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.