Department of Veterans Affairs 

Office of Inspector General 

Healthcare Inspection 

Appointment Scheduling and 

Administrative Issues 

Carl T. Hayden VA Medical Center 

Phoenix, Arizona 

Report No. 07-00050-146 June 18, 2007

VA Office of Inspector General 

Washington, DC 20420 
To Report Suspected Wrongdoing in VA Programs and Operations 

Call the OIG Hotline – (800) 488-8244 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Executive Summary 

The purpose of the review was to determine the validity of allegations regarding delays in 

appointment scheduling and other administrative issues at the Carl T. Hayden VA 

Medical Center, Phoenix, AZ. 

The complainant alleged he was told to call within 30 days for a follow-up appointment, 

and if none was available, continue to call each day in case an appointment became 

available due to a cancellation. We substantiated that at the time of the allegations the 

appointment scheduling system for primary care caused delays in scheduling 

appointments, was ineffective, and was problem prone. A high volume (40 percent) of 

patient complaints during the last quarter of FY 2006 pertained to phone calls not 

answered/returned and excessive delay in scheduling appointments. 

The complainant also alleged the average wait for an operator response was 

approximately 1–1.5 hours. We did not substantiate the allegation that medical center 

operators’ response time was 1–1.5 hours. The delays in the telephone system occurred 

once calls to the main number had been transferred to extensions within the medical 

center. 

Finally, allegations by the complainant stated certain staff schedule appointments in 

advance and beyond 30 days. As a result, some veterans were receiving preferential 

treatment. We did not substantiate that appointments scheduled beyond the 30 day 

requirement by their providers demonstrated preferential treatment. 

When we visited the facility, a new call center had been operational for 3 weeks. The 

staff expressed receiving positive feedback from veterans but could not assess the impact 

of the changes at that time. Therefore, we recommended that the medical center establish 

and monitor performance improvement measures for the call center to assess primary 

care appointment improvements and patient satisfaction with these services. We will 

follow up on the planned actions until they are completed. 

VA Office of Inspector General 
DEPARTMENT OF VETERANS AFFAIRS

Office of Inspector General 

Washington, DC 20420 

TO: Director, Veterans Integrated Service Network (10N18) 

SUBJECT: Healthcare Inspection – Appointment Scheduling and Administrative 

Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Purpose 

The VA Office of Inspector General (OIG), Office of Healthcare Inspections (OHI) 

conducted an inspection to determine the validity of allegations regarding delay in 

appointment scheduling and administrative issues at the Carl T. Hayden VA Medical 

Center (medical center), Phoenix, AZ. 

Background 

The OIG Hotline Division received allegations regarding long wait times for medical 

center telephone operators to respond when a patient calls to schedule a primary care 

appointment. Specifically, the complainant alleged he was told to call within 30 days for 

a follow-up appointment, and if none was available, continue to call each day in case an 

appointment became available due to a cancellation. He also alleged it was extremely 

difficult to speak to a “live person,” and the average wait for an operator response was 

approximately 1–1.5 hours. He further alleged certain staff schedule appointments in 

advance and beyond 30 days. As a result, some veterans were receiving preferential 

treatment. 

Scope and Methodology 

The OHI conducted a telephone interview with the complainant, followed by a site visit 

to the medical center. We examined the appointment scheduling process and reviewed 

local policies and procedures for scheduling appointments, access to care data, operator 

response times, and patient wait times. We interviewed the patient advocate, outpatient 

clinic clerks/schedulers, operators, telephone system supervisor, and outpatient clinic 

manager. 

VA Office of Inspector General 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

We also reviewed patient complaints to determine if there had been other allegations 

regarding preferential treatment and the related Survey of Health Expectations of Patients 

scores to validate patient complaints during fiscal year (FY) 2006. 

We conducted the review in accordance with the Quality Standards for Inspections

published by the President’s Council on Integrity and Efficiency. 

Results 

Issue 1: Long Wait Times 

We substantiated that there had been long patient wait times when scheduling primary 

care appointments. The FY 2006 patient advocates’ report revealed 40 percent of patient 

complaints during the last quarter pertained to phone calls not answered/returned and 

excessive delay in scheduling. Medical center staff and managers told us the 

appointment process for primary care was not efficient. Patients experienced long delays 

– up to an hour – after their calls were transferred by operators to the primary care 

scheduling staff. Once the patient reached a clinic scheduler, appointments within the 

required 30 days were rarely available. As a result, patients were required to call the 

primary care clinic schedulers each day until they were able to obtain an appointment 

within the Veterans Health Administration’s (VHA’s) 30 day requirement. 

