How One Hospital Used Scheduling Flexibility to Improve Access

A hospital may have world-class experts and provide world-class care. But if children can’t access that care, those other things don’t matter nearly as much, says Dane Snyder, MD, associate chief medical officer for Ambulatory Services at Nationwide Children’s Hospital.

In 2023, Nationwide Children’s had some work to do on access. Only about 45% of new patients were scheduled for specialty ambulatory/outpatient visits within two weeks of referral. Only about 60% of possible healthcare appointment slots ended up being completed appointments.

And that still made Nationwide Children’s one of the United States’ better children’s hospitals on those measures.

“Access is difficult for an academic medical center,” says Dr. Snyder. “You have to match the right patients with the right provider for the right kind of visit. There’s the reality that in an academic medical setting, a provider may have research or other non-clinical responsibilities. Supply and demand don’t always line up, and you don’t want to put more burden on providers.”

But that lack of access puts stress on families, who want the best for their children. So beginning in 2024, staff members from around Nationwide Children’s started coming together across specialties and siloed areas to work on the issue.

After two years of an organization-wide effort to improve ambulatory care access, about 53% of new patients are scheduled within two weeks, and more than 70% of possible appointments are completed – with an unexpected benefit that the hospital’s no-show rate has also declined. Nationwide Children’s hasn’t yet reached its ambitious goals, but the work so far suggests that other hospitals can make similar changes and impact access.

“So much of this comes down to flexibility and using technology efficiently,” Dr. Snyder says.

Among the changes the hospital has made that have been the most effective:

• Minimizing restrictive scheduling rules. Certain appointments are typically reserved for certain kinds of sub-specialty patients – a block of time might be meant for patients with seizure disorders, for example. But if those appointments aren’t filled, they can be converted to appointments for more general neurological concerns, allowing more patients to be seen.
• Standardizing appointment durations. If one kind of appointment is 15 minutes, and another is 20 minutes, it can be hard to convert one appointment into another. But if all appointment durations are multiples – 15 and 30 minutes, or 20 and 40 minutes – those appointments become more flexible.
• Creating a dynamic waitlist. The “Fast Pass” functionality of online scheduling at Nationwide Children’s notifies families when an appointment opens up through a cancellation.
• Aligning on the same access goals across the hospital. Various medical specialties had tried to address access for decades, with sporadic success. Alignment allows everyone to work on the same ideas and measure success in the same way.

These and other measures have had the ancillary effect of reducing no-show rates, says Dr. Snyder. National research shows that those rates are in the single digits if an appointment can be made in fewer than 14 days after referral, and that has also been Nationwide Children’s experience.

In concert with the initiatives to boost access, Dr. Snyder and his colleagues have been working on the issue of “continuity,” or allowing patients to see the same provider over time. Access and continuity can be at odds with each other; if a family wants to see the provider they’ve developed a relationship with, it may take longer to schedule an appointment than if the family is willing to see one of several appropriate providers.

That means it’s important to keep access in mind when addressing continuity, and continuity in mind when addressing access. Nationwide Children’s has done that and has now become a model for addressing both.

“I do think we’re now looked to by our peers because of our steep improvements since 2024,” Dr. Snyder says. “We still have work to do, but we have shown that a sustained, hospital-wide effort can make a real difference.”