This means that scheduled appointment times should match the actual time that the patient is seen by the care team. Gaps between scheduled visit time and actual visit time drive significant patient dissatisfaction, are related to patients not showing up for scheduled visits, and lead to office staff time spent in explanation or apology. Measure from the start of one appointment to the start of the next appointment for 50 or 100 consecutive appointments to find out how long it takes each clinician to do their work. Create a schedule template that matches the reality of the clinician’s pace. This allows the office to work in a continuous flow mode.

Doing work as it occurs during the course of an office visit (e.g., doing documentation at the end of each visit) reduces the bottlenecks created by holding similar types of work to be done at a future time (batching). For example, some practices save all telephone calls, documentation, refills, etc., for the end of the day or session. This is referred to as batching. With continuous flow, all work is accomplished as it presents itself and completed in one continuous action. Appointment times may need to be lengthened, or pauses placed in the schedule, to accommodate continuous flow and reflect a certain truth in scheduling. Continuous flow does not mean that time is added to the day, but that it is reallocated throughout the day.