The Most Effective Way to Improve Medical Practice Productivity

July 30, 2014

When medical staff members do not perform tasks properly, it drives down productivity and profits. Here's how to gauge the size of the problem and resolve it.

The single most effective way to improve patient care and satisfaction, reduce costs, and increase physician income in a medical practice is to drive down the percentage of re-work.

The term is self-explanatory, but the implications can be subtle. Intuitively, a task that has to be redone increases the workload by a factor of one: If a five-minute task has to be done twice it takes 10 minutes.

The reality is far worse than that. Consider the following example (the time estimates are illustrative and not based upon any actual data):

• The medical assistant takes and records a patient's vitals: three minutes   
• The physician enters the exam room and greets the patient: 30 seconds 
• The physician reviews vitals and sees that the numbers are nonsensical: 30 seconds
• The physician either retakes and records vitals (three minutes); or leaves the exam room to finds the medical assistant and send him back to exam room to correct the error (two minutes to five minutes)
• If the physician asked the medical assistant to correct the error, the physician may go on to see another patient while the medical assistant retakes and records the vitals: three minutes
• When the medical assistant is finished, he leaves the exam room to tell the physician the patient is ready: five minutes
• The patient sits in the exam room waiting for physician: 15 minutes  
• The patient complains to the physician: two minutes
• The physician apologizes: two minutes

So, a task which should have taken three minutes ends up taking between seven minutes and 21 minutes. (The patient waiting time is not included in the calculation because it does not directly affect the physician or staff time spent on the task.)

If the physician sees an average of 30 patients per day and this failure occurs 10 percent of the time, the practice will lose between 105 minutes and 315 minutes of productive time per week. If the error rate can be reduced to 5 percent, the practice will gain as much as two and a half hours of productive time per week. In an office where not everything is getting done, two and a half hours per week can be put to good use.

The example makes it clear that it is more efficient for the physician to correct the medical assistant's error and move on. Please note that is an ineffective solution.

Behavior changes when a person recognizes the need for change, when not changing is less pleasant than changing. As long as the physician assumes responsibility for the medical assistant's work, the assistant has no incentive to change.

The effective solution is to require the medical assistant to correct his own work, even though it takes more time in the short run. That is the only way to drive down the error rate. The physician can mitigate the negative short-term consequences of not doing the work herself by checking the record before she enters the exam room.

Consider all of the sources of rework in a practice: missing lab results, incomplete or misplaced charts, multiple calls from patients for the same question or request, unverified insurance, an out of control schedule, specialized medication or devices not available when needed, etc.  In a typical medical practice it amounts to at least one third of available staff time.

Rework in a medical practice is an elephant, and it can be eaten one bite at a time.

Pick the most common service failure in your practice. Try to understand the root cause and develop a solution. Then, resist the temptation to do it yourself rather than hold the responsible parties accountable.