In outpatient settings where patients are coming and going each day, finding ways to make sure scheduling practices not only accommodate the patient but also maintain the overall flow of a facility can be a struggle.
Outpatient treatment center administrators often are tasked with the challenge of predicting when slots will be available, how to adjust when a patient no-shows or unexpected staff absences occur, and how to improve operations so that flexibility is seamlessly woven into a facility’s culture.
“The bigger the scope and the higher the volume, you’d think it would be easier to manage, but sometimes it’s a little bit more difficult. And it just takes a lot of communication,” says Terri Hayden, executive director of the outpatient facilities for the Hazelden Betty Ford Foundation in Minnesota.
While most facilities have made appointment reminder calls or texts a regular part of their practice, treatment center administrators say there is often more to great scheduling than simply sending patients their reminders. Here are some of the best tips and practices they’ve learned along the way that keep their facility running smoothly—even in the face of unexpected or urgent needs.
1. Use an electronic system for scheduling
Electronic systems integrated throughout the mental health or addiction facility can be a helpful resource to track and predict openings at a given facility. For instance, the Hazelden Betty Ford Foundation uses a pre-entry system nationwide that allows schedulers to see when the next available chair will open up.
“That’s really helpful to be able to have an electronic system that lists the site, and then each of the groups that are running and then when their next available chair is,” Hayden says.
The center was anticipating implementing a new electronic system this summer that will even allow counselors to use the platform and check off specific chairs within groups as open or closed depending on the progress they are seeing from patients.
Maintaining a balance at outpatient facilities where resources aren’t over- or underutilized is a challenge for many organizations. Some scheduling teams have found that overbooking appointments is one way to try to balance patient flow.
“We typically overbook by at least one or two people because the reality is that somebody might not show up for their intake appointment, things might change for them or they get scared,” Hayden says.
Barbara Wahl, RN, MA, business operations director for Concerted Care Group Baltimore, says they typically overbook by two patients. The key, providers say, is not to overbook by so many that the facility wouldn’t have the resources or be able to maintain best practices in the event that all patients show up for their intake appointments.
“If everybody shows, that makes for a very busy week or a very busy couple of weeks,” Hayden says. “But there are always weeks where we have an atypical discharge and somebody leaves when they didn’t plan to leave, so that helps keep that balance going.”
But not all facilities agree that overbooking is the way to go. Cecily Crawl, senior director of outpatient services at Caron Treatment Centers, says their center has purposely chosen not to overbook appointments.
“One of the reasons we don’t is because, for example, if all of the patients did show then that means that someone is going to be put to the bottom, and we want to make sure that every patient is treated in a customer-service-friendly atmosphere,” Crawl says.
3. Communicate often
While openings initially may be calculated based on best-case scenarios, the human element of treatment can alter how quickly or slowly a patient progresses through a given program. For that reason, providers say having frequent communication is key to maintaining patient flow within a facility.
Hazelden Betty Ford Foundation in Minnesota holds weekly census meetings that include Hayden and the supervisor of the outpatient programs at all three Minnesota locations, in which they discuss what the census looked like for each group, how attendance was and whether they anticipate anything atypical that would need to be accounted for when scheduling.
“Then we send out an email census to our schedulers to tell them all the openings in each group, and then they just pick from those openings,” Hayden says.
At Caron, Crawl says she evaluates the schedule every day throughout the day to account for patients who want to cancel, reschedule or aren’t planning to show up for their appointment that day.
4. Train all clinicians to do initial evaluations
When patients call Caron Treatment Centers for help, the center strives to get patients into the facility as soon as possible. For that reason, they typically only schedule initial patient visits five to seven days out and have a preset number of days and appointment slots available when scheduling. The center has also trained the staff so that all clinicians are able to do initial patient evaluations.
“That way you look at the first available time slot and that gives you more of a variety of choices versus trying to lock yourself into a specific clinician,” Crawl says.
5. Create a pool of on-call staff
Clinicians and group leaders aren’t immune from illnesses or unexpected absences, and staffing for that inevitability is one way behavioral healthcare providers can prevent unexpected absences from causing big scheduling headaches and breakdowns in patient care. Hazelden Betty Ford avoids the typical problems caused by expected or unexpected staff absences by having a special group of on-call staff at each of the foundation’s locations.
“The on-call team members are trained to work in any of those groups, and they also work in day treatment and residential programs so they are cross-trained.” Hayden says. “They can come and fill in at any time.”
Caron Treatment Centers also has a specific counselor designated to fill the on-call role at its facility.
“That person will fill in for a sick clinician as well as scheduled vacation times,” Crawl says.
6. Integrate services
Making sure patients arrive for their appointments not only helps them reach their clinical goals but also aids in smooth scheduling as well.
Wahl says she believes one aspect that helps maintain high attendance rates at Concerted Care Group Baltimore is the high level of integration of patient services that has been incorporated on the campus. As part of the center’s model, addiction treatment, behavioral health, primary care and other services are all located in the same area.
“As much as you can put that together into one campus setting, you increase compliance, and you increase the ease for the patient in being able to make all their appointments,” she says.
7. Coordinate group start times
Scheduling all group sessions to begin at the same time every morning, afternoon or evening, also aids in flexibility when unexpected scheduling problems arise.
For instance, at the Hazelden Betty Ford St. Paul location, there are six treatment groups that meet from 10:30 a.m. to 12:30 p.m. If there is an unexpected staff absence, it’s possible to combine two groups for the day, and patients still receive services.
8. Build in incentive management
Some outpatient facilities have also adopted contingency strategies to ensure that each facility is helping as many patients as possible while also making the best use of facility resources.
At the Hazelden Betty Ford, if patient absences become a particular struggle for a given group, contingency management strategies help to ensure that group members arrive on time. For example, give everyone in attendance an opportunity to put their names in a drawing for a small gift certificate to a coffee shop or a group pizza party if attendance is consistently high. It seems simple, but it works, Hayden says.
9. Monitor wait times
Centers often try to remove obstacles for patients seeking treatment, which can also improve patient attendance rates and reduce no-shows. But part of the task is to make sure patients who arrive for treatment aren’t kept waiting excessively prior to appointments, lest they give up on their treatment because of time constraints or lack of engagement.
Concerted Care Group staff are tasked with interacting with patients arriving in the waiting area to make sure no one is left without attention for too long. These staff members can also promote other services the center offers.
Jill Sederstrom is a freelance writer based in Kansas City.