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Improve patient flow by using communication, flexibility, consistency


All of us have experienced it: a day where the doctor just can’t seem to run on time, the waiting room is full, and everyone is unhappy at having to wait. Few things are more frustrating for any optometric practice. Fortunately, with a little planning and a lot of patience, these days can be greatly reduced and your patients’ experience enhanced.

Three things are required to improve patient flow and keep the practice on schedule: communication, flexibility, and consistency.

Communication begins when the patient makes the appointment. Your scheduler needs to clearly establish why the patient wants an appointment in order to allow the proper time. A patient might say, “I’m coming because I want the doc to check my glasses,” when he or she really means, “I think my glasses need an adjustment.” On the other hand, that statement could just as easily mean “I haven’t had an eye examination in 5 years, and I am really not seeing well.” A good EHR (electronic health records) system could help you here. Your EHR would allow you to quickly look up a patient’s record to verify the most recent visit; that would tell you if a comprehensive eye examination is warranted. If the patient is new to your office, ask about his or her most recent eye examination and where it was done. I ’ve had patients tell me “Oh, I had an eye exam last week,” only to uncover that the “examination” was really just a screening at the DMV. 

If your scheduler knows exactly why patients are coming , then the scheduler can more easily advise the patients how long they should plan to be at your office so the patients can plan accordingly. Let the patient know ahead of time if the exam will require dilation; this avoids long conversations about it on the day of the appointment and may prevent the patient from rescheduling the dilation because of post-appointment plans. If the patient is interested in contact lenses, but has never worn them before, he or she will need to allow time to learn application and removal; if it’s late in the day or if you are short-staffed, the patient may need a second visit for this. Knowing these things ahead of time can greatly reduce frustration for all concerned.

Planning ahead

The scheduler can also greatly assist patient flow by getting as much information as possible about vision plans or medical insurance prior to the appointment. Have a list handy of plans or procedures that may require pre-authorization so that it can be taken care of prior to the scheduled visit, thereby shortening wait times. Many practices e-mail required paperwork to patients in advance to be filled out ahead of time. Planning ahead is also very useful if you can note any special circumstances, such as language or mobility difficulties, right on the schedule. Many practices have one room that is wheelchair friendly, so such notes can insure that the proper room is available at the right time. Also, if you have a technician or optician who speaks a second language, you can be sure that person will be available when a particular patient needs assistance.

Good communication between the doctor and staff is also important. If I have a meeting or special event, I inform my staff ahead of time. That way they know it is important to me to finish on time and will schedule accordingly. Talk with the doctor and be sure you understand how much time to allow for specific types of appointments. If a patient calls and says he or she might be a little late, take a moment to ask the doctor’s advice on possibly rescheduling. Try to show the doctor the schedule at the beginning of the day. Often, the doctor will recognize patient names as folks who might take a little longer to examine or require a little extra care. After you have been with the practice for a while, you might also recognize those names and schedule accordingly. If you are in a group practice, remember that every doctor is different. In that situation, you might need to vary the schedule based on the doctors’ individual needs. This can be especially true if you have doctors who specialize in different clinical areas. A low-vision practitioner will have far different scheduling needs than someone who sees mostly young and healthy patients for routine vision care.

Flexibility keeps the pace brisk

Everyone involved in the practice needs to have the authority to change things up once as needed. For example, it’s 9:35 and your 9:30 appointment hasn’t shown, but the 10 o’clock patient just finished her paperwork. The technicians should feel free to get her started with pretesting. The 9:30 might not even show, but if the patient does eventually make it, he can expect a little longer wait in return for being tardy. Your tech can always tell the 10 o’clock patient that she might have to wait a little while after the pretesting to see the doctor. This creates a perfect opportunity for your tech to suggest the patient browse your optical during the wait. Always have at least one optician in the optical area to help unexpectedly early patients. Patients appreciate the chance to look at frames before being dilated or poked, plus it diverts the patients’ attention from having to wait.

It is advantageous if you can have several waiting areas within your office space. That way, the tech can do pre-testing as patients are checked in, then direct them to wait for the doctor in a different area. Patients will then feel the appointment is in progress, and the perception of time waited may be less. Of course, always have interesting reading material or patient education videos in all the waiting areas. These secondary waiting areas can also be a useful place for patients to wait while they are dilating.

Flexibility is also the key to setting your schedule for the day. Most practices have set times for examinations and briefer time slots in between for quicker checks such as emergencies and contact lens follow-ups. However, your scheduler should be empowered to change these around a bit without necessarily adding appointments as warranted. If, for example, you have a family of three coming in together, and there is an open quick check slot between the exam appointment times, move the examinations together and the quick check to the end of that combined time slot. It is often much easier for the doctor to see all the family members together, because health histories and the like can be discussed at the same time. Nothing will disrupt patient flower faster than having the doctor interrupt several family members’ examinations by running to another room-or worse yet requesting the room be vacated-to see a contact lens check who was scheduled in between and doesn’t have time on a busy workday to wait until the entire family is seen. Avoid that scenario by moving the quick check spot to later.

Consistency enforces perimeters

As important as it is for all staff involved with the patient to be flexible with timing and scheduling concerns, consistency is just as crucial to maintaining proper patient flow. Staff will feel more comfortable in being proactive and flexible by knowing there are consistent rules to guide them. This goes back to communication.

Ask your doctor to set guidelines for changing and rearranging appointments, and then stick to them. If the doctor will insist on rescheduling if a patient is late, know the drop dead time beyond which the patient cannot show up and be seen. In other words, if the doctor won’t see patients who are more than 15 minutes late, the rule isn’t 15 minutes for some people and 20 for others. Of course, this shouldn’t apply to true emergencies. If the doctor knows that she can count on staff to enforce her rules, she will be more comfortable with giving staff the authority to be flexible within those boundaries. Keep in mind that to make the process work effectively, the doctor needs to be consistent in her own instructions.

All of your patients deserve the same consideration. Make sure that there aren’t different sets of rules for different patients or staff. If everyone communicates this properly, your office will run smoothly and everyone will be happier.


Optimal patient flow requires:

  • Communication

  • Flexibility

  • Consistency


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