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Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine.
Urgent message: Integration of healthcare delivery with mobile technology is leading more urgent care operators to embrace digital queuing systems that, given their ability to positively impact patient wait times, offer the promise of elevating the patient experience—and a distinct competitive advantage.
In a perfect world, every patient who showed up at your urgent care center would be quickly checked in and then immediately seen by a provider. But the urgent in urgent care doesn’t necessarily mean instantaneous, so depending on the number of patients already at the center, there is usually a wait of some duration. And while most urgent care patients have grown accustomed to a reasonable wait, expectations continue to shift as more and more service providers and businesses push the envelope in leveraging technology to provide faster and frictionless service delivery. This is where the concept of queue management becomes important to urgent care. What’s more, its strategic application can greatly benefit the urgent care center’s patients and staff and contribute to overall operational excellence.
A queue is simply a line of people waiting to receive products and services. Queues form when the number of customers waiting to be serviced exceeds a businesses’ ability to immediately service them. People waiting their turn in some sort of line is as old as civilization itself, but over time, experts have developed theories, concepts, and approaches to better understand and improve the best ways to manage queues—hence, the concept of queue management. The businesses that therefore excel at understanding how their customer queues form; how to manage the speed, pace, and flow of those queues; and how to positively influence the customer’s perception of time spent waiting in those queues reap the benefits of increased customer satisfaction and loyalty.
With that in mind, the traditional urgent care queue has the following components:
- Enter the center
- Registration at the front desk
- Wait in the lobby
- Triage (vitals, history)
- Provider visit
As total wait (or door-to-door) time is the biggest determinant of patient satisfaction, the faster patients can get in and out (with a positive clinical outcome of course) the happier they will be with the service. Once a patient has experienced a speedy door-to-door encounter during one visit, though, the expectation has been set for future visits to be of equal or shorter length. This visit length cannot be guaranteed by the urgent care, however, given urgent care’s unpredictable ebb and flow of patient traffic. When the center opens first thing in the morning, for example, there may be three or four patients waiting to be seen, followed by a midmorning lull where there are no patients for an hour. This variance and unpredictably lead to bottlenecks and prolonged waits on the front end, and productivity-sapping lulls on the back end. This ebb and flow continues throughout the day and is influenced by a multitude of factors, including seasonal demand.
Bottlenecks are indeed an issue in urgent care. Despite popular opinion, bottlenecks aren’t caused by slow speed; they’re caused by variances in speed. Consider a traffic analogy: Imagine driving down a freeway at 65 miles per hour. Traffic suddenly slows, then stops, then resumes. In this case, that slow-down and braking wasn’t caused by an accident up ahead. It was triggered in fact by the cumulative effect of all the drivers’ in the chain braking. So, if the cars in front start to slow down, the traffic behind will back up. That’s because the change in speed (ie, change in velocity) created a slow-down. Cars going 65 mph that come upon cars going 35 mph have no choice but to slow down.
Another example is the “bottle” analogy based on an episode of the television show Undercover Boss, featuring a CEO working in a factory putting soda bottles into boxes. The CEO fell behind in the task due to the uneven flow of bottles such that some of the bottles eventually crashed to the floor. Had the bottles come to the CEO in a steady, even flow, he would have had little difficulty maintaining his pace in grabbing them individually for the box.
Both scenarios mirror the urgent care ebb and flow of patient traffic highlight the dilemma that often results because of it.
One popular solution being implemented by an increasing number of urgent care providers is employing a digital queue management system (QMS). Queue management is defined as a set of principles aimed at controlling customer flow and streamlining the queuing experience.
Rather than deal with the challenges of uneven patient ebb and flow along with the unpredictability of walk-in patients, these systems create, manage, and maintain an organized digital queue that evenly paces the flow of patients through the center. The components of the urgent care queue influenced most positively by a queue management system are the registration process and wait-to-be-seen interim, as those are the ones that have the most time variability. A fully optimized queue management system does more than just lend predictability to average patient wait times—it positively impacts the patient experience and the urgent care staff efficiency/productivity by addressing several key factors, including:
- Functional shifting
- Frictionless transactions
- Wait time perceptions
- Unexplained waits
In effect, queue management is largely customer service. To that end, the following sections will briefly examine each factor, and the ways a digital queueing system facilitates the improvement of each.