The medical center director established a work group comprised of VA employees in the 

primary care clinics and veterans. The group identified causes for delay in clinic 

schedulers answering telephones and patients’ inability to obtain appointments. They 

provided their findings and recommendations to the Medical Center Director. Process 

changes suggested were to: (1) acquire more staff to improve timeliness of clinic 

schedulers answering response and (2) open more appointment slots to improve 

availability within the 30 day requirement. In response, the Medical Center Director 

authorized five additional patient telephone appointment scheduling agents. The number 

of appointment slots held for emergencies was decreased to allow more available followup appointment slots for each provider. In addition, a call center was established to 

centralize all scheduling and enhance the efficiency of the appointment process. 

Issue 2: Operator Response Time 

We did not substantiate the allegation that medical center operators’ response time was 

1–1.5 hours. We inspected the main switchboard area and observed the telephone 

operators receiving incoming telephone calls, which were promptly directed to other 

extensions. The delays in the telephone system occurred once calls to the main number 

had been transferred to extensions within the medical center, where calls are placed on 

hold until the clinic schedulers answer. (As discussed in Issue 1.) 

VA Office of Inspector General 2 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Issue 3: Preferential Treatment 

We did not substantiate the allegation that some veterans received preferential treatment 

when scheduling their appointments. Staff interviewed denied having knowledge of or 

giving preferential treatment to patients. Two primary care providers acknowledged 

scheduling patients for a follow-up appointment beyond 30 days at the exit of their last 

encounter for the provider’s convenience. However, we did not substantiate that 

appointments scheduled beyond the 30 day requirement by their providers demonstrates 

preferential treatment. 

 Conclusion 

We concluded that at the time of the allegations, the appointment scheduling system for 

primary care was ineffective and problem prone. For example, a high volume (40 

percent) of patient complaints during the last quarter in FY 2006 pertained to phone calls 

not answered/returned and excessive delay in scheduling appointments. However, a 

work group comprised of VA employees and veterans, supported by management, 

identified the need for additional staff and resources to improve the primary care 

appointment scheduling system. When we visited the facility, a new call center had been 

operational for 3 weeks. We were provided with the call center’s standard operating 

procedures and interviewed various appointment schedulers. The staff expressed 

receiving positive feedback from veterans but could not assess the impact of the changes 

at that time. 

Recommendation 

Recommendation 1. We recommend the VISN Director ensure the Medical Center 

Director takes action to establish and monitor performance improvement measures for the 

call center to assess primary care appointment improvements and patient satisfaction with 

these services. 

VA Office of Inspector General 3 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Comments 

The VISN and Medical Center Directors agreed with the findings and recommendation 

and provided acceptable improvement plans. Performance improvement measures have 

been established for the call center (VA Helpline) to assess primary care appointment 

improvements and patient satisfaction with these services. Furthermore, they have 

specified measures and monitoring mechanisms. Patient Satisfaction will be monitored 

by reviewing and trending data in the Patient Advocate report. (See Appendixes A and 

B, pages 5–9, for the full text of their comments.) We will follow up on the planned 

actions until they are completed. 

 (original signed by:) 

JOHN D. DAIGH JR., M.D. 

Assistant Inspector General for 

Healthcare Inspections 

VA Office of Inspector General 4 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Appendix A 

VISN Director Comments 

Department of 

Veterans Affairs Memorandum

Date: February 15, 2007 

From: Network Director (10N18), VA Southwest Health Care 

Network, Mesa, AZ 

Subject: Healthcare Inspection — Appointment Scheduling and 

Administrative Issues, Carl T. Hayden VA Medical Center, 

Phoenix, Arizona

To: Assistant Inspector General for Healthcare Inspections 

THRU: Director, Management Review Service (10B5) 

I concur with the facility response. See Medical Center 

Director’s Comments for specific actions. Please contact 

Joan Funckes, Executive Assistant to the Network Director, 

VISN 18 at 602.222.2692, for any questions. 

Patricia A. McKlem 

Network Director 

VA Office of Inspector General 5 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

VISN Director’s Comments 

to Office of Inspector General’s Report 

The following VISN Director’s comments are submitted in 

response to the recommendation in the Office of Inspector 

General’s report: 

OIG Recommendation

We recommend the VISN Director ensure the Medical Center 

Director takes action to: 

Recommendation 1. Establish and monitor 

performance improvement measures for the call center to 

assess primary care appointment improvements and patient 

satisfaction with these services. 

