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Breakdown · A specialist pediatric clinic

From 2–3 weeks to same-day contact

A multi-provider, multi-specialist pediatric clinic with a general pediatrics service running alongside had hundreds of urgent referrals waiting in the fax queue. Families waited two to three weeks for a first call. Here is how the back office was rebuilt so every family hears back within one business day.

The clinic's intake, built one piece per sectionA pile of faxes sits past the 14-day line. Piece by piece, training, three work queues, the clinic's existing system, a patient email app, scripted calls, one front door, one shared standard for front and back, confirmation rules and a cancellation list join into one loop where every appointment slot is filled and first contact moves to the same day.14-day ruleHundreds of faxesFirst call: same dayOne standardChecklistReferralsFilingUrgentRoutineThe clinic's existing systemEmailScriptsFront doorConfirmWaitlistEmpty slots are no-showsEvery slot filledA person checks

  1. Hundreds of faxes, one person who could read them

    Urgent infant cases have to be seen within 14 days. The clinic had the demand. It did not have the people or the process.

    Referrals came in by fax. One experienced employee knew which ones were urgent. When he cut his hours, the queue grew past 300, then past 500. Most of it was already outside the 14-day rule.

    New hires did not fix it. Each fax was one long task: file it, read it, decide, call, leave a voicemail, call again, write it down. Nobody could see who was urgent.

    Where it startedA pile of faxes sits past the 14-day line. First call: 19 days.14-day ruleHundreds of faxesFirst call: 19 daysOne standardChecklistReferralsFilingUrgentRoutineThe clinic's existing systemEmailScriptsFront doorConfirmWaitlistEmpty slots are no-showsEvery slot filledA person checks

  2. Teach anyone to spot urgent

    Deciding what is urgent turned out to be a short checklist. A few findings make a case urgent. Most can wait.

    We wrote that checklist into a training course with tests, progress tracking and small rewards. Staff without a medical background learned to sort faxes the same way, every time.

  3. Split one job into three queues

    One person filing. One person calling urgent families. One queue for routine calls.

    Each person does one kind of work at a time. 100 faxes used to take an experienced person 5 to 6 hours. After the split, 2 to 3.

  4. Keep the clinic's existing system

    Replacing the patient records system would have caused more trouble than the backlog. So we kept it.

    Every patient file now carries a short note with the appointment type, the reason and the urgency, added with a keyboard shortcut. When a family calls back, the front desk can book them on the spot.

  5. Email families from the same screen

    Staff used to copy letters into emails by hand, and replies got lost.

    A small email app, hosted on the clinic's own servers to meet health-privacy law, sends the appointment details. A reply turns into a confirmed appointment.

  6. Call from a script

    Three voicemails, with an email after each one, all in one queue.

    The script gives the family the email address and the website, so they can answer in whatever way suits them.

    HalfwayTraining, three queues, the existing system, email and scripts are in place. First contact is already moving toward the same day.14-day ruleHundreds of faxesFirst call: 8 daysOne standardChecklistReferralsFilingUrgentRoutineThe clinic's existing systemEmailScriptsFront doorConfirmWaitlistEmpty slots are no-showsEvery slot filledA person checks

  7. Fix the front door

    The website listed the wrong contact details. Voicemail was a third inbox nobody checked.

    Now there is one correct number and one standard way in. Posters and simple guidelines tell families how to reach the clinic.

  8. Front desk and back office work as one

    The front desk got the same training and the same standards as the back office.

    A family gets the same answer whoever picks up. The discipline of a call centre, without building one.

  9. Confirm early, release on time

    Confirmations go out 72 business hours before the appointment. No answer by 48 business hours before, and the slot is released. Friday confirms Wednesday. No answer by Monday, the slot goes.

    A released patient moves to the next open slot, at most twice. After that the referral goes back to the doctor who sent it, so nobody waits forever.

    Mondays got busier. The system handled it.

  10. Fill every slot from the cancellation list

    No urgent faxes today? Staff work the cancellation list and fill the freed slots.

    An urgent baby comes in? A routine patient moves to another day and goes on the cancellation list.

    A person checks the work between every step, and one manager view shows each person's queue. Nothing is fully automatic.

  11. Every slot filled, every referral answered

    No-shows stopped being lost time. They became room for urgent babies, which kept the clinic inside the 14-day rule.

    The backlog cleared and stayed cleared. 50 faxes a day is one person's job. 100 is one or two.

    The finished machineEvery piece is in place, the work circulates and every appointment slot is filled. First call: same day.14-day ruleHundreds of faxesFirst call: same dayOne standardChecklistReferralsFilingUrgentRoutineThe clinic's existing systemEmailScriptsFront doorConfirmWaitlistEmpty slots are no-showsEvery slot filledA person checks

What changed

First contact went from 2–3 weeks to usually 3 hours and never more than one business day. The same work now takes 3 people instead of 7, and they handle 100+ faxes in a five-hour day. No-shows fell to under 1% with nearly every released slot refilled from the waitlist.

First-hand figures from one clinic, rounded. Your numbers will differ. How we report numbers

No AI. Better process.

All of this was built before ChatGPT existed. Clear rules, simple tools and a person checking each step did the work.

That matters if you run a clinic: you can start this with the software you already have.

Where it went next

In 2026 we added automation on top. Each fax is read and entered into the clinic's system, the way a trained person would. Today less than 10% of intake needs a person. People still review every urgent case and make the calls.

The training course moved to an AI training platform. Training time dropped by 60%.

Curious what no-shows cost you? Work it out in ten seconds.

Keep reading

Part of our Operations & Automation work for Healthcare, built as Patient Access & Back-office Automation.

Every referral answered within one business day.

Want the same for your clinic? Book a call and we will look at your intake with you.

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Systems built to SOC 2, ISO 27001 and PIPEDA/PHIPA controls.