One important area for GP practices is the appointment booking process. The appointment booking process is the gateway into the practice for almost all patients. A good booking process is, therefore, essential to ensure that resources are properly allocated and efficiently managed. A poor appointment booking process puts patients in with clinicians that cannot deal with their problem (resulting in dissatisfaction and the need to consume another appointment); it lumbers patients with appointment slots they do not like (leading to a higher incidence of DNA); it leads to excessive pressure on clinicians from a poorly organised schedule; and it results in waste and rework.
Any practice looking to improve what it does might be well advised to look at its appointment booking process first. The question is, how to do that; and where to start? Here are a few pointers:
1) Gather data around the efficiency of your booking appointments.
a. For one or two weeks ask clinicians to fill in a simple tick sheet – “was this appointment appropriate for me?”; “could it have been dealt with by another professional – nurse/ health care assistant/pharmacist/ other specialist?”
b. Ask your receptionists to fill in a tick sheet too, to record appointments that have to be rebooked because a patient has been given a slot with someone who cannot help them
c. Record DNAs (did not attend) with the patient details and the type of appointment booked
2) This data will give a picture of the number of appointments “lost” due to errors, mis-bookings and poor attendance. In many cases it will be larger than you think!
3) Review the “script” that your staff use to book appointments with patients. Is there even a script? A small number of questions will help direct patients towards the most appropriate appointment. For example, one surgery developed a simple laminated card that showed the type of appointments suitable for each type of clinician (nurse, HCA, GP, pharmacist, GP telephone consultation etc). Rather that say their problem out load, the patient could point at the box that best described what they needed. That allowed the correct appointment slot to be booked.
4) Review the type of appointments that are most frequently DNAed. In one practice, early morning appointments were frequently not attended. In another practice, appointments involving young children were an issue. Consider what can be done to help those patients and reduce DNAs. Make it easy to cancel appointments. People will not wait in a phone-queue for 10 minutes to cancel their appointment. Send text reminders the evening before where they can reply “CANCEL” if they no longer need the appointment. Have a dedicated cancellation line or email address. Allow cancellations through the practice website.
5) Bring a small team together to discuss the elements that need to be in place for an efficient appointment booking process. One practice came up with the three Rs – Right Process, Right Slot, Right Patient.
a. The Right Process was about having a defined booking process and everyone trained in using it. Staff were also trained in handling difficult patient conversations so that they could firmly, but fairly (and calmly), interact with the patient.
b. The Right Slot was about directing appointments to the most appropriate type of appointment with the most appropriate clinician. This lead to the production of the “navigation card” mentioned above so patients could point to the type of appointment they needed without having to discuss it in front of others. It was also about discussing the urgency of the issue so that pre-booked rather than urgent slots could be offered where appropriate. This also involved reviewing the appointment templates used in the booking system so they reflected current needs.
c. The Right Patient was about making sure that the correct patient details were pulled up on the system so that the right notes were available to the clinician. It also involved checking with the patient their contact details (for reminder texts) and, where appropriate, encouraging them to sign up for online appointment booking and prescription requesting etc. This work also involved auditing patient records so that the correct warnings and reminders were available on the front screen when the patient record was pulled up – to assist booking; to warn receptionists about any issues they needed to be aware of; and to allow receptionists to remind patients about anything that was required of them.
6) Develop a procedure and training materials that can be trialled in the “live” situation. Listen to the feedback from the trial and make adjustments as appropriate.
7) Implement the new process, monitoring how it runs. After a couple of months collect the data at step 1 again and (hopefully) discover how much more efficient the new process is and how much less clinical time is being wasted. Where there are still problems, reconvene the team to work through them.
There’s nothing particularly complicated here. The techniques are straightforward and largely common sense. What matters is taking the time to bring people together, listen to their views, and work with them to make things better.
It does work, I promise!