Instant Messaging: A Simple Tool to Improve Teamwork and Wait Times


On-screen alerts can help a spread-out staff work together to keep patient care moving smoothly.

Fam Pract Manag. 2016 Sep-Oct;23(5):28-30.

Author disclosure: no relevant financial affiliations disclosed.

In this modern age of technology and the instant gratification it brings, people have become accustomed to a certain level of expediency. For many of our patients, the old adage “Patience is a virtue” no longer applies. In fact, the largest source of patient dissatisfaction is the time spent waiting for an appointment.1,2 One study found that 75 percent of patients who waited less than 10 minutes gave an excellent or good rating compared with 3 percent of patients who waited longer than 20 minutes.3 Another study, using surveys from 44 ambulatory clinics over the course of one year, found that every aspect of the patient experience, including the patient's confidence in the care provider and perceived quality of care, correlated negatively with longer wait times.1

At our site, patients used to wait between 10 minutes and 20 minutes before being shown to an exam room, even longer if a medical assistant (MA) was busy performing an electrocardiogram, lab test, or other duties and was not immediately available to take the patient to a room. To address this, we had to find a way to communicate better and work as a team.

Looking for a solution

To find ways to improve wait times in our clinic, we examined the workflow of the patient experience from the time the patient enters the clinic to the time he or she enters the exam room. We looked for factors we could control and then tried multiple potential solutions. For example, new patients must fill out extensive paperwork, and we spend a lot of time verifying their insurance, which can cause delays in rooming. We tried asking patients to arrive 15 minutes earlier than their scheduled appointment to allow time for these tasks, but they often still arrived at their actual appointment time or later. We also tried using alerts in our electronic health record (EHR) that inform us of a patient's status, such as showing us that a patient is ready to be roomed. However, this alert doesn't help if the MA or physician the alert is meant for misses it or is not looking at the patient schedule screen.

Like many practices, ours had logistical problems with communication. The front and back offices are separated, and our MAs are scattered throughout the clinic. Because of this, our MAs were less likely to know when a patient's chart was ready and rooming could begin. In addition, each MA was used to working as a “silo” with a specific provider, rooming that provider's patients, working them up, and taking care of them only. Meanwhile, if the front-office staff needed to speak with a physician or MA because a patient was late or there was a problem with the patient's paperwork or insurance verification, the staff member had to call or even leave his or her area to track down the physician or MA. This introduced another layer of delay, especially

About the Author

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Dr. Cuenca is a board-certified family medicine and sports medicine physician and a member of Family Practice Management's Editorial Advisory Board. He serves as the site physician lead for OptumCare Medical Group in Ladera Ranch, Calif....

He would like to thank Angela Booth, supervisor of clinical operations, for her assistance.

Author disclosure: no relevant financial affiliations disclosed.



1. Bleustein C, Rothschild DB, Valen A, Valatis E, Schweitzer L, Jones R. Wait times, patient satisfaction scores, and the perception of care. Am J Manag Care. 2014;20(5):393–400.

2. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.

3. Howard M, Agarwal G, Hilts L. Patient satisfaction with access in two interprofessional academic family medicine clinics. Fam Pract. 2009;26(5):407–412.


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