Open-Access Scheduling System 1

Running Head: Open-Access Scheduling System

Open-Access Scheduling System – Best Practices in US

(Literature Review)

M. Sabeva, MHSM Student

W.P. Carey Graduate School of Business

Arizona State University

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Open-access is an approach that is patient-centered and allows patients to be seen the same

day. The majority of appointments are left open and unscheduled until the day the patient

requests a same-day appointment.

The open-access scheduling system idea was introduced and promoted in 1999 through the

Idealized Design of Clinical Office Practice (IDCOP), a program run by the Institute for

Healthcare Improvement and the Department of Family and Community Medicine. The

Institute of Medicine (IOM) report, “Crossing the Quality Chasm: A New Health System for the

21st Century”, cites open-access scheduling system as one of the advanced tools for improving

patient-centered care and improving efficiency.

The approach gained such popularity that according to a survey of the American Academy of

Family Physicians (AAFP) 62% of the survey respondent do offer open-access (same-day)

scheduling.

The study of Forjuoh SN, Averitt WM, Cauthen DB, et al., 2001 has shown that the major cause

for patient dissatisfaction is the reduced access to a physician. Other studies (Murray M and

Berwick DM., 2003) have made similar findings that patients cannot get care when they request

it – 27% of surveyed adults under 65 were not able to get access to a physician on time and

from 1997 to 2001 the percentage of people who were not able to get timely appointment

increased from 23 percent to 33 percent.

A comparison approach of the existing traditional scheduling model, the “carve-out” model

(modified traditional model, which would “carve-out” urgent care slots for its doctors) and the

open-access model (called also advanced access model) is taken from Murray M and C Tantau.

(2000). Murray and Tantau (2000) emphasize that today’s work should be finished today and

that patients should receive an appointment the same day they call. This form of open-access

model is more of a relaxed model since will leave about 50% of the physician’s time open and

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the rest booked with necessary follow-up visits and visits from patients who prefer to come

next day. It is noteworthy that the open-access model will not differentiate between urgent and

routine appointment, which results in more flexibility of the routine visits to be scheduled for a

later date.

Murray and Tantau (2000) offer a stepwise plan how to implement the open-access scheduling

system:

1. Major requirement for successful implementation is to measure the supply and demand

as accurate as possible.

2. The team of physicians, nurses should be on board for the implementation and willing

to try this new approach.

3. The backlog of appointment should be reduced prior to switching to open-access

system, which may take 1 to two months.

4. Standardize appointments to last roughly the same time.

5. Have a contingency plan in place for unexpected demand surges – who can supplement

or substitute a physician.

6. After open-access implementation the practice should assess its effectiveness of

scheduling appointments on a daily basis.

While open-access sounds promising and exhibits advantages over the traditional scheduling

model it has it challenges and limitations. Murray and Berwick (2003) have shown that one of

the successful open-access implementation could be the staff itself, because they are skeptical

about matching demand with supply with the same resources. Physicians and staff have had

only experience with one scheduling system and the new open-access model seemed

unintuitive to them. Another challenge could be the appointment backlog and the time it is

eliminated before open-access system implementation. The larger the organization the more

challenging task became to eliminate the appointment backlog. The open-access is not a

panacea for every family practice, no matter whether it is training residents, is in traditional

hospital environment or is private. If the demand outstrips the supply no scheduling method

will work properly.

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Although it has its challenges the open-access model has been implemented in a number of

hospitals and clinics in US and Canada. Murray and Tantau (1998) mentioned several examples

of successful open-access scheduling implementation in their study. Lowering the wait time for

routine appointments was reported from Kaiser Permanente in Roseville, Northern California

(55 days to one day), The Mayo Clinic’s Primary Care Pediatric (from 45 days to approximately

two days) and the Alaska Native Medical Center (from 30 days to one day). Increased ability to

see her/his own physician or continuity of care was observed in Kaiser Permanente in Roseville,

Northern California (change from 47 to 80 percent) and the Alaska Native Medical Center

(increase from 28 to 78 percent). Fairview Red Wing Clinic, Red Wing, Minnesota was able to

reduce also the cycle time to see patients from 75 to 40 minutes.

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References

1. Forjuoh SN, Averitt WM, Cauthen DB, et al. Open-access appointment scheduling in

family practice: comparison of a demand prediction grid with actual appointments. J Am

Board Fam Pract 2001;14(4): 259-65.

2. Murray M and Berwick DM. Advanced access: reducing waiting and delays in primary

care. JAMA 2003;289(8): 1035-40

3. Murray M and C Tantau. Same-day appointments: exploding the access paradigm. Fam

Pract Manag 2000; 7(8): 45-50.

4. Murray M, Bodenheimer T, Rittenhouse D, et al. Improving timely access to primary

care: case studies of the advanced access model. JAMA 2003; 289(8): 1042-6.

5. Murray M and Tantau C. Must patients wait? Jt Comm J Qual Improv 1998;24(8): 423-5.