Glacier Bay began their standardized scheduling initiative by gathering data from the EHR and one-on-one conversations with physicians to reduce “irrational variation” across appointments.

Analyze scheduling data to identify most common visits

Before this initiative, Glacier Bay had 150 different visit types across primary care. To reduce this number, Glacier Bay analyzed data from their EHR to identify the most common visits across the past year and found that 98% of all visits fell within six types. Leaders used this information to reduce the number of visit types from 150 down to six: new patient, established patient, Medicare AWV, non-Medicare wellness exam, well-child, and procedure. Because these changes were based on data and the six types encompassed almost all the visits typically seen in primary care, physicians were receptive to these changes after understanding the organization’s reasoning behind them. Part of their initial clean-up also involved removing some provider scheduling blocks.

Now that they had six common visit types, Glacier Bay turned to standardizing length for these visits next. They started again by reviewing EHR data. Leaders looked at EHR time stamps to measure how many minutes physicians typically spend on each visit. This data helped inform how long each visit should be.

Supplement data with anecdotal physician feedback

However, Glacier Bay knew that data alone wasn’t enough. To ensure buy-in, they needed to get a more holistic understanding of scheduling from the physician’s perspective – so the team went to them directly to learn more. They met one-on-one with nearly 200 primary care physicians to confirm that the EHR time stamps accurately reflected the actual time they were spending with patients. Leaders used this anecdotal feedback to supplement the EHR data and determine the right amount of time for each type of primary care visit.

In the end, Glacier Bay came up with three common lengths for each visit that vary based on time: A (less time), C (more time), and B (in between). Glacier Bay also allows physicians to request longer visits on a case-by-case basis for patients who need more time.

To roll out these new schedules, Glacier Bay recognized that they couldn’t take a one-size-fits all approach. To keep physicians bought in, leaders needed to make sure that physicians didn’t feel like they were giving up control over how they spend their day. So Glacier Bay let physicians pick their preferred schedule— within predefined options agreed upon by the group.

Allow physicians to choose preferred template speed

In particular, leaders at Glacier Bay recognized that physicians are especially sensitive to how much time they spend with patients. To address these concerns, Glacier Bay let physicians pick from the three standard templates based on their preferred speed. By letting physicians pick from these three options, Glacier Bay made physicians feel like they had flexibility and choice while at the same time maintaining consistency across the organization.

To facilitate this, the operations team at Glacier Bay sent a survey to each physician that allowed them to pick their preferred schedule. They also included a report with the physician’s average visit times and a recommendation for the template that would likely work best for them based on their data. Physicians were then given three weeks to respond and pick their preferred schedule.

In the end, 90% of physicians ended up picking the template that was recommended to them. But sending a survey and giving physicians a choice was important for making them feel like they had a say in the decision.

Selected template speed affects compensation

Giving physicians control over template speed also means they have control over their compensation. Ultimately, it’s up to each individual physician to decide how they want to balance their schedule and compensation, based on their personal preferences.

To ensure that these scheduling changes stick, Glacier Bay built a transparent performance dashboard to measure physician adherence to the group’s new scheduling standards. You can see a screenshot of their dashboard below.

Use dashboard to monitor adherence to scheduling standards

By looking at time stamps in the EHR, Glacier Bay can compare the actual time providers spent with each patient to the time that they should’ve spent according to the template. Leaders can use the data in this dashboard to identify physicians who are underperforming or unproductive--resulting in unused capacity.

Meet with low-performing physicians to find solutions

Glacier Bay then holds one-on-one performance conversations with these physicians. Leadership dyads share data from the dashboard to ground the conversation but they want to hear the physicians themselves explain why their data looks the way that it does and how their team can help. The goal of these conversations is to find tailored solutions that help improve the physician’s efficiency and adherence to group scheduling standards. For example, some solutions include adjusting a physician’s FTE status, providing them with additional care team support, or switching to a template with more time per visit.