To the Editor:

I enjoyed Dr. John Giannone’s article in the January 2003 issue [“Open Access as an Alternative to Patient Combat,” page 65]. We’ve adopted open access but have encountered some stumbling blocks. First, how do we get patients to accept the new model? Although we offer assurances that appointments will be open (and they are), a lot of people still want to schedule appointments. Second, how do we get buy-in from all of our providers?

Author’s response:

As with any change, there has to be transition. It’s been two years since we implemented open access, and we still have quite a bit of transition ahead of us. It takes time for patients to trust that they will get in when they call. You and your staff must stick firmly to two rules: 1. Do today’s work today. 2. Protect tomorrow at all costs. Your reception staff has to kindly, yet firmly, “bring them in today.” Unfortunately, I have a three-week backlog for scheduled visits, so patients can be seen today –or in three weeks. Most choose today. Patients know they can get in any day they call. Staff know that by protecting tomorrow at today’s expense, they may actually get home on time tomorrow. I think there is even a little pride when we’re less than 50 percent booked at the start of the day. So, hang in there with your patients, and the transition will happen.

Invite those colleagues who want to get onboard and leave the rest alone. They will get tired of having their lunch eaten. This is a difficult concept for doctors and others to accept. Show them it works, and then help them catch up. But be careful about acute visits for their patients. All your hard work with backlog will be for naught if you try to provide open access to your patients and urgent care to your colleagues’ patients. Remember, open access is counterintuitive, but it works.