What Is Modified Wave Scheduling

Perchance ane of the most important factors in the success of a family practice is patient flow. An part that tin successfully smooth out the peaks and valleys in its schedule tin can see more patients more than efficiently, reduce vesture and tear on function staff and physicians and brand more money.

Although much recent attending has been given to open-access scheduling, there are other, more moderate changes yous can brand in your scheduling that can yield significant results. You can brainstorm by identifying where in your schedule peaks and valleys tend to occur. Several causes of peaks and valleys and strategies for dealing with them are described in boxes that appear throughout this commodity.

To address peaks and valleys in my practise's schedule, I adopted "modified-wave scheduling," a elementary technique where patients are purposely double-booked at the front of each hour and the terminate of the hour is left open for catch-up. I've used this system with much success for 19 years. Information technology has increased my lesser line by almost 15 per centum without increasing my overhead. Here's how it works.

Primal POINTS

The first step to improving patient scheduling in your practice is identifying where the peaks and valleys in your schedule occur.

One way to smooth scheduling peaks is by using the modified-moving ridge method.

The fundamental to modified-wave scheduling is to double-book patients for the commencement slot of each hour, leaving the end of the hour open so in that location's time to catch up if the dr. begins to run backside schedule.

Doing the wave

I first encountered moving ridge scheduling in the early on 1980s when I was doing a rotation in pediatric cardiology. Patients traveled from throughout the region to the clinic where I worked, and they were all told to come up at one p.m. Once at that place, they were told they'd exist seen on a "offset-come, beginning-served" basis. This was how original "moving ridge" scheduling worked. Loading the patients at the front stop of the day optimized the efficiency of the staff past guaranteeing there was never a lull in patient menses. While information technology was adept for productivity, it was unpopular with patients. Some had to wait several hours to exist seen, despite having arrived on fourth dimension for their appointments.

The "modified-wave" method takes reward of the chief behind the "wave" method, but it is more patient friendly. The key to the modified-moving ridge technique is to load up the front end of each hour and leave open up slots in the schedule afterward on to catch up. Perhaps the best way to empathise the modified-wave technique is by comparing it to the standard method of scheduling [see "Standard scheduling vs. modified-moving ridge scheduling"].

Advantages

Using the modified-wave technique helps prevent long patient expect times by giving physicians free time at the stop of each hour to catch up if they've begun to run backside. In my experience, patients rarely complain when they have to wait from 15 to 25 minutes to meet the doctor. It's when the await exceeds the 25-minute mark that patients start to go upset and satisfaction begins to suffer. With modified-wave scheduling, if a physician begins to run late, the result isn't cumulative: In that location is time built into the schedule at the finish of the hour to grab upward.

Another plus of modified-wave scheduling is that because the beginning appointment of the hour is double-booked, the physician – enlightened that the next patient is either already waiting or is in the process of being put in an exam room – tends to utilize time more wisely. And patients who demand more attending do non finish up getting rushed through. Why? The modified-wave schedule allows physicians to infringe the unscheduled time from the end of the hour or from patients with less complex problems without having to rush to get dorsum on schedule.

SEASONAL VARIATION

The geographic expanse where you practice will have a high and low season uniquely its own. One mode to help shine scheduling peaks is to encourage all patients with chronic diseases to take their comprehensive evaluations performed during your low season. How many times have you encountered a patient with circuitous, non-urgent problems scheduled into a xv-minute slot on a Monday during flu flavour? While these types of visits can't always be avoided, they tin can be minimized. We've found that once we schedule our patients with chronic conditions to come in for routine exams during low flavour, they stick to that schedule. Another way to motility visits of this type to the less busy fourth dimension of year is to adjust the number of refills you prescribe then that patients' refill requests coincide with your less busy months.

In addition to smoothing out your workload, scheduling comprehensive, non-urgent evaluations during low season allows you lot more than fourth dimension during the visit to hash out health maintenance issues and clean up the patient's medication list, problem list and the overall chart. At that place's also more time to ensure that your documentation and coding support the high level of care you provided. And, with a clear and organized chart, acute visits during the busy months can be handled much more efficiently.

