Patient scheduling has always been difficult. During COVID it became a real nightmare for some, as changing scheduling practices led to confusion, increased scheduling errors, and no shows at a time when providers are trying to get accustomed to new technology and a new way of handling visits. From a high-level, there are 3 strategies to scheduling that determine how likely errors are to occur. The tactics that each provider organization takes will depend on those strategies.
Getting scheduling right comes down to decisions on how to balance scheduling complexity. On one side, there are the differences between providers and the flexibility they have in determining their own schedules, visit requirements, and methods of practice. On the other side sits the expense of longer training times for scheduling staff and the errors that arise from trying to consistently get complex scheduling right. Whatever choices your organization makes, these two side must balance. It is a law of scheduling nature.
The law of scheduling flexibility/complexity – the flexibility given to providers must be offset with costs of complexity on the part of schedulers. Greater flexibility means greater complexity. Less complexity means less flexibility.
There are natural costs to complex scheduling that cannot be avoided. They must be managed or automated.
There are three, and only three, ways of addressing this dilemma:
A Schedule’s complexity is driven by the number of items that must be considered when scheduling an appointment. The more items to consider in a schedule, the more complex it is.
Some items that tend to influence a schedule’s complexity may be:
These are just the tip of the iceberg. All these examples are of the variability you get with a single provider or a single appointment type.
Multiply this complexity across all an organization’s single-appointment types.
Then there are the multi-resource schedules that involve perhaps a machine and a technician or a provider and an anesthetist. Multiple requirements must be taken into account for these.
Then there are sequential schedules with rules on the sequences, and the variability between providers on how these are handled.
Then there are the complex schedules that combine these. For example, the patient may first need a pre-op visit with intake and an anesthetist. Within a specified window of time, a scan is scheduled where multiple resources, including equipment and radiologist are available, followed by a recovery room and then a post-op visit with a provider. Sometimes these might be specified as being same-day or next day.
Take one mental health practice as an example. They have 72 primary diagnosis and 73 secondary diagnosis possibilities that combined determined the visit type. In addition, they have 4 service types, different rules for established vs new patients, and 160 provider preferences to account for. The total individual combinations is nearly 7 million!
It is no wonder that schedulers are forced to rely on reference materials for scheduling. It is very common to have books, or PDF documents, or even a SharePoint site dedicated to maintaining scheduling criteria across all visit types, all physicians, and most insurance types. The scheduler is then navigating unwieldy documents that are 50-100 pages long in the middle of the scheduling process.
Training - It takes weeks of training time to get schedulers up to speed on this complexity. The rule of thumb we’ve seen is that 10-15 pages of documentation equates to a week of training. That means that many practices are training their schedulers for 2, 4 or even 6 weeks before they can let them handle live requests.
Recurring overhead - This training is not a one-time expense. Scheduling is a high-turnover field and every new provider or new piece of equipment has the potential for adding more variables. This means documentation must be maintained, training must be maintained, and QA practices continually reinforced or expanded.
Cost of errors - The other expense is the scheduling disruption due to delays. Due to the complexity of scheduling, schedulers always make mistakes for weeks and months afterward until they have a chance to internalize most of these detailed rules. This results in schedules that need to be reviewed, patients that need to be called, scheduling gaps that cannot be filled, and increased no-shows as a result of errors or communication.
Other expensive problems associated with scheduling complexity:
While these costs are tremendous, the benefits for maintaining a flexible schedule are also tremendous. Providers gain the following benefits for having the flexibility to determine their own schedules:
You may notice that the problems and the benefits accrue to different individuals. The benefits of flexible scheduling are experienced by providers. Increased appointments filing schedule gaps, etc all benefit the provider.
The problems are experienced by those managing the provider’s schedule. The extra time, costs, and effort in making corrections are born by operations, practice managers, and their non-clinical schedulers.
There are 3 choices for balancing scheduling flexibility and complexity:
The benefits of doing this are that fewer staff are needed to maintain documentation, to QA schedules, and training can be drastically reduced. Scheduling consistency means fewer errors and gaps in the schedule.
The problems with this are that individual providers lose their flexibility. Provider engagement decreases and burnout increases. This has its own impact on the revenue and provider retention.
The benefits of this approach are that a process exists for encapsulating practice and provider requirements. This process delivers these requirements to the schedulers, updated regularly, with a QA process that ensures the provider the calendar is filled.
The costs of this approach can be substantial. There is overhead in maintaining the documentation, overhead in employing the QA personnel, and overhead in the ongoing training and retraining. Because of this, there is almost always ongoing tension as the providers want the benefits without the burden of the full costs. The law of scheduling complexity states that the costs WILL be paid somewhere, and if the overhead is too expensive, then the impact will be felt in the provider’s schedule.
By letting an application handle the complexity, you remove the perceived complication by the schedulers. The automation uses advanced logic to handle huge combinations in conjunction with your practice management system. Practice management systems provide scheduling support, but do not provide this automation.
Complexity is greatly reduced on the behalf of schedulers, since preferences, scheduling workflows, differences between new and established patients are all factors that are automated by the software.
Training is slashed to a quarter or a third of the time. This allows other roles besides schedulers to also be training in scheduling, giving your organization options during high call volumes and reducing the costs of scheduling. Errors are avoided. Even after training, schedulers always make mistakes for weeks or months after landing on the floor. With intelligent scheduling, most of those errors disappear, since the complexity is guided by the software. No full-time QA is needed for calling patients or checking for errors.
Add Patient Self-Scheduling to filling empty schedules automatically with wait lists, letting patients schedule themselves, reschedule themselves across your entire calendar
Once scheduling is automated, it is so simple that other roles can be trained. Our clients train other non-clinical and even nurse roles in scheduling. This improves patient satisfaction, as they are no longer being forwarded to someone new whenever they need to schedule. This improves operations as the organization has overflow options. Crucially, it also serves to cross-train others and break down silos, which is a critical step in developing a mature telehealth practice.
The trade-offs that exist between a provider’s choices and the expenses born by schedulers is not something that can be changed. There is a balance that is part of the nature of complexity. This trade-off can be used to justify hiring that full-time QA role to check for errors and keep the schedule full or perhaps to begin to standardize all providers' schedules, or perhaps invest in intelligent scheduling tools to make it all easier.