Case Study — Providers Who Frequently Change Their Schedules

Case Study

While running a busy family practice, one provider would approach the administrator at least weekly with the question, “Can you change my schedule for this afternoon? I am leaving early.” It was also common for this provider to request time off within the next few days. These attempts only occurred when the Medical Director was not present leaving the administrator to make the decision. This placed the administrator in a very awkward position wanting to serve the provider while considering patients’ time. Within a month, it became a usual setting. The administrator brought the matter to the medical director’s attention, whose response was not to be concerned about it, saying “It wasn’t that bad.”

Another week went by with several more provider-spurred reschedulings, which the administrator again discussed in a meeting with the medical director. It was explained that it is not only the provider’s schedule we need to consider, but also the patients and staff. The medical director did not see an issue or problem with this if the schedulers were able to reschedule the appointments.

The medical director remained unconcerned about the negative impact this behavior could have. It was hard for the director to recognize how frequently this was occurring, even though it had been explained in detail, so a proposal was made. The administrator requested five dollars ($5) for each patient that needed to be rescheduled for the next 30 days. The medical director agreed.

These are the challenges presented:

• The provider was taking advantage of the medical director’s absence and not respectful of patients needing to reschedule and staff who had extra tasks due to the sudden and frequent cancellations.

• Due to the cancellations, other providers had to adapt their schedules for additional add-ons, which was quickly breeding resentment.

• The provider needs to understand the repercussions of abruptly changing the schedule without consideration of others, which was greatly affecting the patient and staff’s schedules.

• The frequent schedule changes were also bad for the reputation of the practice as a whole, especially when some patients were being rescheduled more than once, which was leading to patients leaving the practice.

The administrator explained in more detail that some patients may need to take the day off or arrange for transportation for a doctor’s appointment and cannot afford to lose that time. Further, it can take an inordinate amount of time to reschedule a patient for the time they prefer when it is so close to the original appointment. Patients do not like being rescheduled. Therefore, it is imperative to honor the time selected for the visit or procedure before considering changing availability.

There is also a loss in productivity of the staff’s time, as rescheduling replaces other duties that also need to be done, often daily.

The medical director established documented standards of provider leave and procedures to request leave within a certain period prior to the actual time off requested. Unless in the event of an emergency, provider time off cannot be granted by anyone other than the medical director.

The provider and medical director had a meeting to discuss the importance of maintaining a professional presence, including the matter of respecting both the patient’s and staff’s time.

Results and what was learned:

• The administrator accepted a check for $450 at the end of the month for almost 100 re-scheduled patients. She then purchased generous gift baskets for the staff to say, “thank you.”

• Other staff members often must make up for the shortfall of services by other employees when they are pulled back from their expected duties.

• The practice must set standards and follow them other than in urgent situations.

• Providers learned to listen to staff’s input regarding care that has the potential to grow into a larger problem when unaddressed.

Excerpted from The Emotionally Intelligent Physician Leader by Susan Fink Childs, FACMPE