What is the difference between wave booking and stream time specific scheduling?

Optimizing patient schedules is a continuous process that is critical to physician efficiency and satisfied patients. Tools such as flow mapping and cycle-time management provide a means of gathering data to assist practices in addressing scheduling issues and streamlining the process to increase productivity and proficiency. Taking inventory of the scheduling trends in your practice can have a positive influence on tackling appointment templates, which determines patient flow that affects your revenue.

Appointment Trends

There are tools available to help you identify appointment trends; flow mapping and cycle-time measurement are two of these tools.

Flow mapping is an organizational process designed to help businesses decrease inaccuracies and find opportunities to increase productivity. The flow-mapping method requires you to walk through your practice as if you were a patient and take detailed notes about the entire visit, from check-in to check-out. If you find a problem during any step of the process, it is vital to identify how you can streamline the process. Creating an action plan and sharing it with your staff will help your practice implement these changes. Practice expert James Womack advises organizations to challenge each step of a process and consider whether it is valuable, capable, available, adequate, and flexible.1 It’s not sufficient to simply state that it is important to know if each step of your process creates value for your patients.

Cycle-time measurement is the actual time it takes to complete a process. This time measurement procedure builds on flow mapping and involves measuring and recording the time associated with various tasks within your practice. Total cycle time is generally considered to be the number of minutes from the time a patient signs in at the front desk to when he or she checks out. The best thing to measure, especially for better patient flow, is the practice’s high- to medium-level patient visits. Keep in mind that the cycle-time measurement should differentiate the wait time from check-in and the face-to-face visit time. Identifying the cycle-time measurement for your typical patient visits will help prevent bottlenecks that delay your schedule.

The information gathered from flow mapping and cycle-time management will identify inefficiencies that result in longer visits, leading to staff having to work overtime, a decreased number of office visits per day, increased wait time for patients to get an appointment, increased no-show rates, and reduced revenue.

Once problem areas are identified, discuss concerns from both staff and physician perspectives and collectively discuss recommendations. All practice staff, managers, and physicians should be encouraged to think outside of the box and focus on increasing patient volume and improving patient flow.

Scheduling

An important contributing factor in optimizing patient schedules is to understand the various types of scheduling methods and apply the one best suited to your practice. There are a variety of schedule methods:

• Clustering: This type of scheduling applies a production-line work concept, where the practice repeatedly performs a one-step process. An example of this model is to schedule patients with similar problems consecutively or block certain times or days of the week to see these patients.
• Wave scheduling: This method is for facilities that have several procedure rooms and sufficient staff for each room. Using the wave method, two or three patients are scheduled at the top of the hour and then another wave of patients at the bottom of the hour. If three patients are given the same time for their appointment, the physician will see the first to arrive; if they all arrive at the same time, the sickest of the three will be seen first. This scheduling process usually irritates patients because they don’t understand the method; however, it allows practices to take into account no-shows and late arrivals to maximize the number of patients seen during the day. Modified wave scheduling is a variation of wave scheduling. With this technique, two or three patients are scheduled at the top of the hour, followed by single appointments every 10–20 minutes through the rest of hour.
• Double-booking: This scheduling method is similar to wave scheduling, except that two or more patients are given the same appointment time because the practice can support attending to more than one patient at a time. For better patient flow, a practice can schedule Patient A for a full checkup and Patient B for an injection. While Patient A is having his or her vitals taken and the necessary labs done, the physician can see Patient B for the injection. If a practice doesn’t have enough staff or office space to accommodate this type of scheduling, it’s wise to avoid this method.
• Stream scheduling: This is the best known and most widely practiced type of scheduling in physician offices. It has a steady stream of patients at set appointments throughout the day—for example, a 30-minute appointment at 9:00 a.m., 15-minute appointment at 9:30 a.m., and then another 15-minute appointment at 9:45 a.m. This method works best when the practice establishes realistic time guidelines for particular types of appointments, such as 45 minutes for new patients and consultations, 15–20 minutes for routine check-ups or minor illnesses, and 30 minutes for certain procedures.
• Practice-based scheduling: This is used for practice settings that have a unique patient load. This is a customized system and you can set it any way that suits the practice. Practices that deal with a specific patient demographic can use a combined schedule outline from any of the previous methods.

Physician practices should establish an appointment matrix to help staff schedule patients more efficiently. This matrix should have an accurate and up-to-date record of all appointment slots filled and times that are open for patient visits. This matrix can be accessed through a paper system or electronically through your practice-management software; either way, it should be accessible and visible for all staff to reference as needed throughout the workday.

Training

Providing continuous training for your staff and tracking scheduling errors is critical for optimizing patient scheduling. Schedules are only effective if your staff is trained and equipped to maximize them. Tracking scheduling conflicts—whether they are overbooking, incorrect scheduling, or underbooking—at certain times of the day can help address inefficiencies.