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Physicians Practice Pearls: Creating an A+ Practice


Consistent staff performance is crucial. Here’s why.

I recently visited a busy, primary-care practice where the physicians were struggling to stay on top of the workload. “There just aren’t enough hours in the day,” the manager said. “These doctors have too much to do in too little time.”

Not true. The culprit was in fact low-quality clerical and clinical staff performance, and it was costing them plenty!

There were gross inconsistencies across the staff in how administrative tasks were performed, from filling out a disability form to collecting information for a phone message. Clinical staff charting was a problem as well: Sometimes the medication flow sheet was updated. Sometimes it wasn’t. Sometimes it was just plain wrong. Patient visits were truly a mixed bag - charting vitals, noting the reason for the visit, and preparing the patient for an exam were rarely executed in the same way.

Naturally, these physicians felt no confidence in their staff. This meant the doctors had to spend endless hours double-checking and reworking many tasks supposedly done by the staff. There were long wait times for patients too, some of whom became so disgruntled they took their business elsewhere. And the workdays that never seemed to end resulted in excessive overtime costs, disenchanted staff and physicians, and unhappy patients. This practice was in trouble.

I worked with the manager and physicians to put together a plan that streamlined processes, developed simplified written guidelines for performing support tasks, and revised job descriptions to clearly define each person’s responsibilities. We also defined measurable performance outcomes for each staff position, tying them directly to the job description and discussing them during the annual staff performance reviews.

Next, I coached physicians on how to delegate tasks, provide constructive criticism, and hold staff accountable for performing tasks - all based on standard, defined procedures. The physicians learned how to guide and train new employees to fit in with these policies.

In addition, we instituted a customer service training program that rewarded employees according to patient satisfaction.

It may seem like a lot of work to put this type of structure in place, but it’s the right way to do business, as there is much to gain when quality is consistent. Remember, your staff wants to serve the practice well, but they can only do it with proper training and a full understanding of their jobs and your expectations.

Several months down the road, these physicians decided to examine variables in their clinical decision-making. They developed clinical indicators they could measure and report on. The result? Attractive performance bonuses from several of their third-party payers.

Quality counts. Get on board with implementing internal quality initiatives throughout your practice and start reaping the rewards.

Judy Capko is a healthcare consultant with more than 20 years of experience and is the founder of Capko & Company ( She is the author of the top-selling book, “Secrets of the Best-Run Practices.” She can be reached at

This article originally appeared in the February 2008 issue of Physicians Practice.

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