Five Principles for Better Practice Operations

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Five Principles for Better Practice Operations

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Learning Objectives

• 1.      Identify the causes of heavy telephone
  traffic in your practice and proactively design a
  plan to handle these issues before the calls are
  received.
• 2.      Summarize ways to prepare for the patient
  visit, create more efficient work stations, and
  work in real time to improve practice operations.
• 3.      List ways your staff can support the
  practitioner to provide more time for patient
  care.

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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching v. Real-Time
• Supporting the Practitioner
• Conclusion

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Two Patient Flows
WHEN PHYSICIAN IN OFFICE
EVERY DAY
15 to 25 Patient Office Visits
75-100 Patient Phone Calls

1,000 to 2,000 patients per MD

Source Physicians Practice PCHIV research 2003
office visits per physician, active patient panel
size are patients seen at least once during the
past 3 years.
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Two Patient Flows
75-100 Patient Phone Calls/Physician
PATIENT ACCESS OUT OF THE OFFICE

• Reason for Call
• Rx Refill - 20
• Test Results - 10
• Phone Triage - 20
• Schedule Appt - 20
• Billing - 5
• Other - 10

Sample
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Two Patient Flows
Example 2-Physician HIV Provider Practice
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Two Patient Flows

• Rx Refill Ask patients while theyre in the
  office and review meds list
• Extend meds to NEXT appointment
• Test Results Establish realistic expectations
• Schedule appointment
• Phone Triage Prevent the call altogether
• Study why are patients calling?

ANSWER THE PHONE!!!!!
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Two Patient Flows
Percentage of Patients Unable to Understand
Instructions
Source Albright J, et.al., Readability of
Patient Education Materials Implications for
Clinical Practice, Applied Nursing Research,
1996, 14 139-143 Picker Institute,
Supportive Cancer Care The Patients Perspective
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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching v. Real-Time
• Supporting the Practitioner
• Conclusion

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Preparing for the Visit

OPERATING ROOM
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Preparing for the Visit

• Anticipate the Visit
• Preview the Chart
• Staff/Physician Huddle
• Exam Room Prepared
• Consistent Support Staff

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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching v. Real-Time
• Supporting the Practitioner
• Conclusion

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Efficient Workstations
RECEPTIONIST A
RECEPTIONIST B

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Efficient Workstations

• Reception/Registration Front Office
• Physicians Exam Room
• Nurse/MA Nurses Station
• Others?
• Every unnecessary step is unproductive!
• Solution Get closer to one another or use
  technology

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Efficient Infrastructure

• Resolving the Problem
• Co-location
• Resources to people
• People to people (care teams in large groups)
• Technology
• E-mail
• Workflow module in practice mgmt system
• Cordless phones
• Other
• Be aware of the walk-n-talk phenomenon!

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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching v. Real-Time
• Supporting the Practitioner
• Conclusion

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Batching v. Real-time

• Look for Batches!
• Dictation
• Messages
• E-mails
• Voicemail

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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching v. Real-Time
• Supporting the Practitioner
• Conclusion

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Supporting the Practitioner

• Practitioners Time
• Wasted
• Delegatable
• Productive

lt60
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Supporting the Practitioner

• 1. Start on time and stay on time! (Use Dr.
  Jones if necessary)
• 2. Communicate in writing
• Charge ticket/encounter form
• Message board
• Numbers on the exam rooms
• Patient flow sheet

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Supporting the Practitioner
3. Stay on the court dont escort patients
4. Create a FOURTH exam room let the work
come to you, and take care of it!

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2


3
4
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Supporting the Practitioner

• 5. Dictate/document right after or even
  better, during the visit.

6. Dont be trapped by your own schedule!


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Supporting the Practitioner

Down to 3 or 4 types


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Supporting the Practitioner

• Try modified wave scheduling

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Supporting the Practitioner
7. Make your staff truly supportive

• Smooth volume and match supply to it
• Beware of Professional Organizers
• Shift staff BACK to seeing patients
• Process work on a real-time basis
• Dont let crises consume every day
• Simplify the work

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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching v. Real-Time
• Supporting the Practitioner
• Conclusion

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Conclusion

• Efficiency is not elusive
• YOU are the System!

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For Further Reading on Streamlining Flow

•    The Goal by Eliyahu M. Goldratt, North
  River Press, 1985
•    Lean Thinking by James Womack and Daniel
  Jones, Simon and Schuster, 1996
•    Mastering Patient Flow by Elizabeth Woodcock,
  MBA, FACMPE, Medical Group Management
  Association, 2000
•   The Perfect Practice by Sherry Delio, Medical
  Group Management Association, 2000
• Reducing Delays and Waiting Times by Tom
  Dolan, et al., Institute for Healthcare
  Improvement, 1996        
• Service ManagementOperations, Strategy and
  Information Technology by James A. Fitzsimmons
  and Mona J. Fitzsimmons, Irwin McGraw-Hill, 1998.
  
•  The Service Profit Chain by James L. Heskett,
  W. Earl Sasser, Jr. and Leonard A. Schlesinger,
  The Free Press, 1997
• Stop Managing Costs by James P. Mozena, Charles
  E. Emerick and Steven C. Black, American Society
  for Quality, 1999
•  The Successful Physician A Productivity
  Handbook for Practitioners by Marshall Zaslove,
  Aspen Publishers, Inc., April 1998

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Agenda

• Managing Both Patient Flows
• Preparing for the Visit
• Efficient Workstation/Space
• Batching vs. Real-Time
• Supporting the Practitioner
• Conclusion

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Contact Information

• Elizabeth W. Woodcock, MBA, FACMPE
• 428 Emory Drive
• Atlanta, GA 30307
• 404-373-6195
• 404-373-1698 fax
• ewoodcock_at_physicianspractice.com
• Ask an Expert at www.PhysiciansPractice.com

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an independent educational grant from Roche
Pharmaceuticals.
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