An unanticipated do good of scheduling consummate evaluations well in advance is that patients go far expecting a longer visit and don't seem to listen paying more than for information technology. Early in my practice years, I recall several patients with whom I had spent twice the normal amount of time bitterly complaining that I had charged more my usual rate. It didn't take me long to larn that when patients make an appointment for a regular function visit they look a regular office accuse. Scheduling comprehensive visits well in accelerate seems to increase patients' satisfaction that they're getting what they (or their insurance programme) pay for. Also, in our practise, where the low season is summer, many patients have already met their deductibles by the time they see us for these more expensive part visits.

STANDARD SCHEDULING VS. MODIFIED-WAVE SCHEDULING

Each of the post-obit instance examples is based on the mix of patient visits a family unit dr. might encounter on an average morn.

Standard scheduling method

In this scenario, patient appointments are booked in 15-minute increments.

Number of patients seen: 10.

Number of patients who waited: four (2 waited for 25 minutes and ii waited for 15 minutes).

Minutes "wasted" by the doctor: 35 minutes (20 minutes waiting for the adjacent scheduled patients and 15 minutes for the no-prove).

Modified-moving ridge scheduling method

Again, patients are scheduled in 15-infinitesimal increments, but two patients are booked for the first time slot of each 60 minutes. A grab-upwardly period is congenital into the schedule at 9:45 a.m., ten:45 a.chiliad. and 11:45 a.g. During this time, no appointments are scheduled. In this scenario, more than patients had to wait, just in my feel, patients rarely complain when they accept to expect up to 25 minutes to see the doc.

Number of patients seen: 12.

Number of patients who waited: nine (one waited for 25 minutes and viii waited for 15 minutes or less).

Minutes "wasted" by the doctor: 0.

VACATIONS

Every doc has experienced existence swamped several days earlier and several days afterwards a vacation. Reducing the number of routine follow-up appointments before and after a vacation can help prevent this. The key is tapering. Several weeks before your holiday, take your receptionist block out progressively larger and larger portions of your schedule for the several days preceding your vacation. Practise the contrary (i.e., block out progressively decreasing portions) for the few days following the holiday. The receptionist should be instructed non to schedule any routine appointments during those blocked-out periods. Then, mayhap one calendar week prior to the holiday, open up up the schedule so that when patients telephone call with semi-urgent needs, they tin can be easily accommodated.

In a group exercise, it is oft just equally important to block out some slots on the other physicians' schedules during the week(s) a physician is on vacation. Often, it is the remaining partner(s) who gets the brunt of the patient overflow. These appointment slots should be blocked out well in advance and should be reserved for same-24-hour interval appointments.

After each vacation, the physician, the office managing director and the person scheduling patient appointments can evaluate.

Finally, by stacking patients at the beginning of an hour or session, you ensure that physician and staff fourth dimension isn't wasted if i of the ii patients booked at the height of the hour is a no-testify.

Fine-tuning the schedule

To get fifty-fifty more out of modified-moving ridge scheduling, you lot tin group similar types of office visits in a single session. Some practices have surgical-procedure days, complete-physical days or all-pediatric days. For example, consider setting aside one midweek morning time office session for physicals. If an average physical takes 25 to 30 minutes, two physicals tin can be scheduled at nine a.m. and one at 9:xxx a.k. The dr. sees 1 of the patients at 9 a.m. while the second patient has testing done past the coincident staff. Then, 20 minutes later, the patients tin can switch, and the first patient can have testing done while the second patient sees the physician. This way, both patients with 9 a.m. appointments have the perception that they've been seen immediately. The entire function gets into a groove, and you cease up seeing more than patients.