Functional shifting in the service context entails shifting routine data entry tasks, such as registration, away from the front desk staff to the lowest cost (in terms of labor) resource—the patient, who essentially works for free. Only, patients don’t perceive themselves as working for free; in fact, patients feel empowered and like it when they have control over that portion of their transaction. Patients also tend to be more accurate when entering their own information as opposed to hurried front desk staff who may not notice their own data entry errors. Of course, errors in registration lead to delays in payment when insurance claims cannot be processed correctly on the first pass. This is such a critical issue that first pass resolution rates remains a prominent key performance indicator in many urgent care operations.
Functional shifting has an additional positive benefit: when the staff is freed up from the administrative burden of data entry, they can focus more of their time and energy on patient service. And as labor is the largest single expense in urgent care, functional shifting allows the urgent care to reduce staffing levels, resulting in cost savings.
How queue management systems help
An optimized queue management system would provide functionality for the patient to enter their registration information either at the urgent care center (kiosk) or through the center’s website accessible online or through a smartphone. When made easily accessible to consumers via smart phone technology accessed through a website or app, and combined with the ability to register online, this patient-facing technology offloads administrative burdens to the patient and lets the front desk staff focus on solving patient issues—which improves the overall quality of the patient experience.
Friction is the now-ubiquitous business and tech buzzword that refers to obstacles, steps, or extra effort standing between a consumer and their utilization of a product or service. Businesses are increasingly leveraging web and mobile technology in innovative ways to make it practically effortless for a customer take control of a transaction and have their product or service delivered with speed, efficiency, and on their terms. Restaurant bookings, meal delivery service, hotel accommodations, and in-store purchases that don’t require a trip to the register or interaction with a sales clerk all happen quickly and seamlessly through smartphone apps that link to digital platforms designed to eliminate friction. As a result, consumers have grown accustomed to managing their own transactions with vendors. As almost every major retailer and service provider now has a transactional app and/or website, this type of digital interaction is becoming an expectation among consumers. And even though the average urgent care patient only visits a center 1.7 times a year, the onus is on urgent care to make planning and carrying out an urgent care visit as frictionless as possible when the need arises—or lose out to a competitor that does.
How queue management systems help
Numerous studies show that the vast majority of urgent care patients look online first when searching for a solution to their health problem. Provided the urgent care’s website is SEO optimized to rank highly in search results, a patient will likely find their way to the urgent care’s website. If a queue management system is integrated with the urgent care website, the system will provide location information that communicates with the smartphone’s built-in GPS, directing the patient to the nearest facility. The QMS further integrates with the website to provide information such as:
- Estimated wait times
- Next available appointment
- The ability to reserve a spot online
- Complete registration online
- The ability to book an Uber or Lyft for transport to the urgent care center
In theory, with a robust QMS operating, a consumer could type in a search keyword such as “urgent care near me” into their phone, and within minutes have a spot reserved in line, a time to arrive at the center, and an Uber on the way to transport them there—with little or no friction experienced during the process.
Wait Time Perception
Queue management systems feature a built-in algorithm that adjusts wait times according to patient throughput and demand. This evenly paces patients through the urgent care center, resulting in shorter average wait times. Beyond simply shortening the average wait time, though, QMS functionality provides tools and technology that helps influence the perception of the total waiting time, regardless of where it takes place.
Wait time perception among consumers is a fascinating subject. Researchers have found that people’s reaction to waiting is influenced less by the actual time elapsed and more by the circumstances surrounding the wait. For example, studies have shown that people have greater tolerance for a longer wait that is clearly explained than a much shorter wait that is uncertain and unexplained. The issue seems to be not the length of the delay, but in the way the delay is experienced. For urgent care patients sitting in a waiting room or lobby with no sense of how long they’ve been waiting, how long the surrounding patients have been waiting, or how much longer their remaining wait will be, waiting becomes a frustrating process that significantly detracts from how they perceive the entire experience.
