Auren Weinberg, MD

Does your practice have numerous quarterly, monthly, and even weekly meetings?  How effective are these meetings? Is your staff meeting for the sake of meeting, or is work actually being accomplished?

Here are some tips for making sure your meetings are productive:

Create practice teams around areas important to the practice.  Some examples of possible teams include EHR, front desk, staff scheduling, triage, patient satisfaction, and patient population trends.  Set the day and time each practice team meets.  Install a suggestion board - a large white board - in the meeting area with a list of meetings and the days and times the recurring team meetings occur.  Encourage staff members to join the practice team that interests them, but ensure everyone is on a team.  Challenge staff members to think about both the issues that come up each day that could be improved, not just in the areas their team manages, but in all aspects of the practice.

The best meetings cover topics that the attendees are invested in themselves, or at least recognize how important the topics are to the success of the practice and, by extension, their careers.  When team members are engaged in work flow improvement or policy development, they are more likely to follow the process or policy and have greater job satisfaction. Encourage staff to set meeting agenda topics by writing issues on the suggestion board under the appropriate team. Encourage staff members to include their initials, so during meetings that individual can:

- Explain the details and subtleties of the issue.

- Receive praise from management for bringing up the topic and potential solutions.

Writing on the suggestion board should be strongly encouraged and lauded as it empowers staff to propose a solution and will likely reduce negativity and complaining. Prioritize topics to keep meeting duration manageable; however, keep staff engaged by ensuring lower priority topics are acknowledged and addressed during subsequent meetings. 

Each meeting should have a designated leader or facilitator who distributes the agenda to participants prior to the meeting. Larger teams may want to consider rotating meeting facilitation among staff members or management to ensure across-the-board responsibility and buy-in.

The facilitator should prepare the agenda before the start of the meeting by gathering the topics from the suggestion board. A typical agenda may include the following topics:

• Review follow up from previous meeting.

• New items for discussion (topics from suggestion board).

• Discussion topic goal: what objective should be met by the end of the meeting (e.g., a problem defined, a completed plan, or a decision made, etc.).

• Next steps/follow up for next meeting.

• Wrap up – next meeting time/date, preliminary agenda.

The facilitator with the agenda in hand controls the discussion, and should ensure that that every attendee gets a chance to provide input.  Avoid “meeting dominators” by asking questions of quiet team members who you think may have a point that should be heard.

Meetings must start and end on time to demonstrate efficiency and the importance of time mangement.

Practice improvements are lost from meetings if the meeting adjourns without additional follow up. The facilitator must distribute meeting minutes containing notes, major discussion points, and decisions.  Include post-meeting follow up items in the minutes, including who is responsible and the target completion date. Team members are more likely to complete follow-up tasks on time when they are expected to provide an update at a future team meeting. 

As the practice grows and changes, the standing meeting schedule should be reviewed periodically and adjusted to eliminate redundancy and reduce drain on employee and management time/effort.  Develop a list of meetings including the purpose, attendees, duration, and schedule of each meeting. Review the following:

• Are meeting topics serving the intended purpose and benefiting employees, the practice, the patients, and their families?

• Do the topics overlap with other scheduled meetings?  Are there opportunities for meeting consolidation?

• Are the appropriate people attending?

• Does the meeting frequency and duration need to be adjusted?

• Are certain meetings often canceled?  These meetings may need to be consolidated with those of another team or even eliminated.

With some simple preparation, organization, and structure, your practice meetings will be engaging and productive events that your staff won’t want to miss.

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Don't just hold a meeting with your staff members for the sake of holding a meeting. Here are tips to make sure the meetings are productive. 

Effective Practice Meetings Promote Input, Productivity

The days of stumbling into medical practice success are gone.  A practice not only needs clinical leadership, it also needs what you weren’t taught in medical school - business leadership and management. You must run your practice like a business to continue to provide the best care possible for your patients and to ensure long-term practice success.

By focusing on a few key areas and activities you can keep your “business” viable. Here are a few ways to get started.

Where is your practice today?  Are you succeeding in certain areas, but performing poorly in others?  Do you excel on clinical quality metrics but have poor patient satisfaction?  Are your finances on the edge every month despite effective workflows?  Identify one or, at most, two areas in which to invest time, effort, and money to improve.

Write a plan, even if it is short and basic, that will be the roadmap for the practice to follow in your one or two areas of improvement.   Create a short term and long-term strategy to realize your practice mission.  Use S.M.A.R.T. goal setting (specific, measurable, attainable, relevant, timely) to carry out your strategy/mission.  Document and communicate your mission and ensure the entire staff is committed. 

