One tool makes optimal practice profitability, productivity, and risk medication possible. So do you have it at your medical practice?
Most ambulatory practices lack the single most valuable tool for optimal practice profitability, productivity, and risk mitigation. Its presence in a practice is so unusual that physicians and staff often don't even realize it is missing.
The tool is an operations manual. Here are some of the benefits it provides:
Satisfactorily committing any idea to paper, or to any permanent storage medium, requires more disciplined thought and expression than just talking about it. The reason is that contradictions and omissions are less obvious in the spoken word. Verbal communication depends heavily upon non-verbal cues. Listeners feel a lot of pressure to signal understanding, and speakers are anxious to be agreeable. The written word or flowchart must communicate without that outside help.
A written document can help communicate relative priorities, either by the order presented or a special format or other signal.
A written record helps demonstrate sequences, branches and dependencies, i.e. context. Section headings, or table of contents entries, allow the reader to step back from the details and get a feel for the flow of events. Flowcharts, another permanent record, are even better for this function. Logical inconsistencies are more obvious and easier to correct.
An operations manual communicates the physician's goals and standards; what she wants and how she expects it to be done. Developing an operations manual requires a physician to think about her priorities and objectives in at least a somewhat organized fashion.
[NOTE: That does not mean that the physician has to actually create the manual, only that she provides guidance and ultimate approval.]
There is only so much an individual can retain from instruction, certainly until she has had the opportunity to practice a task. Most people understand this and take notes during oral instruction. Unfortunately, a trainee's lack of understanding can lead to inaccurate notes, and time constraints can result in incomplete notes.
A fairly detailed listing of the elements of a task, developed by someone who understands the objectives and the issues well is a valuable reference when a staff member realizes she does not quite remember all of the instructions.
Consistency of Execution
A listing of the elements of a task is extremely helpful when someone is unexpectedly required to step in and perform the task.
Over time, specific performance tends to drift from the standard. Periodically comparing actual processes to the documented processes can catch and correct the drift.
A clear description of the sequence and interdependence of tasks avoids many errors. It is sometimes useful to expand these into actual checklists when it is especially important to assure that each task has been completed in the correct order.
Staff Turnover Assistance
Some staff turnover is inevitable, and staff turnover is always disruptive. A comprehensive and current operations manual can minimize the disruption. Temporary employees can actually be useful because it allows them to act with a degree of autonomy. New employees can study and do some work independently. They are not a complete drag on existing employees and pick things up quickly.
An operations manual also mitigates staff turnover itself. Employees want to perform well. Those who know what is expected are much more satisfied with their jobs.
The only constant is change. An operations manual provides a central place to record new and different information and processes. A particularly valuable contribution of the manual is that the context it gives makes it easier to notice and address additional elements that need to be changed, added, or dropped. Tasks that are no longer necessary or helpful are the biggest time waster in many practices.
An operations manual supports holding both the physician and staff accountable. The objective of accountability moves away from blaming a person to correcting a situation. If the problem was a lack of knowledge, the manual is a resource. If the problem was a misunderstanding, that section of the manual needs to be better explained and it may need to be improved. If a new development made an old practice obsolete, the manual needs to be updated everywhere the new development affects operations. There is a personnel or discipline issue only if the manual is clear, correct and current.
The list of benefits could go on. I would be very interested in learning what you would add.
Next week, I will address how to develop a useful operations manual in even a very busy practice and with minimal, albeit critical, physician involvement.
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