Outpatient schedule management raises the hospital’s credibility and authority
The outpatient department of a hospital should focus on patient demand, the concept of patient-oriented service, and providing patients with high-quality, affordable, and reliable services . Currently, China’s medical and healthcare field is attempting to manage the conflict between the rapidly growing need for medical services and the slower development of service capacity. The effects of this conflict have been exacerbated by inefficient supply mechanisms for medical services, while the main manifestation of the conflict is difficult and expensive hospital visits. “Supply-side reform” has taken centerstage in the healthcare field . A hospital’s outpatient-schedule management can improve the supply of medical services, while also raising overall management of medical services and promoting honest communication. This is a task for health officials and hospital management, which is consistent with China’s new-era socialist values. Improved communication among all parties relevant to the outpatient environment (physicians, patients, administrators, and other staff members) also enhances the hospital’s brand, reputation, and culture.
Outpatient schedule is a facilitator of efficient operation
Large general hospitals are often patients’ first choice due to their advantages in providing high-quality medical resources and comprehensive specialist and sub-specialist departments. The outpatient department drives the operation of various departments and sectors of the hospital as the physicians who work there admit and discharge patients. Therefore, an appropriate outpatient schedule is necessary to ensure a hospital’s efficient operation. Following the introduction of the consultation reservation system in 1992, our hospital became the first to make all consultations with experts, specialists, and sub-specialists available to the public for reservation. Patients can make appointments via the mobile app, WeChat, the hospital’s webpage, telephone, and self-service machines. Subsequently, the average daily outpatient volume increased from a daily average of 8000 in 2008 to 20000 in 2019, which represented a challenge for the continued credibility of the outpatient schedule. An additional issue is that 70% of patients do not reside locally, including patients who live in remote mountainous areas. To address this issue, our hospital implemented the consultation reservation system and the segmented consultation mechanism, which improved the service provided to patients and encouraged physicians not to miss consultations, thereby raising the credibility of the hospital in the eyes of its patients . Jing  indicates that the reservation rate for specialist consultations was 29.9% higher than that of ordinary consultations, whereas the suspension rate of the former was 3.6% lower than that of the latter. Nevertheless, our study finds that specialist consultations produced the most suspensions between 2016 and 2018. In 2018, specialist consultation suspensions and substitutions represented 75.5% and 60.8% of the total, respectively. These percentages demonstrate the disparity between the supply of and demand for specialist consultations. Another possible explanation for those rates is that by continuously analyzing patient visit data and improving services, our hospital has increased the number of specialist consultations offered in order to satisfy patients’ demands for high-quality medical service and specialist consultations. On this basis, standardized management of the outpatient schedule can improve the quality of specialist consultations, thereby ensuring the hospital’s exceptional operation.
The department director should be responsible for the outpatient schedule
In order to raise the credibility of the hospital, when reviewing applications for service suspension, the director of the department should consistently focus on both providing patient-oriented service and preventing physicians from suspending their services without acceptable reasons . Reasons for outpatient-service suspensions and substitutions were not provided until 2017. Our results show that 27.3% of suspensions and 23.3% of substitutions came in the first quarter in 2016, percentages that then fell to 10.4% and 16.0%, respectively, in the first quarter of 2018. However, the suspension and substitution proportions were higher than average in the third and fourth quarters, with the third-quarter figures significantly higher.
In 2018, conference leave accounted for 26.7% of service suspension and substitution, which was higher than the 20.4% of 2016. Conversely, the proportion of service suspension due to education, sick leave, and holiday was lower in 2018 than in 2017. In 2018, departmental arrangements accounted for 21.9% of service suspensions and substitutions. In sum, holidays, conference leave, and departmental arrangements have respectively accounted for more than 20% of service suspensions and substitutions in the time period studied, and cumulatively account for more than 84%, as seen in Figure 1.
We believe that the influences of holidays, conference leave, and department arrangements on the outpatient schedule are controllable. Assigning the responsibility of service-schedule preparation to the department director has several advantages. Directors possess a better understanding of the department and the required allocation of appointments and they are more aware of the conference schedules of different groups within the department.
Large general hospitals integrate medical service, education, and scientific research. When the director of the department formulates the outpatient schedule, that person can organize a schedule that is implementable and that ensures physicians’ rights to take leaves. With detailed and relevant department knowledge, patient services are prioritized, and suspensions can be reduced to a minimum. In contrast, a temporary outpatient schedule prepared by either the departmental secretary or a temporary staff member can be difficult to implement, resulting in high service-suspension and substitution rates.
Successful implementation of the outpatient schedule relies on physicians
With the current focus on healthcare reform, providing premium services to patients, increasing quality resources, and promoting physicians’ enthusiasm are common challenges for health administrative departments and hospital administrators . Our results indicate that although the number of outpatient visits grew steadily over the period studied, the suspension and substitution rates fell to such an extent that the differences were statistically significant (p< 0.05). By managing outpatient consultations according to the hospital outpatient-service suspension and substitution management method and publishing documents such as Notices on Further Strengthening the Management of Outpatient Service Suspension of Re-Employed Doctors after Retirement and Supplementary Explanation on the Rules of Service Suspension and Substitution Evaluation, our hospital can regulate doctors’ behaviors. In addition, the announcement of evaluation results on WeChat can improve the implementation of the schedule. Standardized management of the outpatient schedule not only provides patients with added convenience but also induces both doctors and patients to promote the credibility of the hospital. In addition, outpatient physicians in large general hospitals are all evaluated on performance indicators for time and tasks, which are included in the plan assessment and provide important indicators of physicians’ self-development and practice of their specialty and sub-specialty.
Physicians are the primary implementors of the outpatient schedule; they also play a significant role in achieving self-development goals by providing organized outpatient services. The support of physicians is essential for the successful implementation of this type of program.
The outpatient schedule should be adaptable
Outpatient-schedule management is an important part of hospital management. Our results demonstrate that satisfaction indicators including patient loyalty, doctors’ level of service, and convenience of registration have all steadily increased in the hospital and time period we analyzed. In addition, the overall satisfaction rate grew from 85.0% in 2016 to 89.4% in 2018, indicating that the standardized management of the outpatient schedule has led to improved patient satisfaction.
Our hospital, the subject of this study, supervises departmental implementation of the program using appropriate information technology. Internally, the outpatient department monitors and publishes each physician’s outpatient consultation attendance while, externally, outpatient appointment information is updated in a timely manner on the reservation platform. Facilitated by technology growth and improved access to information, these efforts have provided solutions to many problems. However, the outpatient schedule system technology cannot incorporate humanistic management concepts and, therefore, refined management rules should be established, incorporating same-level substitution, non-complete unit consultation addition, service suspension, and appointment restriction . More effective and sustainable schedule-management methods should be considered to optimize performance and ensure that patients and medical staff continue to be satisfied while the quality of medical services are continually enhanced . Overseen by people with the best access to the necessary information, and utilizing the most advanced technology available, a modern and prioritized outpatient schedule maximizes patient–physician encounters and minimizes or removes wait times as well as staff substitutions and suspensions. A finely tuned, multipurpose, and fully functional outpatient schedule can be developed into an important tool in a hospital’s quest to provide quality health services, stellar patient care, and high levels of patient satisfaction.