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Staffing for Work Flow


Wondering if you are overstaffed? Make sure to evaluate your work flow and practice operations first before cutting staff.

“Am I overstaffed?” I hear this question all the time from physicians. Generally what I find are appropriate staffing levels, but ineffective coverage. In other words, over the course of a week, the right number of staff are in place, but on a given hour of the day they are not. The key to effective staffing is understanding your practice’s work flow.

Phones. Even without consideration for specialty type, every practice administrator will tell you that the phones are busier on Monday mornings than any other time of the week. Yet, practices often have the same number of staff answering phones on Monday morning that they have on Thursday afternoon.

To get a better idea of your phone volume and peak hours, do a simple study of incoming phone calls by asking your phone staff to make a tick mark for every incoming call (on a per hour basis) over the course of a week. If you think you didn’t get a typical week, try it for two or three weeks. You can further break down your demographics by identifying calls by type: appointment requests, prescription refills, questions for the nurse or doctor, test results, and billing questions. Once you have a better handle on your highest call volumes - broken down by days of the week and hours of the day - you will be better equipped to assign staff effectively.

Triage. A triage nurse can typically support about sixty-five calls per day. All too often, physicians don’t staff for this position, instead trying to return calls themselves in between patient visits, no-shows, or even lunch breaks. This often creates additional problems: repeat calls from patients, high staff burn out and turnover, and poor patient satisfaction ratings.

Lunch hour. In any business, customer service shouldn’t stop during lunch hour; yet all too often I see practices close operations for lunch. Many patients have only their lunch hour to make personal calls, and if your phones are off service they can’t access you. You should know how many calls come into your practice during a typical lunch hour. And, if you don’t answer them, your patients may go somewhere else for their care. Even the smallest practice can stagger lunch hours so that phones will be answered the entire day.

Work hours. If your first patient is scheduled at 8:30 a.m., then your door should be open by 8:00 a.m. That means your receptionist should start her day at 8:00 a.m. as well. However, you don’t need your check-out and referral staff starting that early. Have these positions come in later and leave later so they are available at the end of your day. This is also a great way to reduce overtime. Don’t forget to release your receptionist earlier than check-out staff; once your last appointment is roomed, that function is complete for the day.

You know your practice better than anyone. Make an effort to critically watch your work flow and adjust staffing as necessary - being flexible will improve efficiency and lighten the load for everyone. It just makes sense!

Rosemarie Nelson is a principal with the MGMA healthcare consulting group. She conducts educational seminars and provides keynote speeches on a variety of healthcare-technology and operational topics. Drawing upon her diverse experience, Nelson provides practical solutions to help medical groups succeed in their practices. She may be reached at www.mgma.com/consulting/nelson.

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