Patient flow problems can be conquered

A realistic look at how long it takes the physician to see each patient is a first step for administrators to fix scheduling woes.

ByDerek A. Preece, MBA

Physicians and administrators often do not realize what contributes to their scheduling woes. “I don’t understand why I am way behind schedule about 10 o’clock each morning and 3 o’clock each afternoon. My patients have to wait an hour or more before they see me.”

The doctor was truly puzzled and had been living with this situation for years. I spent the morning timing him with a stopwatch as he examined patients and found that, on average, he was spending 10 minutes with each patient. The problem? He was scheduling 10 patients per hour – an average of 6 minutes per patient.

In other words, every hour he worked, he got further and further behind. He then worked through his lunch hour to try to catch up and stayed in the office well past 5 p.m. to try to finish his patient load.

He was stressed, his patients were unhappy with the wait times, and his staff was frustrated by the long hours.

Why do so many offices have so much trouble seeing patients on time? In general, there are two basic problems. First, practices do not know how much time to schedule for different types of patient exams (short, medium, long) because they have not determined how long their physicians take to examine those patients. Second, practices schedule patients without regard to how much time with the physician each patient will need.

10 steps

This article presents 10 steps that will allow your practice to analyze and fix patient flow problems.

1. Track how long it takes to see different types of patients. If you use an electronic health record system, it may be able to track how much time the physicians are spending with patients. You can also use a tracking form attached to patients’ charts to record the times, or you can assign someone to monitor and record physician times with patients.

Most practices have three types of exams: short (postoperative, quick checks of previous problems), medium (routine, established patient exams) and long (new patient exams, complicated patients).

Let us assume that you are managing an imaginary practice. By tracking your physician’s work times, you find that short exams take an average of 4 minutes of physician time, medium exams 8 minutes and long exams 12 minutes.

2. Determine how many of each type of exam you need to schedule. In our imaginary practice, you might find that 50% of your exams are short, 30% are medium and 20% are long.

3. Calculate your average weighted exam time by multiplying the exam times by the exam type percentages, as in this example:

Short:
(4 minutes) × 50% = 2 minutes
Medium:
(8 minutes) × 30% = 2.4 minutes
Long:
(12 minutes) × 20% = 2.4 minutes

Add these times together to calculate the average weighted exam time: 2.0 + 2.4 + 2.4 = 6.8 minutes in our example.

4. Divide the weighted average exam time into the number of minutes the physician works per morning or afternoon session. If we figure 4 hours of work per morning, then 6.8 minutes divided into 240 minutes equals 35 exams in those 4 hours.

5. Multiply each exam type’s percentage by the number of exams per session (35 in our example) to determine the number of each type of exam to schedule during the session. Our example yields these numbers of exams per 4 hours:

Short: 50% of 35 = 17.5
Medium: 30% of 35 = 10.5
Long: 20% of 35 = 7

6. Divide the number of exams per session by the number of hours per session (4 hours in this case) to figure the number of each exam type to schedule per hour. Here are our figures:

Short: 4.375 per hour, rounded to 4 per hour
Medium: 2.625 per hour, rounded to 3 per hour
Long: 1.75 per hour, rounded to 1 or 2 per hour

7. Double check the number of minutes you have scheduled per hour by multiplying the number of minutes needed for each type of exam by the number you are scheduling per hour:

Short: Four exams × 4 minutes = 16 minutes
Medium: Three exams × 8 minutes = 24 minutes
Long: One exam × 12 minutes = 12 minutes

The total minutes scheduled per hour is 52.

Note that it is usually difficult to schedule more than 80% of a physician’s time if you want to keep to your schedule. Scheduling two long exams per hour in our example would require 64 minutes of physician time per hour.

8. Design your schedule to reflect your practice’s data regarding lengths and types of exams needed. Our schedule might look like this:

Short
Long
Medium
Short
Short
Medium
Short
Medium

9. Build the rest of your flow processes around the physician’s schedule. For example, you must have enough technicians to balance the patient flow with the physician’s schedule. If the physician is on a schedule similar to the one we have outlined here, he or she will be taking an average of 6.8 minutes per patient. Let us round that to 7 minutes. So if a typical exam takes 25 minutes total, technician plus physician time, and the physician is taking 7 minutes, then the technicians will average 18 minutes per exam. In order to balance the flow and keep the physician working all the time, you will need three technicians; their 18-minute work times mean that three of them can work up a patient every 6 minutes on average, so they would stay slightly ahead of the physician, who is ready for a patient every 7 minutes.

10. Provide enough space. You will find that the number of exam spaces you need, at a minimum, is one for the physician, plus one for each technician, plus one more. In our imaginary practice, you would need one space for the physician, three spaces for the three techs, plus one more, for a total of five work areas minimum. If you have fewer spaces, someone will always be standing around waiting for a place to work.

These 10 steps will help you begin to tackle patient flow problems. Once you have determined how many exams your physician can handle in an hour, have designed an appropriate schedule and have provided the appropriate number of assistants and exam rooms, you will find that your patient flow problems are on the way to being conquered.

For more information:

Derek A. Preece, MBA, the president and chief executive officer of Enhancement Dynamics Inc., practice management consultants, can be reached at 165 N. 1330 West, Suite D-2, Orem, UT 84057; 801-227-0527; e-mail: derekpreece@aol.com.