more important is to establish your own benchmarks and continually be working to maintain or surpass them whenever possible.