Open Access Scheduling - A Success Story!

By Kristie Thorson, MAFP Communications Coordinator
From the January/February 2002 Minnesota Family Physician

Physicians at the Family Practice Medical Center in Willmar were frustrated. They weren’t able to see their own patients. There was such a backlog, a person’s wait for a routine physical was 63 days! Doctors were overwhelmed, patient satisfaction was falling and preventative service numbers were lower than acceptable. It appeared many people were treating the clinic as an urgent care center.

That’s when physicians and employees opted for a change. They joined the Institute for Clinical Systems Improvement (ICSI) in January of 2001. The organization helped them implement an open access (advanced access) scheduling system. Within four months, the backlog of patients was essentially gone. Today, when someone calls the medical center, they are, in most cases, offered an appointment with their primary doctor the very same day.

How does it work? What does it take to successfully implement open access scheduling? The following is an interview with Dr. Michael Morris, a family physician at the Family Practice Medical Center, and Stacy Zondervan, the Patient Services Director.

MFP: You knew you wanted to try open access scheduling. Where did you begin?

Zondervan: After two months of careful planning, we randomly picked a day in April and decided to start. Every patient who called was offered an appointment. Also, everyone who already had an appointment scheduled was seen. It was kind of like tough love; not fun, but in the end it paid off. Eventually, the only appointments scheduled were follow-ups and those specifically requested by a patient. The idea was to have at least half the schedule open when the doctors came in each morning.

MFP: What were the first days like?

Dr. Morris: Busy! There was a definite period of transition that required commitment from everyone—the doctors, nurses and other staff members.

Zondervan: With no limits and the already-scheduled appointments, it meant hard workand a lot of patients. The nurse practitioners helped out as much as they could. Everyone had to be a constant cheerleader for each other. Patients did spend more time in the waiting room at first, but it leveled off.

MFP: What is the biggest hurdle to open access success?

Dr. Morris: The backlog! Clinics usually have to add some hours to get it done. We took ICSI’s suggestions and decided what worked best for us, such as doctors using their days off for about a month to see patients, coming in early and staying late, and making an extra effort to include any preventative medical services a patient might need with periodic visits they make. For example, a patient needs to come in for a test in a few weeks. They’re in your office for another problem today, so go ahead and give them the test now so they don’t need to come back again. The theme of open access scheduling is do today’s work—today!

MFP: What did it take to pull off something like this?

Dr. Morris: It worked because we were committed to making it work. There really wasn’t a time when we thought it wouldn’t. We joined ICSI and did it as a collaborative project with others.

Zondervan: The number one thing was physician commitment and dedication. Second, everyone had to change their thought processes and put patients at the center. In the past, it was not always easy to do that.

MFP: What are the benefits to open access scheduling?

Zondervan: We are again providing more preventative services. We did a patient survey in September, and unlike previous years, there weren’t any patient complaints about not getting to see his or her own doctor.

Dr. Morris: Besides the obvious physician-patient satisfaction, it adds more flexibility within the clinic. The schedule is not fully booked so a doctor can break away for a meeting, take a last minute vacation day if something comes up and there doesn’t have to be a lot of rescheduling. It also dramatically decreases telephone triage time. A patient is basically calling to see their own doctor or a team doctor if their primary care physician happens to be gone. In other words, there are only a few appointment types for schedulers to worry about.

MFP: Would open access scheduling work in an area where there is not an excess of physician supply compared to population?

Dr. Morris: It is admittedly an extra challenge, but we have a shortage of physicians and still managed to do this. It takes a lot of work to get rid of the initial backlog. Becoming swamped is a common fear, but if you implement some efficient practices right away, like combining problem-focused and preventative service visits, linking patients with their primary physician, and effective use of problem lists and medications lists, it can be done. After the backlog is gone, you will realize you aren’t any busier than you were before.

If you would like more information about ICSI, check out their website at www.icsi.org.