Centralized vs. Decentralized Patient Appointment Scheduling

In the 10 years our team has been helping medical practices communicate more effectively with their patients, we’ve come across a variety of patient appointment scheduling processes.

Some practices use a centralized scheduling process, in which all scheduling requests are handled by a single dedicated scheduler or a group of schedulers. Others choose to implement a decentralized scheduling structure, in which scheduling matters are managed by certain staff or team members who have exclusive domain knowledge regarding providers’ and/or other practice locations’ schedules that other staff or team members don’t. And many practices even employ a combination of the two scheduling processes.

With a decade of observation of various scheduling frameworks, we’ve had some time to identify the various pros and cons of each approach and the different ways these scheduling structures can serve a special and important role for a medical practice.  

Consider the following top advantages and disadvantages of each scheduling process or structure and top tips for a more efficient schedule, regardless of which process your organization employs.

A Closer Look at the Pros and Cons of Centralized Scheduling

Many groups have a centralized scheduling structure in place to improve performance. But not all centralized scheduling setups look the same, as each practice is different, and, thus, has different scheduling needs.

We’ve seen some practices that have only a single dedicated person working phones to schedule, reschedule, field phones calls for medical staff, and we’ve seen others that have a call center manned by 60+ people.

Regardless of scheduling staff capacity, however, the chief benefits of centralized scheduling that we’ve observed include:

• streamlined workflows—Practices are often able to break up scheduling responsibilities into a smaller subset of tasks. For example, while some scheduling staff members handle appointment cancellations and reschedules, other staff members can handle incoming calls, which ensures all patient appointment requests are handled.
• increased control—Rather than having to put out any scheduling “fires” that may crop up, larger practices typically have the capacity to assign scheduling tasks to at least one person to ensure scheduling tasks and processes are completed each day.
• measurability—You can use various tools and procedures to ensure all necessary work is being completed and measure the success of your workflows.

The Disadvantages of Centralized Scheduling

Though a centralized scheduling system certainly has its advantages, it also has its drawbacks, three top ones being:

• lack of flexibility—If you are removed from the practice a lot—or if you can’t keep simple schedules for your providers—centralized scheduling can be tough, as you end up having to move stuff around all the time. (If either of these are the case for you, consider using our group messaging tool.)
• decreased awareness—As a practice operations manager or executive leader, you aren’t at the frontlines to answer patients’ questions or serve their needs and, thus, aren’t aware of every scheduling snag or issue, making it super important to have some way to connect to the practice.
• potential ROI loss—If clear goals aren’t set, metrics aren’t followed and monitored, and processes aren’t analyzed, practices may not get a good return on their scheduling investments.
  

Digging Deeper into Decentralized Scheduling

While there’s been a trending move these past several years toward centralized patient scheduling, some practices have found it more advantageous to employ a decentralized scheduling process.

The most common type of organization we see employing a decentralized scheduling system is a multi-location practice whose providers don’t practice at every location, but instead focus their attention on a few, select locations.

The primary advantages of decentralized scheduling that we’ve observed include:

• heightened awareness of practice schedule—We’ve found that operations management team members are often much more familiar with providers’ schedules, off-book rules, and other scheduling nuances.
• increased employee involvement—Decentralized scheduling often provides more availability for staff members to wear a variety of hats and help with additional patient engagement tasks (given a practice isn’t super busy).
• improved patient interaction—Practice managers and staff members have more  opportunity to interact with patients in person, which can help boost patient satisfaction.

The Drawbacks of Decentralized Scheduling

And of course, just as there are advantages to a decentralized scheduling structure, there are also disadvantages.

Some of the most prominent disadvantages we’ve seen include:

• overwhelmed staff—It’s not unusual for there to be too many scheduling tasks for a decentralized staff to complete, making it difficult to also hold them accountable for other scheduling-related tasks, like following up with no-shows or monitoring metrics.
• training snags—It can be difficult to train new staff on procedures at each practice location, and training procedures are often tweaked, causing you to potentially lose best scheduling practices you’ve worked hard to develop.
• less efficient workflow—Not having dedicated schedulers can make it difficult to “keep the rhythm” due to various interruptions that arise.

Centralized and Decentralized Scheduling Best Practices

As you can see, both centralized and decentralized scheduling have their benefits and shortcomings. There is no one-size-fits-all scheduling structure—when choosing a scheduling process for your practice, there are many factors to consider.

Whether you employ a strictly centralized or decentralized scheduling process—or a combination of the two—here are six scheduling practices we recommend to yield a more streamlined and efficient scheduling process:

1. Use decentralized scheduling for patient satisfaction surveys, as well as for tasks that can’t be completed via phone or computer.
2. Push all other tasks (e.g., completing new patient forms, validating demographic information and insurance coverage) to the internet and try to get them done prior to the scheduled appointment date, using your central staff to follow up and assist as needed.  
3. Measure a decentralized staff’s efficiency via patient satisfaction surveys and staff measurement tools; some key metrics to measure include friendliness and attentiveness.
4. Use central staff for processes and tasks that are repeatable and/or that add high value to your practice.
5. Be clear on what your goals are and how you will measure the return. For example, we often automate recalls for our customers, and typically only about 50 percent of patients expressing a desire for an appointment actually end up following through and scheduling. Having the staff capacity to follow up with the other 50 percent might be worth the cost—and will most likely provide a great return.
6. If off-book scheduling rules are a challenge or if you want to enforce these rules at each practice location, you can still have centralized staff transfer patients over the phone to specific locations once they reach them, or you can have another central staff member facilitate reschedules.