Backlog consists of appointments on the future schedule that have been put off due to lack of space on the schedule to do this work sooner; working down the backlog recalibrates the system to improve access. This backlog of appointments clogs clinic schedules, taking up slots that could be used for patients requesting appointments with their providers. The traditional office practice scheduling philosophy has been to push out appointments into the future to protect today's schedule, creating backlog. Improved access calls for pulling today’s requests into today in order to protect the future, eliminating backlog. A practice cannot successfully improve access without working down the backlog and recalibrating their system of access to care.

It is sometimes useful to think of backlog as a reservoir of unmet demand. Water flows into the reservoir (patient demand), and water goes out of the reservoir (supply/services provided). If water comes in at the same rate as it goes out, then the level of water in the reservoir remains constant. If somehow the reservoir could be drained, then the water would flow smoothly with no need for a reservoir. Working down the backlog is like draining the clinic's reservoir of built-up demand. Once the reservoir of appointments has been reduced, there will be no delay in access as long as demand and supply are in balance.

Not all appointments on the future schedule are considered backlog:

• Provider discretionary return appointments for more acute problems
• Appointments made by patient choice (patient calls in today, but wants an appointment in the future)
• Provider generated interval follow-ups for planned care to manage chronic conditions and patients, for preventive tests such as yearly physicals, and for age-specific appointments

Backlog consists of appointments that are deflected into the future for patients who could have been seen today, or requested to be seen today. Backlog is work the practice pushes into the future from today or the past. In order to be successful in improving access, clinics need to reduce and eliminate backlog. To reduce and eliminate backlog, first measure it, and then create and use a deliberate backlog reduction plan.  

Related Tools
Backlog Reduction Worksheet