Analysis of refilling late appointment cancellations in an outpatient practice at a community-based health system
Abstract
Mayo Clinic Health System — Southwest Minnesota Region, one of four practice regions in the Midwest, provides primary and speciality care in ambulatory, procedural and hospital settings. Clinic appointment fill rates, no-show rates and late cancellation rates are closely monitored operational metrics, but at the time this study began, less was known about the refill rates of late appointment cancellations. This metric is of importance because these unfilled appointment times contribute to increased expenses for healthcare organisations, unnecessary delays in care and decreases in revenue. The main objectives of this study were to understand the current state and potential opportunities for refilling late cancellations. Qualitative and quantitative methods were used, including variance analysis, the Tukey post hoc test, Pareto analysis, the completion of interviews with important stakeholders and data extraction from the institution’s electronic health record. Findings showed that late cancellation rates remained steady in 2021 and that late cancellations were not being refilled consistently across departments and regions. Appointment refill rates were higher in departments with few or no requirements for preparatory evaluation, whereas in specialties that did require preparatory evaluations, refill rates were lower across the four regions of the Mayo Clinic Health System. Even in departments with high demand, the refill rates were lower, resulting in missed opportunities for patient visits. Mapping the workflow for late cancellations indicated inconsistent methods for refilling late cancellation openings and the lack of a defined process for refilling them that was understood by the entire care team. The logistics of optimising refill rates for late cancellations were affected by provider preference, selfscheduling functionality and appointment requirements. This study identified opportunities for optimising workflows to use the waiting list proactively to refill late cancellations.
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Author's Biography
Pawan Bhandari is a Principal Health Systems Engineer with Mayo Clinic’s Strategy Department in the Southwest Minnesota Region, where he provides business consultative and management engineering services from discovery to execution at various levels of the Mayo Clinic organization. He holds a BS and MS in manufacturing engineering technology from Minnesota State University and is also an Instructor in Health Care Systems Engineering with the Mayo Clinic College of Medicine and Science. He is a member of the American Society for Quality (ASQ), Association of Technology, Management and Applied Engineering (ATMAE), and Industrial Engineering & Operations Management Society (IEOM). He is an ASQ Certified Six Sigma Black Belt and ASQ Certified Quality Improvement Associate. His research interests are quality and process improvement, technology management, quality systems, performance improvement in healthcare, and business analytics.
Paripuranam (Chitra) Saravanan is an MBA/MHA candidate at the University of North Carolina at Chapel Hill who completed her graduate administrative internship at Mayo Clinic Health System — Southwest Minnesota region in the summer of 2021. During her internship with medical specialities, she worked on projects related to quality improvement, business planning and patient access. Before pursuing her graduate studies, she worked in biotechnology and public health research while completing her undergraduate studies in biology and medical anthropology at the University of North Carolina at Chapel Hill.
Rachael E. Kuiken , MBA, is an operations administrator in the Mayo Clinic Health System — Southwest Minnesota region. She has a bachelor of science degree in business management and a master of business administration degree from Minnesota State University, Mankato. She has been with Mayo Clinic for 12 years, serving in various roles, including health information management, revenue cycle and operations teams.
Ryan R. Johnson , MBA, is a regional vice chair of administration supporting multiple medical speciality practices and overseeing the Department of Access Management in the Mayo Clinic Health System — Southwest Minnesota region. He also oversees Administrative Support Services, Southwest Minnesota Physician Leadership, Critical Care Neurology and Peripheral Nerve Neurology in the region. He is an instructor in healthcare administration at the Mayo Clinic College of Medicine and Science. He has had a 20-year career at Mayo Clinic spanning multiple areas of administration in both Rochester and Mankato, Minnesota. He has a master of business administration degree and is a certified public accountant in Minnesota.
Bipinchandra Hirisave Krishna , MD, is a consultant in the Department of Psychiatry and Psychology, Mayo Clinic Health System — Southwest Minnesota region. He has 10 years of service with the Mayo Clinic Health System and currently serves as regional vice chair of clinical practice and as regional chair of the Outpatient Practice Subcommittee. He is an instructor in psychiatry at the Mayo Clinic College of Medicine and Science. He holds certification both in child and adolescent psychiatry and in general psychiatry from the American Board of Psychiatry and Neurology. He is a member of the American Academy of Child and Adolescent Psychiatry, the Minnesota Medical Association and the Minnesota Society of Child and Adolescent Psychiatry. His special interests include anxiety disorders, attentiondeficit/ hyperactivity disorder, mood disorders (depression and bipolar disorders), obsessive-compulsive disorder, posttraumatic stress disorder and psychotic disorder.
Gokhan Anil , MD, is a consultant in the Department of Obstetrics and Gynaecology, Mayo Clinic Health System — Southwest Minnesota region and an assistant professor of obstetrics and gynaecology at the Mayo Clinic College of Medicine and Science. He has 15 years of service with the Mayo Clinic Health System. In his role as regional chair of clinical practice, he oversees all aspects of the practice in the Southwest Minnesota region and leads integration and practice transformation efforts in alignment with Mayo Clinic strategies. He is also the medical director for Mayo Clinic Health System Digital Practice Enablement. He holds certification from the American Board of Obstetrics and Gynaecology and specialises in female pelvic medicine and reconstructive surgery.
Abraham A. Doolhoff , MHA, is an operations administrator supporting the Office of Access Management in the Mayo Clinic Health System — Southwest Minnesota region. He has a bachelor of science degree in health services administration and a master of health administration degree from the University of Washington. He has been with Mayo Clinic since July 2021.
Citation
Bhandari, Pawan, (Chitra) Saravanan, Paripuranam, Kuiken, Rachael E., Johnson, Ryan R., Krishna, Bipinchandra Hirisave, Anil, Gokhan and Doolhoff, Abraham A. (2022, September 1). Analysis of refilling late appointment cancellations in an outpatient practice at a community-based health system. In the Management in Healthcare: A Peer-Reviewed Journal, Volume 7, Issue 1. https://doi.org/10.69554/TDLL5708.
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