Increasing Efficiency by Overcoming Obstacles
KELLY H. BUCHHEIT
To improve your medical practice’s efficiency, you first have to identify its most problematic areas. Here is a look at some common inefficiencies found within medical practices. They fall under three broad areas: front office, back office and physician care.
Generally, many inefficiencies in the front office are related to procedures that take place before the patient visit. For example, many practices struggle with appointment cancellations and accurate scheduling. To effectively manage this, you should focus, in advance, on decreasing the volume of patients showing up late – or not at all – for appointments. Historically, practices relied on postcard reminders mailed to patients a few weeks out from their appointment. However, in today’s world, we have the benefit of technology to rely on, which will help to save on both time and resources. One study published by the American Academy of Family Physicians found that reminder phone calls decreased no-shows by 30%. In addition to phone call reminders to patients, text and email reminders have the ability to be automated and sent according to a pre-determined schedule (e.g., one week in advance of the appointment).
Another benefit to utilizing technology is the growing number of practices implementing patient portals. A patient portal is dynamic and instantaneous with its ability to be updated in real-time. A physician can, for example, schedule appointments, obtain insurance information and inform a patient of test results via a patient portal in lieu of spending significant amounts of time on the phone.
On the topic of insurance verification, this process can be both complex and time-consuming. Many practices have a designated staff person to handle this task. The importance of verifying a patient’s insurance card is on file and has not changed prior to an appointment cannot be stressed enough. It will undoubtedly eliminate headaches for both the physician and patient if obtained in advance.
For the purposes of this article, “back office” refers to nursing and care staff.
One important back-office issue is practice layout and workflow — the entire process of how patients and staff move between check-in, waiting room, examining room, front desk and out the door. To improve the flow, it is a good idea to check for and eliminate bottlenecks. Develop a single path for patients to flow through the clinic and streamline patient flow for the patient care teams. Standardize exam rooms and maintain organized supply rooms so staff members do not have to hunt for supplies.
It is also necessary to prioritize clear communication, both electronically via an electronic health record (EHR) and on paper. Staff should be trained in updating and maintaining medical records and have access to them as needed.
Your practice needs an appropriate mix of front office, back office and ancillary staff to handle the patient flow and be able to cover for staff members who are sick or on vacation. Rule of thumb for staffing is 3.5 to 4 staff members for each physician, combined in both the front and back offices. Remember to divide tasks appropriately so that no one person has a heavier workload than others. Employee morale is another key to running a successful practice.
There are plenty of good reasons for a physician to run late throughout the day, including emergencies and unexpected problems. However, sometimes physicians run late for preventable reasons.
For instance, some physicians get bogged down in administrative tasks because they fail to delegate duties. Doctors need to delegate responsibilities where they can so that they can focus on the things only they can do (i.e., direct patient treatment).
While it is true that each patient is unique and requires that care be tailored specifically for him or her, there may be similarities among patient cases. This may warrant developing written protocols and scripts that can be used to handle routine, recurring issues, thus increasing physician efficiency. This does not mean your treatment approach should be rote — it merely means you have thought about your processes and how you want your practice to run.
A Hard Look
Many other areas of inefficiencies can exist in any medical practice, but these are the most common ones. Take a hard look at your practice to see if any of these areas can be improved on. When in doubt, consider hiring a practice management consultant to give your practice direct feedback and sensible solutions.
Staying Solvent in a Consumer-Driven Culture
People treating health care like a retail business defines consumerism in health care. One implication of this phenomenon is that patients who do not find what they want in a practice may be quick to shop around for an alternative physician or practice.
Pursue Helpful Strategies
A key piece of the puzzle is customer service. It is true that patients come to a physician to feel better. To make sure they choose you to accomplish that goal (rather than choosing another physician or practice), you will need to maintain, or even improve, the quality of your customer service — including all aspects of the patient’s overall experience. You will want to:
- Improve Patient Flow and Cycle Time
Patient flow concerns how quickly, efficiently and effectively your practice meets patient care demand. Your practice needs to focus on keeping the movement of patients into and out of the office as smooth and painless as possible. Analyze bottlenecks, staff appropriately, perform triage and prioritize services.
- Leverage Technology
Technology and patient service do not have to contradict each other. It is simply a matter of ensuring the technology does not get between the physician and the patient. Use patient portals and make it easy for patients to fill out forms or make appointments. Some portals are easy to use, others not so much, so it is important to test-run the software before purchase.
- Personalize Care
Patients want convenience, but they also want to know that you care about them as people. From the first interaction between the patient and your staff, empathy should be primary. When patients describe their symptoms, respond with sympathy and show your concern. Follow up with them after they exit the office visit as well.
Know Your Patients
Each medical practice’s patient mix is unique — for instance, a rural practice likely has a different patient mix than one located in a university town or a metropolitan area. In addition, a practice with a specialty or emphasis, such as geriatrics or sports medicine, will attract patients with specific characteristics and medical issues. For example, a younger crowd may want convenience and a quick in-and-out. That convenience may include a wider range of practice hours or weekend visits.
On the other hand, an older patient population may want a slower pace to their appointments. They may highly value a longer visit in which the physician slows down and focuses on them. Some patient populations may want a great deal of input into their care — while others may just want to be told what to do.
It is important to ascertain what your patients want and need — and give it to them to the extent possible. To determine this, it is wise to ask, perhaps by giving each patient a card on which to check boxes prioritizing what they value most. Choices could include Web-based appointments, appointments within 24 hours, or extended evening, early morning or weekend hours.
Understand the Drawbacks
There are, of course, potential drawbacks to approaching health care as a consumer product. Physicians who begin to think of themselves as commodities may get into a downward spiral of increasingly lower profitability, focused simply on being cheaper and faster. But part of the consumer and customer service you need to emphasize is that you will provide the highest level of patient care — while making it a positive overall experience for your patients.
Sidebar: Bedside Manner Matters
For some physicians, a sympathetic bedside manner comes easily. Others have to work on it a bit more. But bedside manner is not something confined to the relationship between physician and patient. It also can exist between patients, their families and the entire medical staff. One approach to improved bedside manner within your practice is to adopt the HEART method:
Patients are your guests. Give them the four-star treatment.
Put yourself in the patient’s position. What would you want?
Everybody who comes in contact with patients needs to have an appropriate attitude. Appreciate patients.
Everybody deserves your respect, but your patients in particular deserve it. One way to earn respect is to give respect — and patients will respond to it.
Make staying on schedule a priority. Explain delays to your patients and apologize if necessary.