The “domino effect” is described as a chain effect caused by a small reaction, which causes another similar reaction, and so on.
That is how Rubina Heptulla, MD, chief of the division of pediatric endocrinology and diabetes at The Children’s Hospital at Montefiore, views the changes that resulted in reducing patient wait times in the pediatric endocrinology unit from 11 weeks to 14 days.
Patient wait times in some parts of the nation have been found to be as long as two months, sometimes longer in specialty fields. One study found wait times for new patients to obtain appointments to be especially long.
After monitoring patient wait times from January 2008 to November 2011, Heptulla and her team found that modest scheduling changes—such as utilizing non-physician staff more effectively and developing efficient methods to handle high demand—can significantly reduce patient wait times for appointments with subspecialty healthcare providers, without adding more physicians.
“You change everything when you change one thing for the positive,” Heptulla said. “When you are not able to see patients in a timely fashion, you could miss a diagnosis, or the patient will not come back because they have booked an appointment with another practice that could see them sooner.”
The changes meant that Heptulla and her team were able to implement a full-scale quality improvement initiative while successfully catering to a complex patient population and maintaining scheduling uniformity.
“We got the idea from some work done within our primary care area. It’s flu season: During flu season, patients and their families do not want to wait three months to see a doctor,” Heptulla said. “I wanted to apply the same open-access model, where patients could receive timely access to the specialty practices.”
During the three-year study period, Heptulla’s team monitored and analyzed operational data, Montefiore’s scheduling system, and the appointment call center. The team found that many physician appointment slots reserved for new patients were used for follow-up appointments, causing a severe bottleneck in the scheduling system. Based on these findings, the team worked with hospital staff to schedule follow-up, non-critical appointments with nurse practitioners and physician assistants, leaving more physician appointments for new patients.
According to Heptulla, the new system is especially effective in monitoring cases of childhood obesity, a severe problem in the United States. Patients can schedule follow-up appointments for weight and wellness checks and can get appointments much sooner.
Finola, whose child has been a patient at Montefiore for a little over a year, expressed her frustration with the long wait times for appointments with their former endocrinologist.
“Prior to coming to Montefiore, we experienced difficulties getting appointments with our doctors,” Finola said. “We would be told to come back in two months, but there would still be nothing available.”
While Heptulla admits the scheduling changes can seem daunting, she said that the initiative not only reduced patient wait times; it also improved physician performance and morale. She says the initiative can be implemented at other institutions.
“When you get going and you see the positive changes that happen, everybody gets more motivated to keep it going,” Heptulla said. “If you monitor the data and are transparent with your staff, then this program is more easily implemented.”