When staff members are overloaded, look for simple ways to maximize their productivity. You don't always need to add staff.
Medical practices can be very busy places. As long as patients are well served, staff is not overwhelmed, and nothing slips through the cracks, busy is good. When a practice seems to be too busy, the first reaction is to ask for more staff, which is intuitive but misguided. Adding staff generally makes things worse unless three questions have been asked and effectively addressed.
1. Is everything currently being done really necessary?
Processes and procedures are constantly changing as resources and needs change. New processes almost always add new tasks. The problem is that we seldom look at how a new process can make existing tasks unnecessary. This is especially true with the advent of e-prescribing and EHRs: new processes are implemented without identifying paper processes that can be eliminated. The plethora of forms presented to patients is another good example. Forms get added without an evaluation of what can be combined and/or eliminated. All of that paper irritates patients and adds a lot of work to the front-desk staff.
A more perverse example of unnecessary work is rechecking and rework because processes are not providing reliable results. The office probably has enough staff to do the work once. It should never have enough staff for three people to do the same work three times.
2. Are tasks assigned to the right people?
Part of this is about personality. An extreme introvert is not likely to be effective on the phone or at the receptionist's desk. A high-energy extrovert will have a hard time doing very detailed paperwork for any period of time. Playing to an employee's innate strengths will dramatically increase both accuracy and productivity.
Another element is whether staff members are a good fit for the practice. A bad hire is not only less productive than a good hire; a bad hire degrades everybody's production, including the physician. Once you've confirmed that someone is underperforming and cannot be reformed, they need to go.
3. Are tasks scheduled in the best way, or not at all?
When possible, tasks should be batched to eliminate the productivity loss inevitable in switching from one task to another. Insurance verification, checking on lab results, and prescription refills are examples of tasks that benefit from being performed in batches.
Any task that requires more than minimal concentration should be done away from the reception desk and without an obligation to pick up the phone. Interruptions double both the number of errors and the time the task takes.
As the day winds down, front-desk staff may be underutilized. By transferring some of the work staff does when a patient presents for an appointment to the day before, the practice can more fully utilize their time and get patients into exam rooms more quickly on the day of the appointment.
Adding staff is necessary only when the answer to each of these questions is "Yes" and there is still too much work for available resources. Most practices will find that this exercise will free up more than enough productive capacity to relieve the resource constraint - at least the first several times they go through it. It is relatively simple, although sometimes challenging, to significantly increase productivity by just looking at the work and making adjustments.