Improving Primary Care Access

Synchronization entails organizing multiple processes so that they intersect at a specific agreed upon point in time. To eliminate delays and smooth the flow for both providers and patients during an office visit, the patient should be in the exam room ready for the provider at the same time that the provider is ready to see the patient, along with the patient record (including test results, preventive care screens, etc.). The following are some specific ideas on how to better synchronize the appointment processes.

• Be sure to start every appointment on time. Agree on what a specific clinic appointment time means. If the registration desk doesn’t open until 8:00 AM, there is no way the patient can be placed in a room, have his or her history taken, and be ready to see the physician at 8:00 AM. If all agree that an "8:00 AM appointment" means "physician sees the patient at 8:00 AM," then tasks can be synchronized around that point and waiting times can be reduced. While the concept is simple, the implementation is difficult. It means that the patient must be registered, roomed, and prepped by the point of synchronization (8:00 AM) so the provider can enter the room on time and have all the necessary information to begin the encounter. Some clinics successfully use the strategy of communicating two times to the patient: Arrival time for the important registration and rooming process, and appointment time for the actual encounter with the provider.

• Ensure that all needed information, equipment, and supplies are available for visit. Use a "chart check" as an inspection step prior to the synchronization point (physician entering exam room) to reduce the chances that physicians (a scarce resource) and patients (the key customer) will have to wait for necessary information (e.g., lab results or diagnostic tests, etc.) at the time of the visit.
   

• Use rooming criteria to ensure the patient is prepared for the provider. Rooming criteria check sheets help ensure that the patient is ready for the physician. Check sheets typically include such items as "shoes off" for a diabetes patient. This not only helps fully prepare the patient for the visit, but also aids float or cross-trained personnel when they come in to assist, assuring a standardized preparation for each visit.