When more patients are punctual, clinics are less likely to run over
their allotted time for appointments, researchers found, based on a
real-world test and simulations.
“All it takes is one patient to come late, and then everybody else
is pushed later, regardless of their ability to be there on time,”
said Dr. Kayode Williams, the lead author of the study from Johns
Hopkins School of Medicine in Baltimore.
The study involved all 1,500 patient visits to a suburban Baltimore
outpatient pain clinic with a physician and a physician’s assistant
that took place between February 2008 and January 2009. Clinics were
held two days per week for four hours each and 86 patients were seen
per month, on average.
Williams and his team tracked when each patient arrived and was
registered in relation to when his or her appointment was scheduled,
as well as how long patients waited before being seen by the
Starting in June 2008, patients who arrived late to an appointment
were asked to reschedule, and changes in patient punctuality were
measured one, six and 12 months after this new policy was
After the effort to cut down on lateness, the proportion of patients
who arrived earlier than their scheduled appointment time increased
from about 90 percent initially to more than 95 percent one year
Patients had twice the odds of being at least 15 minutes early to an
appointment under the new policy compared to before it was
implemented. And while 7.7 percent of patients arrived at least one
minute late initially, by the end of the study only about 1.5
percent were coming late.
Over the course of the study, the likelihood that the healthcare
team would complete the scheduled clinic in its four-hour time slot
rose from 38 percent to 51 percent, according to findings published
in the journal BMJ Open.
Based on a simulation using the clinic data, average waiting time
per patient increased by about one minute during the study period,
taking into account earlier arrivals.
When the team first implemented the policy to reschedule patients
who arrived late, there was concern that they “would get flak from
patients unhappy about being rescheduled,” Williams said.
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But when he explained to latecomers that without rescheduling, other
people would have to wait, “All were gracious enough to say they
would be rescheduled,” rather than make the other patients wait,
And after a while, people simply tended to be more punctual.
“Once patients found that the other people were running on time,
they started to be on time,” said Williams.
The researchers note that the impact of their intervention was
limited by the already high proportion of patients who were arriving
early at the beginning of the study. Clinics that start out with
more tardiness could see a greater effect, they write.
The study provides hope that parts of the healthcare system can run
“The fundamental problem is that both sides have expectations that
things will be bad; it’s a self-fulfilling prophecy. But if both
sides believe it can be better, it can,” said Chester Chambers from
The Johns Hopkins Carey Business School in Baltimore, who also
worked on the study.
“Making these systems efficient requires a collaborative effort
between providers, patients and people outside the hospital, whether
they are engineers or business school faculty,” Chambers told
And in an overburdened healthcare system, efficient use of time is
“Using time effectively is crucial and is one of our most important
assets,” said Williams. “We think this will be one of the ways we
can add value to the system.”
SOURCE: bit.ly/1kzVVz7 BMJ Open, online May 15, 2014.
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