KEY ACTIVITY #12A:
Provide Clinic Hours Beyond the Typical Work Day
This key activity involves all seven elements of person-centered population-based care: address social needs.
Overview
Practices may take many approaches to provide family-friendly access to care. A potentially transformative approach is to shift clinic hours beyond the typical work hours. For example, you may choose to offer early morning hours or evening hours at your clinic a couple of days a week, as needed.
Telehealth technology may also be used to supplement and provide flexible hours, as clinicians or other staff may be more able or willing to work early or late hours from their homes. By enabling clinicians to see patients remotely or off-site, telehealth also can reduce the overhead costs of running the practice for longer hours.
Families need accessible healthcare to ensure that children have the opportunity to grow and develop to their fullest potential. Meeting the twin goals of on-time well-child visits (WCVs) and childhood immunizations requires that children and families have access to preventive care. Flexible clinic hours can expand families’ access to care and could be a good match for staff preferences as they balance work and life responsibilities. As such, the AAP includes family-friendly office hours in its list of office strategies for improving immunization rates.
Beyond flexibility, practices should try to be compliant with DMHC timely access standards for appointment availability. All licensed CA managed care plans are accountable for providing this level of access to their members and annually monitor their contracted primary and specialty providers on these standards. Moreover, Federally Qualified Health Centers (FQHCs) also need to be in compliance with Health Resources & Services Administration (HRSA) requirements for hours of operation, which generally means providing extended hours.
Incorporating family preferences for expanded clinic hours is a strategy to foster equitable health outcomes through expanded access to care. Families with low-income or shift work may have very little flexibility with their working hours and multiple competing priorities for their time. Consider providing increased late afternoon and evening access on weekdays to accommodate higher numbers of visits during after-school and after-work hours. Additionally, consider providing weekend hours, such as limited Saturday morning to early afternoon hours.
In addition, this population may face multiple other obstacles to participating in regularly scheduled preventive care visits that are important to learn about, including need for medical interpreter services for non English-speaking members. Of note, the DMHC and DHCS mandate that medical interpreter services are available when needed during all appointments.
Action steps and roles
1. Review current clinic operating hours and available data on missed appointments.
Suggested team member(s) responsible: Director or QI lead
The practices’ data manager or QI lead should stratify the data on WCV completion and immunization rates to identify groups of children who are not meeting goals. Be sure to filter the data by patient demographics to identify subpopulations of children who are unable to keep appointments in the current system.
2. Learn family preferences about clinic hours.
Suggested team member(s) responsible: Staff member
Practice leadership should identify a staff member or peer leader who is very skilled in empathic listening to reach out to parents and families to learn what gets in the way of children participating in WCVs and being immunized. Ask open-ended questions about families’ preferences for accessing care. You could include specific questions about times that would be convenient to the family.
3. Query staff to learn their preferences about working hours.
Suggested team member(s) responsible: Human resources staff or clinic leadership.
Clinic leadership or human resources staff may query the staff team along similar lines, asking about their perception of what gets in the way of families participating in care and their preferences about working hours.
4. Test flexible clinic hours.
Suggested team member(s) responsible: Director
Review what you learned and run a small-scale test, scheduling families to fill slots in one or two shifts of the preferred flexible clinic hours. Continue testing different time slots until the team is satisfied that you have learned as much as you need to designate an expanded clinic schedule. Be aware that this step may need to be repeated at intervals to gauge emerging preferences of patients and staff.
5. Designate an expanded clinic schedule and track the results.
Suggested team member(s) responsible: Director, human resources staff, QI lead
Implement a clinic schedule that incorporates the most-attended appointment windows. Draw staff time based on staff preferences to the extent possible and partner with staff to minimize disruptions in work/life balance. QI lead should review the rate of kept appointments during the flexible hour windows, and compare them to the rate of kept appointments during usual business hours.
For additional interventions to improve appointment access, consider open access scheduling and/or same-day appointments, using a similar careful testing and implementation approach.