He was a hard headed man....

“Life in the Fast Lane,
Surely make you lose your mind“

The Collins Street Medical Centre has developed a strategy that has been effective in changing their capacity to match their demand. Fiona Broderick has generously presented on their ‘Swift Solutions Clinic’ at a number of APCC workshops.

Why block up a 15 minute slot if all that is needed is a brief appointment for a script, a certificate, a referral or a normal result? A number of practices have told us about variations on this idea that have worked for them.

Dr Boyapati’s practice restricted the clinic to prescriptions…

“We allocate 1 hour a week to “script only” time. Patients now know that if all they need is a repeat script they can book in at that time with next to no wait but it can ONLY be for a script. So far it has worked extremely well. Patients are happier that they don’t wait for “just a script”

At Campaspe Family Practice they deal with a wider range of problems but there are still strict guidelines…

“Our most successful innovation to date (shamelessly stolen from the Collins St Medical Centre at a collaborative workshop) is the introduction of the Swift Clinic set up daily for each doctor for approximately one and a half hours. Each appointment time is 5 minutes instead of 15. Patients are triaged at reception and educated about the clinic. A nurse sees the patient first and checks blood pressure etc…or arranges what is necessary for the patient..

The clinics are suitable for : repeat scripts, blood pressure checks, minor paper work (signature), sickness certificates (for a patient who has been treated by the practice already), results (if advised by the doctor to book swift) etc….We set them up after lunch or first thing in the morning to prevent a late start and consultations are usually bulk billed. Patients are very happy as are the doctors and reception staff.”

At Bribie Medical Centre they have specific clinics for individual problems…

“For one of our doctors, we have initiated script and referral clinics (for ongoing referrals and repeat scripts for patients seen within a 3 month period), BP clinics (previously patients were using the chemist for short BP checks but now we see them at the practice), and BSL Clinics.  We have put these clinics in place to help the waiting time for patients with appointments and to stop the interruptions for these types of visits.  .

The script clinics are 8.30 – 9.00 two days per week and 5.00 – 5.30 two days per week Tuesday through to Friday.  The BP and BSL clinics are also 2 days per week Tues and Thurs. The clinics usually see about 10 people per session.  The clinics have proven popular with the patients and other doctors have now started to follow.”

Quick clinics seem to be popular with patients and practices.   Your comments are welcome on this idea for improving practice efficiency

How much of our capacity is lost bit by bit – chipped away in little inefficiencies? This story from Romsey Medical Centre appealed to me because it underlines a lesson it took me years learn. Here is how they tell it…

“It’s hard to choose just one from the most worthwhile collaboratives journey, however, the one that most stands out in my mind is ‘Tracking doctor starting times’, the graphing of which named (and sometimes shamed) each doctor’s performance in this area.

It basically measured how long after the 1st booked appointment the doctor actually saw the first patient and drew direct correlations between this and session times blowing out.

It was painfully obvious that those doctors who regularly started their session late, finished even later, and those who started on time fared much better. As a result, we have seen a behavioural shift in ‘promptness’ which has benefitted everybody; the doctor (not feeling so stressed by the end of a session), reception (not copping so much abuse from patients), and patients (not having to wait as long to see the doctor).

If that’s not a win/win/win, I don’t know what is!!!”

It is a tribute to the healthy team Romsey has developed that they were willing to put themselves under the microscope to improve this area of their performance. As Tony Lembke says 15 minutes late is not on time (see “Becoming a Time Lord”).

In the ‘Carve Out’ model for appointments, some appointments each day are kept reserved as ‘book on the day appointments’, for patients with acute conditions. In our practice, these are coloured green.

If ‘Demand is Finite and Predictable’, we should be able to look at our appointment history to anticipate the future acute requirements, and thereby determine how many appointments need to be carved out.

(Indeed, a few years ago we analysed the appointments over a whole year and found that the number of both acute and planned appointments was very consistent for any particular day of the week.)

Successfully carving out the right number of appointments proves to be harder than anticipated. Even if we know that we will require 54 acute appointments on a Monday, and ‘reserve’ them some weeks ahead of time, many of these reserved slots are mysteriously taken up beforehand. By the time Monday starts, there are always far less than 54 still ‘carved out’.

So in our practice we are now playing ‘Appointments Golf’.

It is way of scoring the success of the appointment system. It is also a means of ascertaining how many acute appointments you need each day, without having to tally them up.

The scorecard we use can be downloaded here.
Part of the scorecard looks like this.

At the start of each day, before the phones are switched on, the ‘early’ receptionist counts how many free appointments are available. (A – Acute at Start of Day”

At the end of the day, the ‘closing’ receptionist counts how many extras needed to be fitted in, “B – Extras at End of Day”and how many gaps there are where noone was booked “C – Gaps”. (an unnusual event). You should also tally how many people (if any) were turned away (hopefully an even more unnusual event!) “D – Unmet”

Your score for the day is
Number of Extras(B) – Number of Gaps(C) + Number Turned Away(D).

The lower the score, the better.
An eagle is zero. Birdie is between one and three. Par is four to six. Bogie is seven to nine. Double Bogie starts from ten.

And here’s the tip to improve your score!

The number of appointments you need to carve out to get zero on the same day of the week in one week’s time will be
Number of Free Appts at start of day (A) + Your Score for the Day (E)
This is the demand for acute appointments (F).

We have found that this number is amazingly consistent from Monday to Monday, Tuesday to Tuesday, etc.

Could you play Appointment Golf in your clinic? Let me know how you score.

Can you think of ways of adapting or extending Appointment Golf?

Do you think the ideal score is zero? Perhaps a few extras each day is a good thing?

Perhaps we should include a doctor and staff ‘zen score’, to determine how much zen was lost in a frazzled high scoring day.

Your questions and comments for this ‘virtual tabletop’ are very welcome below.