There is no shortage of administrative and managerial problems in the hospital ecosystem at the moment. As we have noted in this blog before, Peter Drucker many years ago suggested that the operation of hospitals was the very hardest managerial task of any type of American organization. If anything, post-Covid, the daily operation of hospitals is even harder right now.
The list of hospital administrative problems is long and complicated, but the problem I hear most often from friends, colleagues and hospital executives is how difficult it is to obtain timely appointments in both the doctor and hospital care environments. These complaints apply equally to primary care, specialty care and to a referral appointment process that seems very broken in many hospital organizations.
Obviously, delays in care resulting from significantly delayed appointments magnify issues of clinical quality. Patients with developing disease may have outcomes that are directly correlated with how quickly those patients can be diagnosed and treated in the specialty care system. Complicating all of this is that studies show that the patient no-show rate significantly increases for patients whose appointments are scheduled more than two weeks out. And yet, the average wait time in the United States is three to four weeks, according to a Consumer Choice Center study published by Statista in December — and we all know wait times can stretch much longer. One can imagine that patients who are scheduled three months out or six months out might just give up and not even pursue much needed care until their respective conditions become a medical crisis.
The clinical ramifications of a failed appointment system are obvious, but the importance of timely appointments creeps into hospital management and performance in other very important ways.
The 2025 Vizient Trends report focused on the importance of a “loyal patient” to the progress and performance of individual hospital organizations. A “loyal patient” was defined in the report as a patient who spends 75% of their total healthcare wallet within a single hospital or health system. The analysis further found that a “loyal patient” generates three times as much revenue for the typical hospital than a person who might be viewed as an “uncommitted patient.” If you extend the analysis, you discover that a 1% increase in the number of “loyal patients” will yield as much as $40 million in additional revenue for the typical $2 billion health system.
What is the key to creating “loyal patients”? The answer is likely multidimensional and complex, but the starting point is a highly functioning appointment process that provides easy access. This means timely appointments at the primary care level and at the specialty level. It also requires a referral appointment system that functions seamlessly and keeps patients within your care ecosystem, whether those patients are referred from within or from outside your system of care.
The essential observation here is that the quality of your overall appointment process not only affects quality of care but also has a material impact on organizational revenue, possible financial growth and hospital profitability. Strategically, your organization should be doing everything possible to create “loyal patients,” and that effort begins with the ability to keep as many patients as possible within your care ecosystem. It has been substantially demonstrated that when patients cannot obtain what they consider to be a timely appointment from their usual provider, then such patients will go looking for the first available appointment no matter where that appointment can be found.
Clearly more management time must be focused on creating a world-class appointment system at all levels of the delivery system. Appointment processes should be as intuitive as an Apple iPhone and as reliable as Amazon delivery. These are the consumer standards of our contemporary economy and they define patient expectations for navigating through your appointment and care system. To meet these expectations, hospitals should understand and track key metrics to determine how loyal patients are being created and accommodated. Such metrics include:
- percentage of patients requesting a same or next day appointment who are accommodated;
- percentage of patients seen by system physicians and referred for additional diagnosis or treatment who are seen;
- percentage of patients requesting visits who are seen within two weeks;
- percentage of patients calling for appointments versus the percentage of patients actually seen; and
- percentage of new patients who return for a second visit or service.
Management of complex hospital organizations is complicated. Sometimes the winning formula requires exceptional talent or creative use of technology or the early use of the smartest new idea. But other times successful management is more about thoughtful organization, daily blocking and tackling, and administrative execution. A timely and sophisticated appointment process is probably more a function of the latter approach.
Let’s be real here. The amount of work facing hospital executives is overwhelming. All of those tasks on the “to do” list are just not going to get done. But moving management of your overall appointment process up your priority list is going to pay material dividends. Creating improvements in the accessibility and reliability of that process is going to certainly improve quality of care, add to the numbers of loyal patients and grow revenue with accompanying improvement in financial performance — all goals and outcomes that are worth your team’s time and effort.