Concur Target Completion Date: March 15, 2007 

See Medical Center Director’s Comments for specific actions 

VA Office of Inspector General 6 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Appendix B 

Medical Center Director Comments 

Department of 

Veterans Affairs Memorandum

Date: February 13, 2007 

From: Medical Center Director (644/11Q), Carl T. Hayden VA 

Medical Center, Phoenix, AZ 

Subject: Healthcare Inspection — Appointment Scheduling and 

Administrative Issues, Carl T. Hayden VA Medical Center, 

Phoenix, Arizona

To: Network Director (10N18), VA Southwest Health Care 

Network, Mesa, AZ 

1. The recommendations made as a result of the 

Healthcare Inspection visit to the Carl T. Hayden VA Medical 

Center regarding the allegations of the delay in appointment 

scheduling and other administrative issues have been 

reviewed and our comments and implementation plan are 

noted below. 

2. If you have any questions, please contact Sally 

Compton, QM Program Manager, Quality Management 

Department at 602.277.5551, ext. 6777. 

(original signed by:) 

DONALD F. MOORE, RPh, MBA 

Medical Center Director 

VA Office of Inspector General 7 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Medical Center Director’s Comments 

to Office of Inspector General’s Report 

The following Medical Center Director’s comments are 

submitted in response to the recommendation in the Office of 

Inspector General’s report: 

OIG Recommendation

We recommend the VISN Director ensure the Medical Center 

Director takes action to: 

Recommendation 1. Establish and monitor 

performance improvement measures for the call center to 

assess primary care appointment improvements and patient 

satisfaction with these services. 

Concur Target Completion Date: March 15, 2007 

Performance improvement measures have been established 

for the call center (VA Helpline) to assess primary care 

appointment improvements and patient satisfaction with these 

services. The measures and monitoring mechanisms are 

specified below. 

(a) Phone calls to the scheduling agents from 

veterans who want to make or cancel an appointment 

will be answered within five (5) minutes 90% of the 

time when the call is placed into the appointment 

phone queue. Scheduling agents will make primary 

care appointments for 85% of answered calls. When 

the appointment cannot be made according to VHA 

guidelines, the veteran will be placed on the Electronic 

Wait List. These measures will be monitored by 

tracking times for calls that are answered by 

scheduling agents via data from Symposium software 

and VistA, and monitoring the number of patients on 

the primary care appointment Electronic Wait List. 

VA Office of Inspector General 8 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

(b) Patient Satisfaction will be monitored by 

reviewing and trending data in the Patient Advocate 

report (see OIG reference under Issue 1 on page 2 of 

this report) related to patient complaints regarding 

telephone calls not answer/returned and excessive 

delay in scheduling. 

VA Office of Inspector General 9 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Appendix C 

OIG Contact and Staff Acknowledgments 

OIG Contact Wilma Reyes, Healthcare Inspector 

Dallas Office of Healthcare Inspections 

(214) 253-3334 

Acknowledgments Linda DeLong, Director 

Karen Moore, Associate Director 

Marilyn Walls 

Roxanna Osegueda 

VA Office of Inspector General 10 
Appointment Scheduling and Administrative Issues, Carl T. Hayden VA Medical Center, Phoenix, AZ 

Appendix D 

Report Distribution 

VA Distribution

Office of the Secretary 

Veterans Health Administration 

Assistant Secretaries 

General Counsel 

Director, Veterans Integrated Service Network 18 

Director, Carl T. Hayden VA Medical Center 

Non-VA Distribution

House Committee on Veterans’ Affairs 

House Appropriations Subcommittee on Military Construction and Veterans Affairs 

House Committee on Oversight and Government Reform 

Senate Committee on Veterans’ Affairs 

Senate Appropriations Subcommittee on Military Construction and Veterans Affairs 

Senate Committee on Homeland Security and Governmental Affairs 

National Veterans Service Organizations 

Government Accountability Office 

Office of Management and Budget 

U.S. Senate: 

 Jon Kyl 

 John McCain 

U.S. House of Representatives: 

 Ed Pastor 

This report is available at http://www.va.gov/oig/publications/reports-list.asp. 

VA Office of Inspector General 11