WIXLIB

SPEEDBAR One benefit of modified-wave scheduling isthat there is time builtinto the schedule forthe physician to catchup if he or she beginsto fall behind. This keeps the doctorfrom falling furtherbehind as the day progresses and preventspatients from spendinga long time in the waiting room. Also, because the firstappointment of thehour is double-booked,the physician is awareof another patientwaiting and tends touse time more wisely.VACATIONSEvery physician has experienced being swamped several daysbefore and several days after a vacation. Reducing the number ofroutine follow-up appointments before and after a vacation can helpprevent this. The key is tapering. Several weeks before your vacation, have your receptionist block out progressively larger and largerportions of your schedule for the several days preceding your vacation. Do the reverse (i.e., block out progressively decreasing portions) for the few days following the vacation. The receptionistshould be instructed not to schedule any routine appointments during those blocked-out periods. Then, perhaps one week prior to thevacation, open up the schedule so that when patients call with semiurgent needs, they can be easily accommodated.with less complex problemswithout having to rush to getback on schedule.Finally, by stacking patients atthe beginning of an hour or session, you ensure that physicianand staff time isn’t wasted if oneof the two patients booked at thetop of the hour is a no-show.Fine-tuning the scheduleTo get even more out of modified-wave scheduling, you cangroup similar types of office visits in a single session. Some practices have surgical-procedureIn a group practice, it is often just as important to block out somedays, complete-physical days orslots on the other physicians’ schedules during the week(s) a physiall-pediatric days. For example,cian is on vacation. Frequently, it is the remaining partner(s) whoconsider setting aside one midgets the brunt of the patient overflow. These appointment slotsweek morning office session forshould be blocked out well in advance and should be reserved forphysicals. If an average physicalsame-day appointments.takes 25 to 30 minutes, twoAfter each vacation, the physician, the office manager and the perphysicals can be scheduled atson scheduling patient appointments can evaluate how well they9 a.m. and one at 9:30 a.m. Thedid in predicting the patient flow. Depending on what they decide,physician sees one of the patientsmore or fewer appointment slots can be blocked before and afterat 9 a.m. while the secondthe next vacation.patient has testing done by theancillary staff. Then, 20 minuteslater, the patients can switch, andan exam room – tends to use time morethe first patient can have testing done whilewisely. And patients who need more attenthe second patient sees the physician. Thistion do not end up getting rushed through.way, both patients with 9 a.m. appointmentsWhy? The modified-wave schedule allowshave the perception that they’ve been seenphysicians to borrow the unscheduled timeimmediately. The entire office gets into afrom the end of the hour or from patientsgroove, and you end up seeing more patients.INTRAWEEK HIGHS AND LOWS Many practices find that Mondays, and sometimes Fridays, are too busy. For example, at one of our practice sites,To avoid rushingthrough a visit involving complex problems,physicians can borrowtime from the end ofthe hour or from lesscomplex visits.the office manager and the receptionist were pulling their hair out trying to handle upset patients who couldn’t be fitinto one physician’s Monday schedule. These patients had waited since Saturday to see their own doctor on Monday,only to find they’d have to wait another day or two. Their anger was understandable. Furthermore, it took extra stafftime to cajole patients into waiting another day or two for an appointment.In this practice, the solution was simple. On Mondays, they allowed only two patients to be scheduled in advance forthe first two morning appointment slots. That way, the doctor would be assured of starting on time. The rest of theschedule was filled as the calls came in on Monday. By the time the first two scheduled morning appointments hadbeen completed, patients who had been added to the schedule that morning were already arriving at the office. Thedifference in patient and staff satisfaction was remarkable. Ill patients were told to come in almost immediately.There were also fewer phone calls to confirm patient appointments and less time spent on the phone on Mondays totriage patients away from an already full schedule.Your practice may not need to block out such a large amount of time on Mondays, but you can use the same principles to help you determine the number of slots you’ll need.44 FAMILY PRACTICE MANAGEMENT www.aafp.org / fpm January 2002

