If you were to stop and take a hard look at your practice, would you see annoyed patients sitting for too long in the waiting room? Phone lines that go unanswered? Unhappy physicians suffering from long hours and burnout?
If so, then you may be looking at a practice suffering from inefficiencies, which can be in be in the front office or among the nurses and physicians. What follows are suggestions for how you can make for a more smoothly running practice.
The most expensive labor in a medical practice is the physician. If a urologist, for instance, makes $350,000 annually and staffing expenses are $150,000, physician costs are more than double everyone else. “Because of this, 2 to 3 times as much focus should be put on their own behavior,” said Keith Borglum, a member of the National Society of Certified Healthcare Business Consultants,and owner of Professional Management & Marketing based in Santa Rosa, California. “That needs to be where a majority of the inspection of efficiency occurs.”
So where do you start in your process of self-evaluation? Ask your staff to offer feedback, and make sure they feel comfortable doing so. If they think they will “get in trouble” for speaking their mind, they may not be honest about where you may be holding things up.
For instance, Borglum often sees physicians prone to deviating from the purpose of the visit during a patient examination. “Doctors start talking about their kids, grandkids, travel and things like that, and it puts them behind,” he said. “It helps make the day more tolerable and is a distraction … but would you pay a medical assistant to jawbone with patients about their grandchildren?”
One way to address this habit is to put a clock on the wall behind your patients. This allows you to check the time – without being too obvious – so you can track how long you are taking. Another option is having staff knock on the door using codes. For instance, one of Borglum’s clients who was perpetually long-winded chose the name of a deceased close friend as a trigger. The emotional impact of the name would penetrate his attention. The staff would say, “Dr. Green is on the phone for you,” and knock a single time for each 10 minutes he was behind schedule.
Another challenge for both doctors and staff is being prepared for the first appointments in the morning and after lunch. Make sure you and staff members are in the office well before the first patients arrive so their appointments can start right on time, if not earlier.
Borglum recommends offices play the buck-a-minute game with physicians who are frequently tardy. Whenever a staffer catches you being late for those first patients, you pay $1 per minute on the spot. The money can be held by someone to pay for an office holiday party or staff bonuses. One of his clients put so much money in the jar he used it to take the staff to Hawaii for Christmas. A painful lesson, but it helped him change his ways.
“The activity of paying money out brings a physicality to the behavior that usually fixes it … or the doctor gets mad and cancels the game,” he said.
Another good practice to perform before the morning and afternoon work periods is a team huddle. It does not have to be a major affair, but a 1-minute standup meeting with your receptionist and medical assistant can make your work go more smoothly. Look at the upcoming patients and review your goals and the schedule. You will be able to see where there is space for work-ins or where you might fall behind because of slow or more-challenging patients.
Michael DeVries, health care business consultant and partner at VanderLugt, Mulder, DeVries, Elders, based in Grandville, Michigan, said he frequently sees doctors with what he calls the “do later piles.” Whether putting off reading medical journals or finishing charts or patient notes, he said to do it, schedule it, or delegate it as soon as possible.
Physicians often think that attending to patient records at the end of the day is more efficient, but Borglum said it takes longer to restart something than to do it as part of the original activity. Starting chart entries, then setting them aside and going back to them later also leaves more room for error. Finally, he said patients tend to like it when physicians dictate information into a recorder because this gives them confidence the doctor is saying the same thing to them as what is in the record.
DeVries also recommends learning to make the best use of your practice management system. For instance, office staff should be proficient in Excel so you can make sense of your data. This will allow you to analyze the practice and have a better idea of where you need to make changes.
Another way to improve efficiency is to make templates for all kinds of communications. DeVries finds programs like TextExpander a time saver whether writing letters or sending email. Other simple technology fixes for improving efficiency include dual monitors, which give staff more space to run a practice management system and other software simultaneously; telephone headsets that allow for greater multi-tasking; and scanners at each desktop, which are reasonably priced and allow for handy, quick access.