Managing Medical Practice Staff Workloads

September 5, 2012

Workload inequity can undermine staff motivation and teamwork. Here's how to balance the load.

The well-oiled machine has nothing on your practice. Patient volume is consistent, productivity exceeds your goals, and your monthly charges are well in line with national benchmarks. So why does your scheduler log off late every night in a frenzied fit, while the rest of your staff has time to share gossip by the water cooler?

Most practices experience workload inequity at some point in their lifecycle, where one or more employees shoulder a disproportionate amount of the weight. Often, it occurs between hires when one person has to pick up the slack for a vacant position; after downsizing when tasks get redistributed; or when jobs that result from the adoption of new technology fall to the most skilled hands. That can work temporarily, but it's not a long-term solution, says James Bavendam of Bavendam Research, a business management firm in Mercer Island, Wash., that works with healthcare groups. "That's not sustainable over time and it's not realistic. Eventually, you'll start seeing more errors, burnout increases, and true productivity decreases over time because of higher turnover." To maintain optimal performance and keep your employees content you'll need to take steps to ensure that practice workload is equitably divided.

Assessing workload

That begins by taking stock of who does what, says Frank Chapman, chief operating officer of Asheville Gastroenterology Associates, a 17-physician practice in North Carolina. His group completes periodic throughput studies in which patients are handed a clipboard when they walk in the door. Each member of the team who interacts with that patient - from the time they enter the building to the time they leave - signs off on it and notes the time. "Basically, it's a handoff from one staff member to the next, and then we put the information into a big spreadsheet and look at things like how many people were in the waiting room, and how long did they have to wait?" he says. "We identified that the longest wait period was for patients who arrived between 1 p.m. and 1:30 p.m. because all of our medical assistants were taking lunch at the same time as the doctors, instead of staggering their lunch break so patients would be in the exam room waiting when the doctors were ready."

Importantly, the study also identifies how many patients each staff member is assisting in a given day. "The first time I did this study, we found a 200 percent disparity in workload," says Chapman, noting the results highlight which employees are best at dodging work. "When we define the data we post it so now one employee realizes they're taking 30 patients back a day and another sees that they're only taking 10 - and their co-workers know it." Such data is used not only to bring underperformers up to speed, but to reward the hardest workers through merit-based raises.

For her part, Patty Arnott, office manager with Sierra Skin Institute, a two-physician dermatology practice in Reno, Nev., keeps tabs on workload by monitoring overtime, bottlenecks in patient flow, and the timeliness of daily reports. "When I start to see that an employee is constantly taking overtime, I pull them aside and ask what's happening," she says. "I ask them, 'Are you overwhelmed? Why are we in this situation?'" If it's not because they're filling in for someone on vacation, Arnott asks what part of their job they can delegate to another member of the team. She has the same conversation with the accounting staff when they fall behind on their end-of-the-day financial reports. "I keep an open door policy so I hear what's going on in the office around me, and my employees know they can come to me if they're having problems," she says, noting she requires all staff members to arrive at her desk with at least one solution.

Start with a clean slate

In some cases, of course, it's not the employee's fault that their productivity is subpar. They may not have enough to do. To ensure workload is distributed evenly, try listing all of the mission critical functions that make your office tick (white board style) - from billing and scheduling to recordkeeping, patient registration, answering phones, and exam room preparation, says Donna Knapp, a consultant with Medical Group Management Association Health Care Consulting Group. Now, step back. "Look at your overall work flow to determine where each cog in that wheel needs to be and make sure those cogs are separated appropriately based on the number of people you employ," Knapp says. Some offices, for example, have their schedulers do it all - book appointments, inform patients when they need to bring copays, and provide all instructions for their visit. "That all has to be done, but it doesn't necessarily need to be done by that person," says Knapp. "Assign some of those jobs to other staff members to allow your scheduler more time to make appointments."

Turnover and changes to your office space are a good time to reevaluate workloads and tweak as needed. "Your physical space has a lot to do with how you divide work," says Knapp. "If there's a wall that separates your office, it may take someone five times longer to walk to the other side of the office to get the job done. You have to look for efficiencies." You can't very well rebalance workload, however, unless your staff is able to handle more than one job. "Training is essential to ensure that workloads are fair," says Knapp. "If you have multiple locations, for example, your front-desk [staff] at each office should be trained properly to make sure that the doctor encounter forms are complete and accurate before they go to a central billing office," she says. "Don't dump on one or two people when you can train and have everybody do their part."

Perception plays a part

Remember, too, that workload isn't merely the physical work your staff completes. It's also the amount of work they feel that they're doing. "As your workload increases, so does your stress level, but conversely as stress increases so does your sense of workload," says Bavendam. You can mitigate crises on both ends by ensuring your policies and procedures don't create roadblocks to efficiency. "Often, policies are written in ways that are designed to protect the organization from lazy or inappropriate behaviors, not in a way that helps the employees do their job better," says Bavendam. Consider, for example, whether it's necessary to have your staff complete duplicate forms just to create a paper trail. Or, whether multiple signatures are essential on every financial form, when periodic audits would be equally effective and less time-consuming.

When your workload is out of whack, you risk losing your best and brightest. By monitoring the distribution of responsibilities in your practice you can help ensure that those who aren't pulling their weight don't escape attention, while those who put forth extra effort get rewarded for it. "Ultimately, you want compensation to mirror the level of work," says Bavendam. "There are many individuals who don't work as hard as everyone else but play the social game very well, while the wallflower might run circles around them without getting recognized. If you know what their workload is, it's easier to pay your people for what they do."

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the September 2012 issue of Physicians Practice.