INTRAWEEK HIGHS AND LOWS

Many practices find that Mondays, and sometimes Fridays, are too busy. For case, at one of our practice sites, the office manager and the receptionist were pulling their hair out trying to handle upset patients who couldn't exist fit into one medico'southward Monday schedule. These patients had waited since Sabbatum to run into their own doc on Mon, but to discover they'd have to look another twenty-four hour period or two. Their acrimony was understandable. Furthermore, it took extra staff time to cajole patients into waiting some other twenty-four hour period or two for an appointment.

In this practice, the solution was simple. On Mondays, they immune just 2 patients to be scheduled in accelerate for the kickoff 2 morning appointment slots. That way, the doctor would be assured of starting on time. The rest of the schedule was filled as the calls came in on Monday. By the time the start two scheduled forenoon appointments had been completed, patients who had been added to the schedule that morning were already arriving at the function. The difference in patient and staff satisfaction was remarkable. Sick patients were told to come in almost immediately. There were besides fewer telephone calls to ostend patient appointments and less time spent on the phone on Mondays to triage patients away from an already full schedule.

Your do may not need to block out such a big corporeality of time on Mondays, but you tin use the same principles to assist you determine the number of slots you'll need.

In that location is i valuable strategy that tin can make a huge difference in smoothing patient menses regardless of the scheduling method you lot use: Review the schedule several days prior to the date solar day. My medical assistant and I practise this together prior to re-confirming appointments. That way, nosotros can fix any odd glitches in the schedule by asking certain patients to come earlier or later in the twenty-four hour period or even on another twenty-four hour period, if necessary.

Why practise I assign this task to my medical assistant and not the receptionist or scheduler? Experience has taught me that the scheduler is often too busy to put a lot of idea into how patients are scheduled. The medical assistant is generally the i who is about accustomed to the work style of the doctor(south) as well as to the idiosyncrasies of the patients, and, consequently, is ameliorate equipped to mix and match patients so that each 60 minutes is counterbalanced. A final adjustment to the schedule prior to the engagement 24-hour interval can right the mistakes before they get a reality that both the staff and the patients have to deal with.

Pitfalls to avoid

Over the years, I've helped many practices implement modified-wave scheduling. I would be remiss not to mention having encountered a few problems along the way. Here are some by mistakes I've seen and what your practice can practice to avoid them:

Pitfall 1. Filling the catch-upwards fourth dimension slots with astute visits. Avoid this at all costs. Physicians who are double-booked at the front end terminate of the hour and and then accept no unscheduled fourth dimension at the end of the hr to grab up will fall markedly behind in no time flat.

FPM ARTICLES ON SCHEDULING

Is Your Schedule Out of Command? Shenkel R. September 1995:66–67.

A Checklist for Scheduling Success. Matthies F. January 1995:68–71.

Pitfall 2. Double-booking new patients, hard patients or patients with complicated bug at the front end of the hr. For instance, if two new patients are scheduled at nine a.1000., the schedule tin quickly plow into a mess. Don't book these patients during superlative time periods whenever possible, and endeavor to ensure that their visits are mixed with others that are likely to take less fourth dimension. If the patient asks, just explicate that 9 a.grand. is a high-traffic time in the office and does not give the doctor sufficient time to spend with the patient.

Pitfall iii. Implementing modified-wave scheduling in a large practice (20+ physicians) with centralized scheduling. Practices with centralized scheduling tin have terrible scheduling problems and have greater difficulty implementing this method. The only way that I've establish to make modified-wave scheduling work in a practice with centralized scheduling is to limit a specific scheduler to a specific set of doctors, bear frequent feedback sessions and commit to modifying the schedule on the fly. I generally discourage centralized scheduling birthday and encourage decentralized scheduling at the principal care office site. This manner other issues such as billing matters can exist dealt with at the time patients schedule appointments.

The bottom line

Successfully managing patient catamenia takes thought and careful planning. It is by far 1 of the most challenging aspects of do management. But when done correctly, smoothing the peaks and valleys in your schedule using the modified-wave technique volition increase the capacity and efficiency of your practice without increasing your overhead. Add to that staff and physicians who are less stressed and patients who aren't indelible lengthy waits to be seen and you've got a ameliorate practice all around.