It is the brainchild of Mark Murray, a family practitioner with Kaiser Permanente in California. Murray saw the frustrations and inefficiencies of the traditional system and came up with his novel idea of scheduling. As a first step, his colleagues and he cleared the backlog of appointments so that they could begin each day with a nearly empty schedule. Then they offered same-day visits to anyone who called, knowing by prior analysis of work volume what to expect each day. This system has apparently worked well where it has been used, receiving glowing reviews from patients and doctors.
Doctors seem especially pleased.
Administrators have been happy, too, because costs were reduced. The problem that I see with open access scheduling is that it has been used primarily, if not exclusively, by public clinics such as the Veterans Administration and by clinics like Kaiser Permanente that operate on a fixed budget and serve a fixed population. In the publicly funded operations, the clinic receives an amount of money each year from its controlling agency, whether local, state or federal. Kaiser Permanente and similar prepaid groups also work with budgets based on premiums paid by subscribers for that year. In either case, the funds to be spent on doctors salaries, staff salaries, equipment, supplies, insurance, maintenance, utilities and rent are more or less guaranteed and not truly dependant on productivity.