For example, if claims are frequently being denied and require resubmission, make the short-term goal to have demographics and insurance information always entered correctly.  Audit the performance and provide feedback to staff members on how they are doing.  Long term, ensure claims are getting paid in a timely fashion.  Be sure notes and billing are done efficiently and thoroughly, and lead the charge in making a roadmap to success when you discover problems.  Having the demographics right consistently is a good first step, but see the process all the way through to payment.

A successful business retains customers (patients) by providing an exceptional experience.  Staff and providers must conduct themselves in a professional manner, and treat patients with respect at all times.  If a customer claims financial hardship, even if your staff has their doubts, listen, be kind, and convey understanding.  Allow the customer to go on a payment plan, even if it might reduce your revenue slightly.  If necessary, hire a third party to provide customer service training.  This is an investment that should provide a significant return in customer satisfaction and practice growth. 

Productive staff members have a great sense of job satisfaction, which in turn has a positive impact on the entire practice.  Employee turnover increases costs, decreases productivity, and can have a negative impact on patient satisfaction. Find and retain good employees by understanding your labor market, providing competitive compensation packages and career growth opportunities.

Standard and best practices are key to staff productivity, as they keep the practice team aligned on policies and clinical approaches, and provide clarity and an objective yard stick for measuring performance. How many notices does a patient receive before they are placed in collections?  When patients go into collections are they asked to leave the practice?  How do you ensure that nobody gives an appointment to a patient that was dismissed for non-payment?  Document standards in a practice manual and have staff members sign an agreement that they have received, reviewed, and understand the policies.

As the owner of a business you should have a thorough understanding of its revenue.  Conduct a periodic review with billing staff to discuss the current state and needed improvements.  Ineffective coding, slow billing, poor follow up, and inaccurate patient insurance information can slow down receivables.

Maximize your reimbursements opportunities.  If you are a primary-care physician, are you taking advantage of payer incentives?  Are you aware of the penalties that Medicare invokes for not participating in value-based programs?

Use technology to save time and improve practice efficiency and patient care.  Optimize the use of your EHR through templates and reports.  Templates are critical to reducing documentation time as they streamline the process of conducting the patient visit and minimize distraction during provider time with patient.  Use reports to provide the data you need to understand everything about your business from your financial position to staff productivity to at-risk patients. 

If you don’t have the resources on staff to optimize your EHR, consider hiring third-party help.  The ROI is improved efficiency and patient care, which is often worth the one time fees associated with expert services.

Practice success requires a very specific and carefully planned strategy.  Find one or two areas that need to improve, write out a roadmap to get there, become customer focused, implement consistent training and policies, know your billing, and leverage technology for your benefit.  Feel free to pay for help when you need if the ROI is worthwhile.

Practices need to expand their leadership capabilities beyond clinical-minded decisions. They have to focus on business management, too. 

Run Your Medical Practice Like a Business

With the rapidly changing healthcare environment, running a profitable practice has become even more challenging.  One of the most common mistakes in medical organizations is having staff members "working below their licenses and abilities."

What do I mean by staff members "working below their licenses and abilities?"  Staff members need to be challenged to work on the most complex, challenging tasks that their licenses and abilities allow.  As a result, productivity increases, staff satisfaction increases, and providers have more time to spend with patients.

Rethink what your staff members are capable of doing.  Here are some examples:

• Train medical assistants to answer routine medical questions on the phone instead of nurses.  Create templates for common phone calls including the complaint and the appropriate advice.  If the medical assistant is not sure how to answer, have a nurse or provider available as backup.   Have clear standards indicating what type of questions the medical assistant can answer and what type of questions need to be reviewed by a provider or nurse.  

• Train nurses to make medical decisions using standing orders.  If your office does certain procedures or treatments consistently for specific complaints or problems, create standing orders that the nurse can initiate without having to check with a provider first.  Once a standing order is completed, the provider can sign off on the order.

• Challenge providers to step outside their comfort zone.  Maybe a provider stopped doing a revenue-producing procedure a few years ago because specialists do it more often.  A brief refresher with another provider within or outside the practice can allow the practice to bring the procedure back in house to the medical home while generating revenue.

• Encourage staff to find solutions to problems, not just identify problems and complain about them.  Make a suggestion board so that staff teams can help make the practice run better.

Challenging staff members to work to the top of their licenses and abilities can improve patient health, practice productivity, revenue, and staff satisfaction and retention.  Challenge yourself to rethink what your staff members can achieve.

Auren Weinberg MD, FAAP is the Owner of Lower Bucks Pediatrics and Measures of Wellness in Yardley, Penn

An efficient and profitable practice will push staff members to work to the top of their licenses. Here are some tips on how to do that. 