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Dome - An End to the Waiting Game

Dome April 2010

An End to the Waiting Game

Date: April 1, 2010

How an outpatient clinical service removed obstacles that prevent patients from getting timely appointments.


Otea Stafford-Murray, Carol Legarde and Manisha Patel
Since Dermatology improved its access to doctors, front desk supervisor Otea Stafford-Murray (left), department administrator Caroline Legarde and medical director Manisha Patel have seen happier patients.

As front-desk supervisor of the Johns Hopkins Outpatient Center’s dermatology clinic, Otea Stafford-Murray remembers the time—not too long ago—when some nerve-wracked patients would call every day, hoping that an appointment had opened up.

And when office staff couldn’t squeeze them into the schedule, the callers sometimes vented their frustrations to her.

“They couldn’t understand why we didn’t have appointments,” she says.
Such complaints, however, are rare today. An overhaul of the clinic’s scheduling practices, plus the recruitment of several new faculty members, has helped reduce the wait for first-time patients from 40 days last July to 14 days in December.

The transformation has been such a success that a new subcommittee of Johns Hopkins Medicine leaders, headed by Vice President for Ambulatory Care Mark Bittle, is reviewing ways to duplicate it throughout the Hopkins system.

In many ways, the barriers to timely dermatology appointments weren’t different from those in many Hopkins clinics. For example, there was no single telephone number for scheduling appointments, making it difficult for physicians to refer patients to Hopkins dermatologists.

“Every physician had their own administrative assistant who handled their personal schedule,” says Michelle Campbell, practice and operations improvement manager for the Clinical Practice Association, who facilitated the dermatology project.

In addition, physicians had complex scheduling templates that often forced first-time appointments to be arranged weeks out, when in fact there were open slots within a few days that were reserved for returning or specialty patients.

The lag time didn’t sit well with Dermatology Administrator Caroline LeGarde, who worried about patients waiting several weeks to have a possible melanoma examined.

“This was a patient safety issue as well as an access issue,” she says.

Department Director Sewon Kang saw the need for improvement in September 2008 when he arrived at Hopkins from the University of Michigan. He wanted to overhaul the department so that patients have a good experience “from the moment they pick up the phone to the time they finish their appointment and schedule a return visit.”

With Kang’s support, Dermatology assembled a team in February 2009 that included the clinic’s medical director and the front-desk staff, along with LeGarde, Campbell and Stafford-Murray.

Among the major changes, they created one phone number (410-955-5933) for all incoming calls. Now, appointment requests are directed to a dermatology patient service coordinator; if this person is unavailable, the call rolls over to Access Services, the department that schedules appointments, registers patients and ensures financial coverage for medical services for some Hopkins clinics. The dermatology clinic also designated one or two nurses a day to triage urgent and same-day appointments.

Also, rather than having providers set their own schedules—which resulted in uneven staffing—each department clinic day was divided into two four-hour block sessions, with no more than four providers scheduled per block.

And schedulers were empowered to make appointments for new patients within a short timeframe. For instance, in the resident clinic, appointment slots were made flexible to accommodate new or return patients—not just one or the other.

Now, if a patient has an acute problem, “there’s a good chance there’s an opening and we can get you in,” says Medical Director Manisha Patel.

The changes have helped boost patient traffic. From July to December, volumes in the resident clinic and faculty practice were 22 percent and 15 percent higher, respectively, than during the same months in 2008.   

Bittle’s subcommittee by July 1 plans to define a uniform model of patient access for all outpatient practices to follow. It will target such measures as wait time to first appointment and will adopt such tools as those used in Dermatology.

Streamlining access to care, notes Bittle, has been “studied and studied and confirmed and corroborated many times. We know what works. We just need to do it.”

Joan Jacobson
Jamie Manfuso contributed to this article

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