What if your current staff could actually get all of their work done, you could see 30 percent more patients, or you could get home in time for dinner? How happy would patients be if wait time decreased?
The rule of thumb is that 30 percent of the activity in any type of office is wasted. My experience is that the percentage is even higher in a medical office. The more useless labor you can eliminate, the bigger the increase in productivity and the fewer mistakes. A careful review of some or all of the processes in a medical office can generally be expected to yield productivity gains of at least 30 percent in the areas addressed.
All work, productive and non-productive, is part of a process. Identifying and eliminating the wasted work in a particular process is a project with specific steps. Staff, even those not directly involved in the process, must be included in the project. Their knowledge of what is really happening is invaluable, and their buy-in promotes sustained change.
1. Choose a process you would like to streamline. You will be more motivated to attack a process that is causing major problems, but it might be helpful to practice technique on something simpler.
2. Answer this question: What should the process accomplish and why is that important? Take the time to clearly state the purpose and value of the process and write it down. This is the yardstick for future evaluations. This is the only aspect of the project that the physician(s) cannot delegate or outsource.
3. Write down the steps in the process, in order. Leave some space between the steps. Once you think you have all the steps, walk through them to be certain you have not left anything out. Add what you left out and walk through again. Repeat until all steps have been captured. An individual, with subsequent review and refinement by a knowledgeable group, can create the initial outline of the process.
4. For each step, ask the group:
• What does this have to do with the goal? If nothing, eliminate it. If not much, eliminate it or combine it with another step.
• Is another step performing the same function? If so, which one produces the best outcome? Eliminate the less effective step.
• Is there a better way? Do you have a tool, not available when the process was first developed, that gets the job done more effectively and/or efficiently?
• Could a step be added that would have a positive impact on a subsequent step? Would it help to sort a previously unsorted list? Would a paper report be easier to work than one on a screen?
5. For the amended process, ask:
• Are any additional steps necessary? If something will be printed now that was not printed before, what will be done with the paper?
• Are the steps in the most logical order? Examine alternative sequencing as a possible improvement to the process.
• Is the process intuitive? Will it be easy for the person doing the work to remember?
• Are any steps error-prone? What can be done to minimize or eliminate the propensity to error? If it cannot be eliminated, what can be done to validate the step was done properly?
Repeat from Step 5 until satisfied with the proposed process.
6. Once the improved process is implemented, choose another process and repeat the analysis. Continue until satisfied (even delighted) with the way the office works.
The only difficulty is finding the time and discipline to perform an analysis of a process and implement improvements.
Each successful project frees up resources and makes it easier to address another process. Morale improves because office operations are improving. Stress decreases because there is actually time to do what needs to be done. Staff turnover goes down and profits go up. Give it a try.
Stryker has also posted a detailed case study using the recommendations above.
Carol Stryker helps busy physicians and their practices increase profits, improve patient satisfaction, and mitigate risk by focusing on how work gets done. More than 20 years of responsibility for aggressive operational improvements has produced a strong preference for effective solutions, implemented quickly. Her long history of successfully designing, selecting and implementing complex software systems and managing vendors is especially helpful as clients move to EHRs. E-mail her here.