How queue management systems help
A queue management system can reduce or even eliminate what’s called unoccupied time (time patients spend doing nothing in a lobby while waiting to be seen by a physician). When patients can wait for their spot in line on the couch in their own home, while running errands, or while grabbing a cup of coffee, they don’t count that time toward their perceived wait. That is considered “occupied time” that the patient reclaimed and had control over.
The QMS can also communicate delays with patients through SMS messaging, while allowing walk-in patients to leave the urgent care center if they choose to and receive a text when their spot in line is approaching. Having more control over the way the wait is experienced has also shown to be an important factor in patient satisfaction. So, although patients are still technically in the queue, their time spent waiting at home or work is not perceived as an actual wait in terms of waiting to see a physician. During a busy flu season, for instance, even if the urgent care center is running a 2-hour wait, patients who are seen upon arrival because they were evenly paced and waiting elsewhere in the queue will report having “zero” or “minimal” wait. For these patients, the experience would feel like they were taken to the back to be seen immediately upon arrival. From their perspective, that is excellent and efficient patient care.
Not every urgent care patient will register online first through the queueing system or opt to leave the center to wait elsewhere as a walk-in patient. For those patients, in-center waits that are unexplained, or have the appearance of randomness or unfairness (ie, a patient who waited offsite for their spot in line returns to the center and appears to “cut the line” in front of a patient waiting) are particularly upsetting. Additionally, waiting patients tend to overestimate the time they’ve spent waiting, so in the absence of accurate updates at regular intervals, the anxiety they experience during the wait increases significantly.
How queue management systems help
The queue management system features functionality that apprises patients of the specifics of their wait in real time. The QMS would feature a TV screen in the lobby that displays estimated wait times, patient waiting order—in a manner that is HIPPA-compliant—and walk-in vs online patient status. Ideally, there would also be some sort of tracking board of patient status in the nurse area. There should also be a staff member explaining to patients waiting in the lobby that other patients have chosen to wait offsite and may return to be seen before them as they are actually ahead of them in the queue. This kind of explanation will go a long way to eliminating patient perceptions of randomness and unfairness, reducing the overall stress of their wait. It would also eliminate the all-too frequent patient inquiries of How much longer? to the front desk staff.
Anecdotal reports indicate that when medical clinics having difficulty in managing patient wait times implemented a QMS, the reduction in patients who cancelled and/or opted not to wait under the former method amounted to vastly improved retention rates (and netted the clinics thousands of dollars in additional revenue). Patient satisfaction surveys also showed dramatically higher scores in clinics that implemented QMS.
Queueing System Best Practices
Urgent care operators in search of a digital QMS will find several competing options in the marketplace. Aside from features and functionality, the ideal queuing system should be “white labelled” which allows the urgent care center to brand the product as its own. Urgent care operators should beware of queuing systems that are essentially aggregators designed to create a marketplace for healthcare providers and that include the wait times of other centers and attempt to steer your patients to competing telemedicine providers. These websites commoditize urgent care, place your center alongside competing centers for comparison shopping, and diminish your brand loyalty. And when these marketplaces include transactional functionality—ie, the ability to put down a credit card for payment—it financially locks in unsuspecting urgent care clients. Be sure to due your due diligence when evaluating any QMS to ensure you are getting a system that provides the exact service you intended for your center.
Healthcare researchers have compiled conclusive data showing a definite link between perceived wait times and patient satisfaction. And in a society where mobile technology allows businesses to drastically reduce queues and long waits for their products and services, consumers are expecting similar innovations from their healthcare providers. Queue management systems that help evenly pace patient flow can not only increase patient satisfaction by reducing average wait times and perceived waits, but also free up urgent care front desk staff from burdensome administrative tasks. The reclaimed time can be focused on delivering improved patient care, save the urgent care money in labor costs, and allow the staff to be more efficient and productive—providing a sure path to an elevated patient experience and clinical operational excellence.