Get Past the Chaos

Does it ever feel like your practice is stuck in crisis mode? You spend valuable time putting out procedural and administrative fires when you should be concentrating on your patients. And that's just the beginning. There's never time for creative thinking or long-term planning - critical to the practice's growth and financial health. For many physicians, it's become just a matter of surviving the chaos, one day at a time.

I know what it's like, having witnessed it with practices I work with. How would your office respond to the following?

• The office manager has been in a serious car accident and is in intensive care. Payroll is due tomorrow and she is the only person who knows the password to the accounting system.
• A physician's medical license or credentialing just expired. Both renewal forms were in the pile of mail that nobody's been able to get to.
• There's a major computer glitch, the office has lost electrical power, or there's a medical equipment malfunction, and no one knows what to do.
• The physician's plane was grounded Sunday night and she has a full schedule Monday morning. Does anyone know what kinds of appointments should be rescheduled and which ones should be handled Monday by another provider?

Mobilize your staff

Your staff is there to support you as the physician. Each one of them should have a pretty good idea of what to do in a situation that needs immediate attention - if not to resolve it themselves, to know who to see or where to go to get it done. And forget about the "it's not my job" syndrome. Better-informed employees make ... well, better employees. Fewer emergencies will mean a much more pleasant working environment - as well as fewer patients who pick up on the tension and wonder about the competency of your practice.

In short, mobilize your staff; train them to respond quickly and professionally to the crisis of the day. Eventually, the urgency of these crises will fade.

One of the best ways to empower staff to get things done on their own is to have written procedures that everyone understands and follows to a T, every time. You need written procedures for all routine operations - appointment scheduling/rescheduling, computer system backups and power failures, and recurring financial activities such as payroll. Have staff make a list of all the activities they do on a regular basis and how they go about completing them. It's a good opportunity to step back and see if there are better ways to do things and, in the end, to get all procedures in writing.

Must-have policies

Who you gonna call? - Start by making sure your office has a list of contact information for all vendors, contractors, and consultants - any outside people you do business with. It should include names, phone numbers, e-mail addresses, account/contract numbers, and a description of what that person or company does for your practice (e.g., Internet troubleshooting, cleaning service, building manager). Post it in a few accessible locations throughout the office, and make sure everyone gets an updated version whenever changes or additions are made.

Keep those machines hummin' - Power failures are not uncommon, particularly during spring and summer electrical storms. If your practice has battery backup for critical equipment, a power failure generally requires an orderly logoff of people from computers and a shutdown of some equipment.

A few strategically connected backup units can avert a lot of potential crises. Have battery backup units for the computer server, critical workstations, the phone system (if you use PBX), and medical equipment that must stay on during a procedure.

Show the entire staff how logoff and shutdown must occur and, with written procedures as reinforcement, cross-train enough personnel so the process can be completed even when you're short-staffed - say, during lunch breaks or late clinic hours.

If your practice relies on a big, heavy-duty copier that always seems to need a repairman, consider buying a small desktop copier and establish an account with Kinko's or another local copy store as a backup.

Sutures, please - What's more frustrating than being in the middle of a procedure only to find the necessary sutures aren't in the drawer where you expected them to be? Avoid expensive overnight shipments and rush trips to the office supply store by establishing an inventory system that includes an order point for each item. An order point is the minimum quantity of an item to have on hand; once it is reached, it should trigger an order so new items arrive, with reasonable shipping costs, before the supply is depleted.

Not my job, but I can do it - The long-term benefits of cross-training are well worth the time and effort. People can cover for each other during vacations, illnesses, or unexpected departures. But there are other benefits, too. People tend to enjoy work more when they have the opportunity to do a variety of tasks, and it gives them a perspective and appreciation of how each individual fits into the larger team.

Calendar it - There's no excuse for missing credentialing deadlines or payroll, or having scheduling mishaps when a physician is out on vacation. There are plenty of easy-to-use electronic calendars such as Outlook, ACT, and Goldmine that are just made for putting all key dates in a central, accessible location. Some practices use their office scheduling system to post daily administrative reminders - just create a provider named "Administration" and input key items. Use an old-fashioned paper calendar if you have to, but be sure key activities and deadlines are written down and visible well in advance.

Several months out, note when medical and DEA licenses expire, recredentialing is due, and contracts and leases are up for renewal. Include regular tasks like transferring money to the payroll account on designated days of the month. See at a glance who's on vacation and when to avoid scheduling jams. 

Time to plan

Once you've got the chaos under control, you'll have time to think creatively, and make plans for the future of your practice. What kind of practice do you want to have? Where would you like it to be in one, three, or five years? Every practice, regardless of size or ambitions, should have a business plan to help them map it all out.

According to Hal Teitelbaum, MD, who grew his practice from a small practice with a couple of partners to a 100-plus physician group, the business plan process begins with "what a particular practice sees as its mission and vision. Even before the business plan comes [the question], 'What do I, as the practice leader, feel that our role is, and what's our goal?' What will I be happy with at the end of the day?"

"A healthy business is a growing business," says Peter Lucash, author of Medical Practice Business Plan Workbook. And a medical practice can't grow without a plan.

Once you're ready to put pen to paper (or fingers to keyboard), be sure to include:

• Research about your market - Understanding the market demographics of the community you serve is crucial to making informed judgments about new or expanded services, new technology, or additional service locations. One of the biggest mistakes many physicians make when launching a new service or opening a new office is failing to account for the competition, which often has the advantage of being already established.
• Financial analysis - Though not a budget, per se, your business plan should include detailed analysis of the likely costs and revenue associated with whatever project or service you're launching. Use your examinations of your market demographics and competitive landscape to help you. Build in realistic benchmarks, then measure yourself against them on a regular basis.
• Stakeholder buy-in - Although only the physician leadership (and perhaps the practice manager) should be making business decisions, your staff, accountant, and probably your lawyer should play roles in the preparation and review of your business plan. "You don't want to get six months into something, build up $100,000 in debt, and then find out there's something you didn't know," says business consultant Lynn Hill Spragens. "Smart people ask for help."

And smart practices take the difficult - but necessary - steps away from the chaos and toward a place where they can grow and prosper.

Paul Angotti can be reached at editor@physicianspractice.com.

This article originally appeared in the July/August 2005 issue of Physicians Practice.