One Key Metric to Make Your Practice a Leader in Patient Access: Third Next Available Appointment

Back in January, we wrote a guide to the patient access metrics you should be tracking in 2019. One metric we recommended practices track was how long it typically takes for a patient to schedule an appointment at their location. The industry standard for this sort of appointment accessibility is done through analyzing the third next available appointment (TNAA). In this post we will walk you through TNAA and how you can rigorously use it at your practice.

About TNAA

Looking at the TNAA is a more accurate, sensitive and reliable measure of accessibility. The next, or even second next, unfilled appointment slot could have opened due to a physician choosing to squeeze someone in,  a last-minute cancellation, or other unforeseen event. The TNAA metric provides a better estimate of the time in days, or even weeks, between when the patient requests an appointment and when they actually able to book one with a provider.

According to the Institute for Healthcare Improvement, TNAA is a valuable metric in tracking access, and yet, it appears to be underutilized in U.S. health care. Not enough practices are tracking their TNAAs, and likely without enough regularity. IHI recommends doing a systematic weekly review, through the following steps:

  • Once a week, sample all physicians on the same day and count the number of days between a patient’s appointment request and the TNAA for that doc (for a new patient physical, routine appointment, or follow-up visit).

  • Calculate the average for all physicians sampled.

  • Include weekends and providers’ days-off.

  • Exclude purposefully blocked-off spots for urgent visits.

Hospital-owned practices tend to have worse TNAAs according to MGMA. Yet, surgical, specialty, primary care, and hospital-owned practices alike, should aim to increase their accessibility - there’s always room for improvement. The goal for primary care should be a TNAA of zero days, while specialty practices should shoot for a TNAA of two days or less.


Ensuring your practice does not have a false sense of positive patient accommodation is imperative, and a poor TNAA can have quite harmful outcomes:

  • Delays in care that link to poorer health outcomes

  • Elevated no-show rates 

  • Lack of patient satisfaction

  • Poor patient retention, loyalty

Improving Your TNAA with DASH

  • DASH’s no-show prediction functionality projects which patients are at a high risk of missing their appointments, enabling double-booking without stress and getting more patients in the door. 

  • DASH analytics reveals what surface drivers are hindering access to pinpoint areas for workflow improvement.  

  • The configurable communications functionality allows for reminders and exchange through text, email, etc. to keep patients engaged.

  • DASH’s Intelligent, guided, self-scheduling directs patients to the soonest available appointment they seek and with the right provider.

  • The electronic waitlist feature texts patients when an earlier appointment becomes available, allowing them to book it themselves by simply responding to the text. While this doesn’t actually impact TNAA, it does reduce delays in care and is a great patient satisfier.

Sources & Further Reading