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 By Neil B. Gailmard, OD, MBA, FAAO, Editor May 31, 2006 - Tip #228 
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How to Handle Early and Late Arrivers


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Have you ever had your schedule disrupted by a patient who arrives late? I guess we all have. And the early arriver is not much easier to deal with. Try as we might to keep a well designed schedule, unexpected events that are not within the control of the practice can cause back-ups of patients or wasted time. Here are some tips on how to improve the situation.

The Latecomer

Assuming the usual efforts are made to tell patients the appointment time and confirm it one day in advance, I just accept that some people generally run late. Tough measures to change people's habits can have a way of being perceived as too controlling for a high-service practice. Patients can perceive it as a turn-off. When a patient does arrive late, I think it's very important to handle it well at the initial greeting by a staff member. My staff is trained to say something like "Hello Mr. Smith! It's so nice to see you again! I see you have a 1:30 appointment and it's now 1:50. We should be able to work you into our schedule with only a minimal delay. I'll let you know right away if there will be any problem."

If the staff member feels too shy and passes the first chance to acknowledge the time situation, the opportunity is lost. The same is true if there is no staff member available to greet Mr. Smith because he or she had to leave the front desk (another pet peeve of mine that happens all too often). Mr. Smith then conveniently forgets that he was late and he can begin to resent any delay, even though he caused it! It seems fair to me that the latecomer should be the main person inconvenienced by the action - not the other patients who were on time for appointments.

The Early Bird

The patient who arrives early can also cause problems with the schedule, because a well-meaning assistant will frequently start the exam for this patient ahead of another one who should have gone first. This is fine for the early arriver - but the next patient (who was on time) may be delayed.

I recommend similar staff training for an immediate acknowledgment, just as above for the late patient. "Good morning, Mrs. Jones! I see you have a 10:30 appointment and it is now about 10:05. We will try to take you in a little early if our schedule permits, but I'm not sure about that just yet. In the meantime, please help yourself to a cup of coffee or tea at the beverage counter, and feel free to browse for frames while you wait."

An office manager or senior staff member should evaluate the schedule and make a decision about when the best time will be to begin the early or late arriver.

A Cut-off Policy?

My staff occasionally asks me if we have an official number of minutes, after which we turn away a late-arriving patient. They would like it to be a little more cut and dry than I think it should be, so I decline to have a specific number of minutes. While it would make things easy on the staff to just say "if a patient arrives more than 20 minutes late for an appointment, they will be turned away and rescheduled for another day." I won't do that. It's a good way to lose a patient and his family and to build a bad reputation. One could argue that those late arrivers are not desirable anyway and they deserve to be taught a lesson, but I don't agree. Patients are too valuable, and the patient very likely will teach the practice a lesson by going elsewhere. Most of these latecomers are good people who had something unexpected happen in their day.

I prefer to be flexible enough to handle things that throw off my office schedule. We should be good enough to manage those inconveniences well. I will generally see any patient who arrives late, unless it is right at closing time and would require staff members to stay extremely late.

What about the wrong day?

Here is another great example of challenges that can upset the schedule. By now, you probably can infer that my office is going to handle the patient who shows up at the front desk saying he has a 2:00 appointment, only for the receptionist to finally find him in the schedule one week in the future. My staff is trained to accept the blame for this mishap, and apologize for apparently recording it wrong. We then do our best to work this patient into the schedule today, which is usually no big deal. What we avoid is the confrontation of trying to prove that the patient made the mistake and should just go home and come back next week. The patient, realizing that the situation could have been his error, is always very understanding. And let's not forget that it really could have been our fault!

Flexibility and Efficiency

This customer-friendly appointment policy works if your practice is flexible and efficient with clinical procedures. Here are some factors that make that possible.
  • A larger staff
  • More delegation
  • Automated instrumentation
  • Shorter appointment slots for exams
  • Doctors and staff who are aware of the schedule and can change the sequence of testing
  • A supervisor to direct patient flow

Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Send questions and comments to neil@gailmard.com.

Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.

Please Note: The views expressed in Management Tip of the Week do not necessarily reflect those of the sponsor.

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