Where other doctors might display medical school diplomas or accolades from professional organizations, pediatrician Joseph C. Barber of Pittsburgh, Pa., hangs a different sort of credential in his office: swim goggles.
Barber is training for a triathlon, but the goggles also serve as an apt symbol of what sets this practice apart from most.
With tireless determination, Barber and his office staff worked several months of 12-hour days last year so the practice could be among the first to adopt a new way of seeing patients called "open-access scheduling."
A new doctor's office scheduling system might not sound sexy, but it takes on a little more glamour considering overbooked schedules are a major source of patient complaints.
Health plans are graded on how easily patients can see their doctors, and they have tried to spur change by sharing these grades with physicians. But the current interest in reducing wait times is driven not so much by health plans as by a recognition among physicians that unhappy patients will go elsewhere for care.
To a growing number of physicians around the country, open access scheduling is the solution. The promise to patients is tantalizing: Call for any sort of appointment — urgent care, an annual physical, your child's school shots — and get seen by your doctor today.
Barber says his office is proof that it can work. What it takes is a leap of faith and a tireless effort to whittle down the backlog of scheduled appointments. Once that's reduced, most appointment slots are open at the start of each day and yet, somehow, are filled by day's end.
"We did it to respond to the needs and concerns of our families, that they wanted to have faster access to medical care," Barber said. "With open access, you lose control and render control back to the patients."
The central idea is that any patient seeking care should be seen today, said Dr. Mark Murray, a consultant who developed open-access scheduling principles while practicing primary care in California. Those principles are being trumpeted by the Boston-based Institute for Health Care Improvement, a nonprofit group that is boosting quality improvement efforts like those championed earlier this year by the federal Institute of Medicine.
Most doctor offices agree to see patients with acute problems today and schedule physicals, immunizations and care for chronic problems later, much like the triage system emergency rooms use to decide which patients take priority.
But often, patients are asked to wait simply because the day's appointments are full, Murray said. For years, doctors with busy schedules have deliberately left open blocks of time so they can provide urgent care.
But that practice has meant patients with non-urgent needs end up waiting even longer.
The notion of serving some customers today, while asking most others to wait, doesn't fly in many other industries, Murray said.
And the first step in shedding that practice is getting rid of the backlog of appointments.
In Barber's practice, for example, patients were told that as of May 2000, they would no longer need advance appointments to receive care.
Instead, they could simply call in and Barber would find a way to treat them within 48 hours.
So, on Monday, May 8, Barber treated six patients who had been given advance appointments under the old system and another 44 who called up that day for care. The next day he treated 28 patients with advance appointments and another 12 who sought open access.
"I approached this as I would a triathlon," Barber said. "They were long days."
Because patients were told they could get prompt attention for whatever sort of care they sought, most stopped making advance appointments. After the first few months, a new pattern developed — Barber treats about 30 patients a day, 10 to 15 percent of whom have advance appointments. Most call within 48 hours of the day they are seen.
The new system required Barber to change behavior — if he notices a patient is due for a checkup or immunization that the patient hasn't arranged, he provides the care immediately rather than schedule a follow-up appointment.
Patients also act differently. Mothers with 15-month-old babies, for example, no longer call long in advance to schedule their baby's 18-month check-up. Instead, they simply respond to a reminder sent by the office and call in for prompt service at 18 months.
In both cases, office staff and patients are spared much of the work that comes with making and rescheduling appointments. That, in turn, eliminates the juggling created by the old system when offices tried to balance overbooked patients with no-shows.
To measure the impact of open access on "cycle time" — the time between when a patient signs in and when she leaves — the practice attached stopwatches to each medical chart clipboard.
It turned out the average cycle time was 26 minutes — the lowest of any primary care group at the St. Vincent Health System.
The biggest impact of open access wasn't a reduction in cycle times, which were already low, or an increase in satisfaction scores, which were already high. Instead, open access gave patients better access to their own doctors and that, in turn, improved their perception of wait times, said Mary Beth Pinto, a business professor at Penn State Erie who worked with the practice.
"When people saw their own doctor, their actual face time was about 7.47 minutes, as opposed to 9.51 minutes when they were with another doctor," said Pinto. "But the perceived satisfaction with the face time and satisfaction with the amount of time they waited was greater when they saw their own doctor."
There are benefits to the doctor as well. If there's a sudden need for time off, for example, there isn't a whole roster of patients who have to be rescheduled. And Barber says that, overall, open access is much less stressful.
Dist. by Scripps Howard News Service.