KEY ACTIVITY #5:
Expand Clinic Hours Outside of a Typical Work Day
This key activity involves all seven elements of person-centered population-based care: address social needs.
Overview
Clinics may take many approaches to provide person-centered access to care. A potentially transformative approach is to offer appointment times outside the typical workday. For example, you may choose to offer appointments at 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, since staff may be more able or willing to work early or late hours from their homes.
Patients need accessible healthcare to ensure that they have access to care that meets their needs. Many health center patients work one or more jobs and often have limited time to attend medical visits during what are considered typical business hours. Flexible clinic hours can expand patients’ access to care and could be a good match for staff preferences as they balance work and life responsibilities.
Beyond flexibility, practices should try to be compliant with the California Department of Managed Health Care’s timely access standards for appointment availability. All licensed California managed care plans (MCPs) are accountable for providing this level of access to their members; they annually monitor their contracted primary and specialty providers on these standards. Moreover, Federally Qualified Health Centers (FQHCs) also need to be in compliance with the Health Resources and Services Administration’s requirements for hours of operation, which generally means providing extended hours.
Incorporating patient preferences for expanded clinic hours is a strategy to foster equitable health outcomes through expanded access to care. Patients and 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.
This population also may face multiple other obstacles to participating in regularly scheduled preventive care visits that are important to learn about, including a need for medical interpreter services for non-English-speaking patients. Of note, the California Department of Managed Health Care and DHCS mandate that medical interpreter services be available when needed during all appointments.
See Appendix E: Guidance on Technological Interventions for further information.
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 hypertension and diabetes management to identify groups of patients who are not meeting goals. The data should be filtered by patient demographics to identify subpopulations who are having difficulties keeping appointments in the current schedule.
2. Learn patient preferences about clinic hours.
Suggested team member(s) responsible: staff member.
Practice leadership should identify a staff member or peer leader to reach out to patients and learn the challenges patients have in keeping their appointments. This person should ask open-ended questions about patient preferences for accessing care. Consider asking specific questions about times that would be most convenient for the patient.
3. Query staff to learn their preferences about working hours.
Suggested team member(s) responsible: human resources or clinic leadership.
Clinic leadership or human resources staff may query the staff team along similar lines, asking their preferences about working hours and if current hours may be causing barriers to patients who are attempting to access care.
4. Test flexible clinic hours.
Suggested team member(s) responsible: director.
Review what you learned and run a small-scale test, scheduling patients 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 and QI lead.
Practices should implement a clinic schedule that incorporates the most-attended appointment windows. Schedule staff time based on staff preferences, and partner with staff to foster a healthy work-life balance. The QI lead should review the rate of kept appointments during the extended hours 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.