The prospect of developing a useful operations manual for a medical practice can be daunting. It becomes much less so with a clear understanding of the objectives and some simple tools.
Remember the function of any operations manual
An operations manual is a ready reference. It is there when:
• A particular subject matter expert, including the physician, is not in the office;
• A change needs to be implemented and it is important to avoid unintended consequences; and
• To support and reinforce staff training.
It should be neat and well-organized. It must be accurate. It has to be internally consistent to fulfill its obligation as the definitive authority on the standards of the practice.
An operations manual is not intended to be great literature — simple words and short sentences are more important than engaging prose.
Accept the practical consequences of a living document
In the best of circumstances, an operations manual is in an almost constant state of flux. It is corrected and updated as understanding, circumstances, and the environment change. The consequence is that it will seldom be pristine and look as though it is fresh from the printer. An operations manual without annotation is probably not being used.
Make a point of formally updating the manual on a set schedule, i.e., quarterly or semi-annually, but accept ad hoc modifications in the interim. Trying to keep the document itself perfect makes it too much work and the effort will be abandoned.
Start with a table of contents
Medical practice operations are so complicated it is very difficult to know where to start. A prospective table of contents supplies a useful framework and discrete tasks. It can make the task manageable.
In the beginning, an accordion file with its tabs labeled according to the table of contents is a handy way to begin organizing information and forms. As new topics present themselves, add them as section headings and placeholders.
When the operations manual progresses to a word processing document, be sure to format section headings in a way that enables the word processing program to generate the table of contents automatically.
If the practice is working with the operations manual as an electronic document, the "Track Changes" feature of Microsoft Word is especially useful. It records who added or changed information and the date, and it preserves the original information.
[Click here for a sample table of contents to use at your medical practice.]
Gather the content that already exists
Look around the office. There will be lists of all sorts of things posted at each workstation. Individual employees will have their own private notes. The best individual resource is probably your most recent hire, because her notes from training will be the most congruent with current practices.
If the information in the lists and notes is correct, it is valuable and needs to be available to everyone in the practice. If not, it needs to be stamped out.
Ask staff to describe what they do
In the process of doing their work, staff can record the steps. The objective at this point is to capture as much as is practical without making the task so burdensome it is abandoned. Missed steps can be added later.
Content reconciliation is critical
Anyone on staff can accumulate the material, but the responsible physician must review and reconcile it, both initially and at regular intervals. In almost every review, the physician will learn something about what is really going on in the practice. It is a wonderful opportunity to discuss discrepancies with staff, gather their input, and come to agreements acceptable to all.
An operations manual is the single most valuable tool for optimal practice profitability, productivity and risk mitigation. It can be developed and maintained without a huge investment of practice time and energy. What is required is a clear view of its function and acceptance that it will never be perfect or completed.
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