Some physicians underutilize their staff or simply feel that the steps necessary to cultivate a productive environment are too difficult. Any increase in an office's efficiency decreases expense and waste and thus boosts productivity and income. Moreover, patients recognize and appreciate a well-run office. They are more likely to return to an efficient practice as well as to recommend it to their friends.
Breaking the re-engineering effort into stages can make the overall goal of greater efficiency easier to accomplish. Identify the necessary changes, create a plan, and be ready to repeat the endeavor as the need arises.
THE PATIENT'S VISIT
Patients' first impression of an office often forms upon their initial interaction with the staff. Efficiency, however, begins before patients enter your facility. For example, mailing paperwork to new patients and allowing all patients to complete the necessary forms online before arriving at your office speeds up processing. Before their visit, remind patients what they need to bring with them: old records, authorized referrals, insurance cards, and photo identification. Also, inform patients of which examinations they are scheduled for and how long they can expect to be at your office. Suggest they arrange for a driver if they are to undergo pupillary dilation to avoid liability issues. Set patients' financial expectations over the phone. Informing them of which services will not be covered by their insurance when an appointment is scheduled can improve collections as well as eliminate hostility at checkout.
STAFF
Each employee should have a clear and appropriate job description. Training must be continuous with the goal of increasing the staff's skills. Delineate your expectations regarding job performance and the time per assignment for each member of the staff. When a team member is unable to complete tasks, identify the shortcoming and provide training. The guidelines for your staff must be realistic, monitored for effectiveness, and adjusted when necessary.
Periodic performance reviews should be conducted for all employees. During these discussions, be sure to emphasize staff members' strengths in addition to pointing out any deficiencies. Bear in mind that training new employees is not cost effective and decreases your office's overall efficiency. Recognize and reward excellent work. Competitive salaries combined with a generous benefits plan enable employees who share the practice's philosophy and support its success to feel well compensated for their hard work. Promote teamwork by recognizing that all employees are essential to the practice's well-being. Listen to employees' suggestions for improvement.
FLOW
Require the on-time arrival of all contributing parties. Having your staff perform at peak efficiency when the doctors arrive late jeopardizes everything that the staff has accomplished. The most difficult component of office flow is scheduling patients. Estimating the length of time that it will take for a patient's visit is critical. Develop benchmarks for the length of each particular type of appointment. Determine the average duration of specific tests, such as imaging and visual fields. The scheduling of patients should create a smooth, well-timed flow from patients' point of entry to their point of departure. A breakdown in any segment will undermine the entire process.
Attempt to cut out repetition. Cross-train your staff to limit the pass-off effect that stymies the movement of patients through the office. When an extra diagnostic test is needed, multitalented staff can get the job done with minimal disruption. Do not tolerate an attitude of "it's not my job." Also, make sure that the physical layout of your office permits patients to move through their visit without retracing their steps.
Staggering the staff's (both support and professional) hours to accommodate the busier times in the office should decrease patients' waiting times and minimize the additional expense of overtime. When staggering hours, it is important to schedule starting, break, lunch, and ending times for maximal efficacy. Remaining open during the lunch hour keeps phone lines functional, allows patients to be seen, and maximizes the facility's utilization. Scheduling for efficiency should create a steady flow of patients through the office. An additional benefit of efficient scheduling is that it should prevent the staff from being overwhelmed and possibly overworked. Neither of these stresses contributes to a positive working environment.
ELECTRONIC SYSTEMS
Electronic practice management and electronic medical record (EMR) systems can transform a good office into a great one. As Bill Gates has said, however, "The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency. The second is that automation applied to an inefficient operation will magnify the inefficiency."
It is imperative that the electronic practice management system be capable of supporting the operation with regard to scheduling, billing, recalls, and any other important tasks. Additional needs can be determined by your management team. The basics must be easy to implement and maintain. Otherwise, a very sophisticated system will not support your efforts and may actually impede progress.
EMR systems are still evolving. In the authors' experience, the professionals who have spent the time, money, and effort to incorporate EMRs into their practices admit that it involved great effort and expense. Many of these individuals say that EMR systems are excellent tools once they are up and running, whereas others have had a negative experience. If you plan to install an EMR system, be sure your office is at peak efficiency or risk magnifying its flaws.
CONCLUSION
If a new product fills a void or complements your present operations, it may be worth the investment. Consider the cost effectiveness of any new system before purchasing it. Try to get a risk-free trial whenever possible. Anything that sounds too good to be true probably is.
Finally, do not lose sight of why you became a physician. Sitting with a patient during an acute attack of glaucoma is not cost effective. Comforting a patient who has lost vision is not lucrative. Holding the hand of a longtime patient who has lost a spouse is not efficient. All of these actions are rewarding, however, and a good leader will balance efficiency with the art of practicing medicine.
Leslie Bardt, COE, is Practice Administrator of Delray Eye Associates, PA, in Delray Beach, Florida. Ms. Bardt may be reached at lesliebsg@hotmail.com.
Steven M. Litinsky, MD, MBA, is Affiliate Clinical Assistant Professor, University of Miami, Miller School of Medicine at FAU, Boca Raton. He is also President of Delray Eye Associates, PA, in Delray Beach, Florida. Dr. Litinsky may be reached at litinskymd@aol.com.
