Use Just-in-Time Processing

Improving Primary Care Access

A typical approach to completing multiple daily tasks is to put some aside and process them later in a batch. An unintended consequence of batching is to increase the number of times patients contact our offices to repeat their request or to find out if the work has been done. Reducing turnaround time reduces the number of phone calls, thereby reducing the net amount of work for the office staff.

The time it takes to make a referral, conduct a patient visit, or phone in a prescription refill is the same if we do it now, in ten minutes, or five days from now. Performing tasks in continuous flow (or just-in-time processing) requires rapidly switching from one task to another. Just-in-time processing initially appears to take more work, but in fact results in less work. This is not an easy transition for all individuals and will require pilot testing. 
Performing all tasks immediately is not possible or appropriate as it would require constantly interrupting the flow of work. Practices must test the best balance between immediately addressing tasks versus interruption.
The following are some practical examples of just-in-time processing:
  • Attempt to do today’s work today, whether the work is scheduling appointments, answering messages, processing refills, or completing forms. A system that does today's work today takes care of each day’s demand on the day it is generated. This ensures that the future is protected for tomorrow’s work. Doing today’s work today can reduce no-show appointments, rework, and repeat phone calls and messages.
  • Document the encounter during or immediately after the interaction. Allowing time in the provider’s schedule to document the patient encounter during the normal flow of the clinic prevents the backlog of documentation at the end of the provider’s day. Such a process increases efficiency since the provider can more quickly recall the details of the visit at the time of the encounter rather than several hours later. Such a system requires adjustments in scheduling such as adding a few minutes to each appointment length so that documentation can be done either during or in between visits (see below) or by scheduling "pauses" (5 or 10 minute blocks of open time) during the course of the day that can be used for documentation or other non-visit related activities by the provider.
  • Attend to refills or messages between patient appointments. Scheduling a few minutes between patient appointments or extending the scheduled time for an appointment for a few minutes enables the provider to answer phone or email messages, respond to questions from other members of the care team, or write or re-new prescriptions. This process reduces the need for interruptions during the patient visit or for batching such activities until the end of the day (see Use Continuous Flow to Avoid Batching).
  • Do an interruption analysis. Interruptions during a patient interaction with a provider can unnecessarily extend the visit and can potentially damage the quality of the interaction. A quick interruption analysis can help a practice pinpoint the causes of the interruptions (e.g., looking for equipment or supplies, answering phone calls, responding to a care team member’s question, etc.) so that they can be minimized or eliminated. One simple method is for a provider to keep a list of all the interruptions that occur over the course of a morning or afternoon on one particular day.

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