SCHEDULINGThere is one valuable strategy that cancians who are double-booked at the front endmake a huge difference in smoothing patient of the hour and then have no unscheduledflow regardless of the scheduling method you time at the end of the hour to catch up willuse: Review the schedule several days prior to fall markedly behind in no time flat.the appointment day. My medical assistantPitfall 2: Double-booking new patients,and I do this together prior to re-confirmingdifficult patients or patients with complicatappointments. That way, we can fix any odded problems at the front of the hour. Forglitches in the schedule by asking certainexample, if two new patients are scheduledpatients to come earlier or later in the day orat 9 a.m., the schedule can quickly turn intoeven on another day, if necessary.a mess. Don’t book these patients duringWhy do I assign this task to my medicalpeak time periods whenever possible, and tryassistant and not theto ensure that theirreceptionist or schedvisits are mixed withExperience has taught me thatuler? Experience hasothers that are likelytaught me that theto take less time. Ifthe scheduler is often too busyscheduler is often toothe patient asks,to put a lot of thought into howbusy to put a lot ofsimply explain thatthought into how9 a.m. is a high-trafpatients are scheduled.patients are scheduled.fic time in the officeThe medical assistantand does not giveis generally the one who is most accustomedthe doctor sufficient time to spend with theto the work style of the doctor(s) as well as to patient.the idiosyncrasies of the patients, and, consePitfall 3: Implementing modified-wavequently, is better equipped to mix and match scheduling in a large practice (20 physipatients so that each hour is balanced. A final cians) with centralized scheduling. Practicesadjustment to the schedule prior to thewith centralized scheduling can have terribleappointment day can correct the mistakesscheduling problems and have greater diffibefore they become a reality that both theculty implementing this method. The onlystaff and the patients have to deal with.way that I’ve found to make modified-wavescheduling work in a practice with centralPitfalls to avoidized scheduling is to limit a specific schedOver the years, I’ve helped many practicesuler to a specific set of doctors, conductimplement modified-wave scheduling. Ifrequent feedback sessions and commit towould be remiss not to mention havingmodifying the schedule on the fly. I generalencountered a few problems along the way.ly discourage centralized scheduling altoHere are some past mistakes I’ve seen andgether and encourage decentralizedwhat your practice can do to avoid them:scheduling at the primary care office site.Pitfall 1: Filling the catch-up time slotsThis way other issues such as billing matterswith acute visits. Avoid this at all costs. Physi- can be dealt with at the time patients schedule appointments.FPM ARTICLES ON SCHEDULINGThe bottom lineSuccessfully managing patient flow takes“Same-Day Appointments: Exploding the Accessthought and careful planning. It is by farParadigm.” Murray M, Tantau C. September 2000:one of the most challenging aspects of prac45-50. Available at: www.aafp.org/fpm/20000900/tice management. But when done correctly,45same.html.smoothing the peaks and valleys in your“Reducing Delays and Waiting Times With Openschedule using the modified-wave techniqueOffice Scheduling.” Herriott S. April 1999:38-43.will increase the capacity and efficiency ofAvailable at: www.aafp.org/fpm/990400fm/38.html.your practice without increasing your overhead. Add to that staff and physicians who“Is Your Schedule Out of Control?” Shenkel R. Separe less stressed and patients who aren’ttember 1995:66-67.enduring lengthy waits to be seen and you’ve“A Checklist for Scheduling Success.” Matthies F.got a better practice all around.SPEEDBAR To get even more out ofmodified-wave scheduling or any other scheduling technique, groupsimilar types of officevisits in a single session(e.g., “physical day”). The entire office getsinto the groove and isoften able to see morepatients. One valuable strategythat can make a difference in any schedulingtechnique is to reviewthe schedule severaldays prior to appointment day. The author does thiswith his medical assistant, who is mostaccustomed to thework style of the physician(s) and the idiosyncrasies of the patients.January 1995:68-71.Send comments to fpmedit@aafp.org.January 2002 www.aafp.org / fpm FAMILY PRACTICE MANAGEMENT 45

modified-wave method of scheduling patient appointments and increased the capacity and efficiency of his practice. With modified-wave scheduling