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What appointment time?

When I went for my outpatient appointment last month, I was not surprised to see that the clinic’s waiting area was chock-full of patients at 8.30 a.m when the clinic is only scheduled to start at 9.00 a.m. I was half-expecting the disapproving glances thrown my way when I walked to the registration counter, which seems to indicate that I was terribly late for my appointment. Just to make it clear, I was not late as it was stated in my appointment card that I will be seen at 9.00 a.m.

Alas, this is common in outpatient clinics all over Malaysia, and you know it. You have been in that position before. You came to the clinic nearer to your appointment time, only to discover that everyone else (even those who may have been allocated later time slots than you) have turned up for registration earlier than you. Majority of them had lined up in front of the registration counter as early as 7.00 a.m. And because of that, you have been pushed out of your pre-allocated 9.00 a.m slot and now have to suffer the consequences of being ‘late’.

Majority of them (patients) had lined up in front of the registration counter as early as 7.00 a.m

Please understand that turning up to clinics for registration way ahead of your allocated appointment time may cause any, if not all, of the following ramifications:

  1. Long waiting time between registration and consultation.
  2. Overcrowding in clinics’ waiting area which may cause discomfort.
  3. Unnecessary stress to clinic staffs and doctors who try to ensure that patients won’t have to wait too long.
  4. Unintentional pushing-out of other patients from their allocated appointment slots.
  5. Increase administrative and amenities’ costs.

There is no greater harm than that of time wasted.

Michelangelo

Despite all that, why has this phenomenon become such commonplace though? Why don’t patients follow their appointment time instead of turning up to the clinics too early? Here, I will list the most common reasons that have contributed to this issue, along with suggestions for improvement. Please note that these are based on my experience as a patient, as well as a hospital administrator.

Reason 1: First come, first serve policy

I believe this is the ultimate reason for the issue we face. Unfortunately, most outpatient clinics in Malaysia, including those in the private sector, still implement it. A number of clinics put it into practice by handing out similar appointment time to all their patients (most common is the 8.00 am slot), while others just implicitly do so by giving priority to those who come early. What’s more interesting is that the policy is often implicit. You won’t be able to find it clearly written in any hospital’s policy even if you try. But, its impact is observable and plain to see. Of course patients would turn up as early as 7.00 a.m for registration. They want to be the ‘first’ to arrive at the clinic for obvious reasons.

Solution 1: Strictly appointment-based policy*

To overcome this, healthcare administrators need to put an appointment-based policy in place and make it explicit. Once it is clearly written, staffs need to be informed and trained to support its implementation, including training in appointment systems management where applicable. Make sure that none of the staffs is still handing out generic appointment time to all the patients, or still give priority to patients who come early as these will signal non-commitment to the policy change and will be ineffective in educating the patients.

Having online outpatient appointment registration/ check-in platforms which allow patients to register from home and then provide estimated time of consult that takes into account real-time data (e.g number of doctor available, estimated time doctor will arrive in clinic, number of patients already arrived and waiting) so that patient could come to the clinic when it is closer to the time would be of great help too. I strongly feel that it will reduce long waiting time and overcrowding in clinics while supporting appointment-based policy.

* Appointment-based policy doesn’t imply zero-tolerance to walk-ins. It simply means that appointment-slots for urgent cases (walk-ins) will have to be incorporated into the appointment systems (e.g for every 10 slots of scheduled appointments, 1 slot is allocated for urgent walk-ins).

Reason 2: Easier to secure parking spots if early

Haven’t we all heard about this before? Patients and their carers come early to the clinics because they want to secure parking spots provided within the healthcare facilities. According to most, if they come to the clinics closer to the appointment time, they won’t be able to get a spot and hence will miss their appointment time as they continue looking for a place to park their cars. They would gladly turn up to the clinics even before its opening time and wait for an unacceptably long time, as long as they have a parking spot for their vehicles.

Solution 2: Educate to alleviate worries

As long as the ratio of parking spots to visitors is within acceptable limits (there is a specific division in MOH that ensures this), there is no need to continue building more. What needs to occur is what I would like to call ‘Education on Parking Slot Recycling Theory’, where patients and carers are educated about the fact that once they follow their appointment time strictly (see above), those who have earlier appointments will vacate their parking spots for those who have later appointment slots and hence a non-issue. They just need to trust the process and overcome their worries. Of course, not driving cars to the clinic at all by using e-hailing services and other modes of public transportation may help too (more on this later).

Reason 3: Dropped off before family members go to work

This is common in areas heavily populated with working adults. Often, patients are dropped off at the clinics at an ungodly hour before working family members make their way to the office. A combination of family members who are reluctant to take time off from work and patients feeling that the best way to get to the clinics is to hitch a ride with that particular family member, often result in these patients turning up too early to the clinic. These patients can normally be seen wandering around the clinics even before the sun rises. Some of them even waited until the working day is over before heading home with the family member who sent them to the clinic in the morning.

Solution 3: Timeslips or other modes of transportation

Working family members could ask the consulting doctors to provide them with time slips which allow them to be away from work for a few hours while they accompany the patients. Should they feel reluctant to use that privilege, the family members and the patients should discuss about other modes of transportation to get the patient to and fro the clinics. Patients and their family members should not feel intimidated to use e-hailing services, taxis, buses or in some cases even trains to get to the clinics and then use the same mode of transportation to make their way back home after they’ve seen the doctors.

I believe that if we tackle the underlying reasons for patients turning up too early to clinics with practical and easy to implement solutions, we can hope to see the phenomenon subside gradually and steadily. We have to start somewhere, don’t we? Well, writing this post is my first step towards making an improvement. Why don’t you do your part and share this article. Let’s make patient experience better, shall we? Slowly now, but surely.

Photo by Shopify Partners from Burst

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