Physicians: Get a Good Look at Practice Operations

The most significant challenge to effective medical office operations is not often mentioned. Physicians have no way of observing, in the normal course of business, their office operations.

The physician is either in an exam room with the door shut, or away from the office altogether. She knows if patients are being appropriately prepped for an exam and if the exam room is properly set up and stocked. Otherwise, the physician is only aware of symptoms, and the noteworthy symptoms are almost always negative: patients are complaining, staff turnover is high, charts are misplaced, and lab results cannot be found. The situation turns the physician into a firefighter, addressing specific problems with a sense of urgency but never identifying and correcting systemic issues.

What's a physician to do?1. Engage a competent, non-threatening ally. Most often this will be an outside consultant, but it can be a talented member of the staff. The essential traits are patience, objectivity, acute powers of observation, and systemic thinking. The requirements for patience and objectivity almost always disqualify the physician for the role.

2. Explain the objectives to the ally. "Make it better – NOW" and a recitation of current failings are not actionable, although the background information can be useful. Instead, the physician must clearly state what the ideal solution would look like and draw an actual or a word picture. The point is to give the ally a target.

3. Let the ally gather information and develop a proposal for a solution. The gathering will involve at least observation and interviews. The staff generally has an opinion as to the root problems and often has solutions to suggest. These may not be accurate, but they are always good input to developing a solution.

4. Evaluate the ally's proposal. This requires staff participation. Sometimes the presentation, evaluation, and any amendments are done with physician and staff together. More often, especially when this approach is new for the practice, the presentations and discussions are separate.

5. Make it happen. A systemic plan will require a contribution from just about everybody. The physician's job is to provide needed resources, and to hold herself and her staff accountable to their commitments.

6. Celebrate the success. Clearly defined objectives make it possible to know when the exercise has been completed. Celebrating successful completion builds trust and momentum for subsequent operational improvements.

What comes next?

More of the same is not a bad answer. Once the most bothersome failing has been addressed, it is time to attack the next most bothersome. Once everything is working well, it is appropriate to ask, "What is OK now, but could be better?"

Regular staff meetings, including the physician, is an even better response. Staff meetings serve several functions:

• They provide a venue to check on how well any operational improvements are holding up. Without consistent reinforcement, drifting back to old habits is probable.
• Staff meetings provide an opportunity to resolve unanticipated consequences of agreed upon changes.
• They provide a venue for staff members to surface other issues and to participate actively in developing solutions for them.
• Constructive staff meetings build mutual trust and respect between the physician and the staff, and among the members of the staff.
  
  The ultimate goal is an environment where everyone in the office is a motivated ally of the practice and its patients.
  
  
  Find out more about Carol Stryker and our other Practice Notes bloggers.