Open Access Scheduling Cynthia Mobley, MD, MPH Medical

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Open Access Scheduling

• Cynthia Mobley, MD, MPH
• Medical Director
• Bureau of Adolescent and Reproductive Health
• Baltimore City Health Department

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Acknowledgments

• Open Access implementation team
• Demetria Rodgers
• Joi Scott
• Tanya Stephens
• Salimah Hassan
• Becky Tonn
• Meagan Shipley

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Objectives
As a result of this presentation, participants
will be able to

• Describe characteristics and benefits of an open
  access scheduling system
• Describe practical strategies for implementation
  of open access scheduling system
• Describe monitoring strategies of open access
  scheduling system

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High No Show Rates
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Long wait times

• Time to schedule appointment
• Extended cycle time in clinic

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Characteristics of Open Access

• Open access advanced access
• same-day scheduling
• Practice settings - private, public, academic
• Guiding principle Do todays work today
• Underlying theory Demand is predictable
• Keep it simple

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Characteristics of Open Access cont.

• Model variations
• Number of days
• appointments kept open for same day
• Minimize appointment types and lengths
• Appointments are scheduled by availability,
• not by type
• Demand / capacity balance

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Anticipated Benefits

• Decreased wait time for appointment
• Increased show rate
• More predictable schedule
• Increased provider productivity
• contact time
• Improved continuity of care
• Improved client care

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Anticipated Benefits continued

• Fewer ED visits, hospitalizations
• Improved client satisfaction
• Improved staff satisfaction
• Increased revenues
• Improved phone access
• Minimized reminder calls

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Implementing Change
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Getting Started at HTYA Center

• Researching Open Access
• Meeting with TRAINING 3
• QI process
• Development of implementation team
• Team and staff meetings
• Conference call with Title X clinic

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Implementation

• Staff buy-in
• Early introduction to all Center staff
• Article sharing
• Solicited staff input
• Strengthening of Open Access team

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Implementation continued

• Measure capacity

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Implementation continued
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Implementation continued

• Measure demand - internally and externally
  generated, for each provider

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Implementation continued
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Implementation . . . continued
Balance demand and capacity

• Adjust weekly clinician schedule as needed
• Coordinate clinician scheduled time off
• Provide adequate coverage for peak times of
  day/week
• Anticipate increased show rate
• Protect administrative time

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Implementation continued

• Commit to a start date
• Put it in writing - September 8, 2008
• No possibility of change,
• short of natural disaster!

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Implementation continued

• Clear backlog of appointments
• Measure extent of backlog
• Allow minimum 1 - 2 months to clear
• Reduce backlog
• Utilize locum tenens
• Extend clinic hours
• Double-book high no-show appt types
• Make follow-up appts via phone

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Implementation continued
Restructure appointment schedules

• Minimize appointment types
• No distinction between routine or acute
• Standardize appointment lengths
• Longer appointments only as necessary
• Minimize scheduling rules
• Allow for good backlog (planned care)
• Hold appointments for same day only

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Implementation continued

• Reduce demand for future visits
• Optimize each visit
• Meet clients reason for visit, and offer other
  needed services appointment conversion
• Review schedule prior to clinic session
• Return appts consider necessity,eliminate where
  medically appropriate

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Implementation continued

• Revise clinic processes
• Phone coverage increased demand in AM
• Appointment scheduling - client driven
• Registration
• Pulling medical records
• Reminder calls -
• for appointments scheduled gt 3
  days

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Implementation continued

• Inform clients and staff
• Staff meetings
• Brief waiting room presentations
• Signs
• Flyer
• Face-to-face
• Outgoing phone message

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Implementation continued

• Develop monitoring system

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Implementation continued

• Develop contingency plans
• Staff out unexpectedly
• Very high show rates
• Demand exceeds capacity
• Cross-train staff

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Implementation continued

• Improve clinic systems
• Clean-up / preparation day
• Exam rooms
• Identical rooms
• Maximize and standardize supplies
• Increase exam rooms
• Adequate copies of forms / supplies
• Changed Ahlers appointment schedule

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Preliminary results
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Preliminary Results - 4 months FY09
vs FY08
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Preliminary results continued

• Show rate increased from 50 to 65-70
• Wait time to routine clinician appointment
  decreased from 3 weeks to 1 - 3 days
• Pending
• Staff satisfaction
• Client satisfaction
• Provider continuity rate

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Issues and lessons learned

• Importance of staff buy-in
• Limitations on catch-up strategies
• Importance of contingency plans
• Very stressful for staff
• Support staff where able
• luncheons, feedback meetings
• Forced self-evaluation of all processes

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Resources

• Answers to Your Questions About Same-Day
  Scheduling (Family Practice Management. March
  2005 59-64)
• A Controlled Trial of an Advanced Access
  Appointment System in a Residency Family Medicine
  Center(Family Medicine. May 2004 36 (5)341-345)
• Implementing Open-Access Scheduling in an
  Academic Practice (Family Practice Management.
  March 200613(3)59-64)
• Open Access in Primary Care Results of a North
  Carolina Pilot Project (Pediatrics. July 2005
  116(1) 82-87)
• The Waiting Game (AAP News. July 2004 25 (1)1)
• Advanced Access Enabling Increased Provider
  Efficiencies (Child Health Corporation of
  America. May 2004)
• The Outcomes of Open-Access Scheduling (Family
  Practice Management. Feb 2004, p. 35-38)
• Pediatricians Honored for Improving Care (AAP
  News. November 2003 23(5)211)

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Resources

• Improving Timely Access to Primary Care Case
  Studies of the Advanced Access Model (JAMA. 2003
  2891042-1046)
• Advanced Access Reducing Waiting Delays in
  Primary Care (JAMA. 2003 289 1035-1040)
• Advanced Access Scheduling Doing Today's Work
  Today (AAP News. June 2001 18(6)266)
• Same-Day Appointments Exploding the Access
  Paradigm (Family Practice Management. Sept 2000,
  p. 45-50)

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Questions ?

Questions ?
Questions ?
Questions?
Questions ?
Questions ?
Questions ?
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Contact Information

• Cynthia Mobley
• Baltimore City Health Department
• 410-396-0063
• Cindy.Mobley_at_baltimorecity.gov

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