Same-Day Specialty Appointments: 3 Lessons from One Hospital System

In early 2017, Allegheny Health Network (AHN) in Pittsburgh began offering same-day appointments across the entirety of our system, in virtually every specialty as well as primary care. It was a big promise to our patients-call in the a.m., be seen in the p.m.-and it was something that had been tried at just a handful of multi-hospital networks across the country.

When we committed to offering same-day appointments (SDA), that commitment was both exciting and daunting. We knew there would be operational hurdles and scheduling challenges, centrally and at the practice level.

But we also knew it was the right thing to do for our patients. We would be there when they needed us, at their convenience.  

One year later, the program is, in our eyes, a success, creating healthcare access entry-points that didn’t exist before. In 2017, AHN provided more than 150,000 same-day appointments across more than 20 specialties. Patient satisfaction is high (92% for those who have gone through the scheduling process) and a growing number of our SDA patients are new-patient appointments (almost four in 10 same-day specialty appointments are new-to-practice).

Naturally, we learned a few things along the way. Here are just a few:

1) Don’t let perfection be the enemy of good, and commit to constant evolution. 

The needs of our customers are constantly changing. Some of that’s due to regional market forces, and some of it’s due to the natural seasonality of this business.

So we knew there couldn’t be a cookie-cutter approach for specialties, practices, or clinicians. Our team developed algorithms based on both historical data and feedback from our physician and administrative leaders. This allowed us to predict and program our needs by specialty and by month. Theories were tested, problems solved-and even if we had it right, we learned adjustments would still be needed in a few months. 

And sometimes, we didn’t get it right. As we maneuvered through our soft launch, we experienced needs for inventory adjustments in both directions. In some cases, our same-day inventory availability was not meeting the volume of our patients seeking care, and we resorted to enacting “emergencies protocols” in order to uphold our same-day patient promise.

In other specialties, the team realized it had over-allocated same-day slots-and left unused, those reserved appointments could create longer wait times for our patients seeking care outside of the SDA program.

Had we waited for perfection, though, the program would never have gotten off the ground. Taking calculated risks, and making thoughtful evaluations and adjustments on the fly, helped us achieve lift-off.

2) Honor and respect the voice of your patient. 

It’s not about us or our own convenience-it’s about them. Over the course of the last year, we have had the privilege of helping so many people through this program. In some cases, patients have started their healthcare journeys sooner than they might have otherwise, for potentially life-altering ailments. So many of these individuals have taken the time to share their stories with us; we are thankful for that feedback. 

Next: The feedback that isn't so positive

On the flipside, though, we need to be equally thankful for and open to feedback that isn’t so positive. These instances have been isolated to date, but it’s important to approach these occurrences with the same vigor and interest as the positive feedback.  

At times, patients’expectations may exceed the limits of the program. We promise same-day access to almost all specialties, but not to a specific specialist, for example-so a caller asking to be seen today by Dr. Smith might be disappointed. Regardless, this gives us an opportunity to educate, mend fences and-hopefully-continue to earn the opportunity to serve them.

At other times, we addressed those limits head-on by revisiting our strategy or making thoughtful exceptions to existing rules, in order to fulfill our access commitment make sure the patient-and future patients in similar situations-can be seen on-demand.

3) It takes a village.

Engaging so many stakeholders across multiple disciplines was a necessary challenge: Physicians, managers, information technology, and centralized scheduling leaders were all brought into the redesign conversation. Diversity of thought and collaborative disagreement were welcomed, because every health system is different, and what worked for the Cleveland Clinic may not work for AHN or another network. Allowing space for discussion and design flexibility contributed to the launch, and sustainability, of the program.

Our biggest lesson learned is that we can all do more to build upon our patient-centered approach to access and satisfaction. For too many years, our American healthcare system-particularly when it comes to specialty care-has been built around the preferences and schedules of providers. But what’s convenient for us isn’t necessarily convenient for patients.  

As healthcare leaders, we should challenge ourselves to innovate, to do the right things for the right reasons, and to earn the privilege to care for patients and their families. More often than not, that privilege can be earned by listening to what the patient has been telling us all along. 

Kenyokee Crowell is senior vice president, Clinical Access, Allegheny Health Network.