Process improvement for behavioral health

Adjust Staff Schedules to Meet Client Demand


There are not enough slots that are convenient for clients or the wrong mix of services is available, making it difficult for clients to schedule an appointment or continue in treatment.


Adjust staff schedules to match client demand for service, including for assessments, group sessions, and individual sessions.

Featured Stories

For assessment appointments

Connecticut Renaissance, Inc. in Bridgeport, Connecticut increased admissions by offering evening walk-in assessments. The outpatient clinic had always been open in the evening, but assessments were conducted only during the day. The 5-6 p.m. time slot proved a popular time for assessments, so they adjusted staff schedules to meet the need.

For treatment sessions

Bridge House in New Orleans, Louisiana increased continuation by changing their staff hours from 12-8 p.m. to 2-10 p.m. so that residential patients who worked during the day could meet with their counselors during the evening. Their continuation rate increased from 59.5 percent to 68.2 percent in the first month and continued to increase in subsequent months.

Lessons Learned

  • Add time slots at those times when requests for service are the greatest, whether in the early morning, during the day, in the evening, or on weekends.
  • Look at your data to determine which times have the highest show rates. For example, if Monday morning is an unpopular time, avoid scheduling assessments with urinalysis on Mondays.

Tracking Measures

Cycle Measure

  • Number of days until the next available appointment
  • No-show rate to assessment appointments or treatment sessions

Data Collection Forms

No-show Tracking Spreadsheet

Next Available Appointment Tracking Spreadsheet



  • 1. Decide what schedule changes you will test to meet client demand.
  • 2. Depending on the aim you have selected, collect baseline data for:
    • Number of days to the next available assessment appointment
    • Number of days to the next available treatment session appointment
    • No-show rate


  • 3. Add time slots for a few counselors at the specified times for two weeks.
  • 4. Re-check your baseline data.


  • 5. Check the fidelity of the change. Was the change implemented as planned?
  • 6. Evaluate the change:
    • Were the additional hours scheduled at the right time of day?
    • Did clients take advantage of the new or added time slots?
    • What hours were most popular or convenient for clients?
    • Did the aim you selected (waiting time or no-shows) improve?


  • 7. Adjust the number of counselors or the staff schedules and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you have added the maximum number of time slots to your schedule.

More Stories

For assessment appointments

Cornerstone Counseling Center in Salt Lake City, Utah reduced waiting time by assigning a counselor to provide assessments on Fridays for any clients not scheduled earlier in the week. All clients are thereby scheduled for an assessment during the same week they request treatment. This change reduced the number of days from the initial request for service to assessment from 13 days to 4 days.

Syracuse Brick House in Syracuse, New York closed 10 groups in the summer to free up staff to do assessments. They planned to hire temporary staff to provide flexible staffing for groups, if needed; the increased revenue generated by the additional assessments and admissions would cover the temporary staffing costs.

For treatment sessions

STEP 2 in Reno, Nevada reduced waiting time for treatment from 15 days to 10 days by adding evening sessions. This also allowed them to make groups smaller than 20-25 clients for educational groups and 8-10 clients for process groups.

Dennis Hill Harm Reduction Center in Milwaukee, Wisconsin opened up treatment time slots for new clients by asking all the clients stepping down from three sessions per week to one session to attend the Wednesday session only. They had previously allowed these clients to attend any of the three days during the week that this group met, making attendance and staffing needs unpredictable. Besides opening up slots in the Monday and Friday groups for clients attending three times weekly, staffing needs became easier to predict. Two counselors now lead the larger Wednesday group; only one counselor is scheduled to lead the Monday and Friday groups.

Terros, Phoenix, Arizona increased admissions from 291 per month to 614 per month one year later by adding extra therapy groups on weekdays and Saturdays.