Eliminate Downtime!
Increase Patient Volume and Enjoy Your Practice Life More.
Waiting on a patient to be ready? Looking for the staff? Waiting for a patient that is in x-ray? Running behind once several patients get ready at the same time? Does this sound like your day?
These frustrations are not uncommon. You went into medicine to care for people, standing around wasting time does not help you accomplish that. Orthopedics is a completed field that has many steps in the patient’s visit process. Those steps often get out of sync and cause the provider to lose time from seeing patients.
To get from where you are today to a practice life that is much more productive, has a higher patient volume and more enjoyable takes getting your 4 S Production Chain in sync. That means Your Style, Staffing, Systems and Space all working together to keep you with a ready patient and patients not waiting long periods during the visit. Although much has been written about Patient Centered Care, in outpatient orthopedics to get that patient centered care, we must focus on the doctors first to dictate how the Chain is built. The reason is, patients don’t control their time and process through the visit, your practice does. And the patient is there to see you, the most valuable resource the practice has, doctor time.
So, to get the patient the care they need in a timely manner we need to focus on how the doctor’s time is used. How your time is used generates your Patient Per Hour Rate. There is the rate you are seeing patients now with all the issues you face, and then there is your Natural Rate. The rate you would see patients if you always had a ready patient to see and could go from patient to patient with no downtime. Your Natural Rate will be affected by your personality, do you like to talk more to your patient or less? Your sub-specialty, are you a hand or sports doctor that are typically higher volume sub -specialties, or are you a spine doctor that are typically lower volume due to the complexities of the patients’ issues. The key is that it is Your rate, not a rate that others tell you your supposed to see, or one dictated by a practice wide appointment template.
That rate determines how large the Style link the Production Chain is for you, with the Staffing, Systems and Space links are all based.
Style
To determine the Natural Rate your Style generates you need to do a doctor focused time study. A study that tracks how the time of the doctor is used and allocating the tasks that are consuming the time to tasks the doctor has to do (review chart, exam, etc), tasks that could be done by others (escorting patients, loading patient into exam room, charting), and time that is just wasted (no patient ready). That along with how many patients the doctor saw during the time study will allow you to calculate the current patient per hour rate and the Natural Patient per Hour Rate.
Once you have the list of tasks that need to be eliminated and/or deleted you can begin devising ways to accomplish that. And as those are implemented the down time will begin to go away and the doctor will have more time to see patients. The appointment template will need to be adjusted to have the correct mix and rate of patients to fill that newly found time. And this higher patient volume does not subtract any productive/effective time the doctor is spending with the patient.
Staffing
When you are doing the time study of the doctor you will identify tasks the doctor is doing that a staff member could do for them. Often this is because the staffing numbers are being kept low to reduce costs. But at what expense of doctor time and revenue? All too often staffing is looked at as an expense only, not the revenue source they can be. Focus on the fact that staff member is allowing the doctor to go see patients and therefore generate revenue.
Not that expense is not considered. Look at what the staff member is being asked to do, their knowledge/pay scale and is it right sized? For instance, is the x-ray tech the one going to get the patient from the exam room and escort them back? Or is there an x-ray assistant/MA level person assisting that higher paid x-ray tech?
For the most part the number and type of staff your practice needs is based on the number of providers in your practice and the patient volumes (Natural Rates) of those providers. The time study will determine the patient volume of each doctor. The weekly schedule will determine the overall patient volume.
A time study much like the one done for the doctors can be done for the staffing. This will determine on average how long tasks take. That time can then be multiplied by the patient volume to determine how many staff is needed. This can be done per provider, such as MAs needed per provider, or clinic wide such as how many x-ray or casting staff needed for all providers in clinic at once. Make sure the tasks that will be delegated from the doctors to staff are accounted for as well.
In an effort to keep staffing as low as it can be, assess the weekly provider schedule. How many total half day clinic sessions are needed each week? How many providers are in clinic at once? Is there a large swing in the total number in at once? Could the schedule be adjusted to keep the total number of sessions per week the same, but lower the number of providers in at once? This will allow the practice to either add doctors and keep staffing the same, repurpose existing staff or lower staffing numbers.
Systems
Systems encompass everything that deals with moving a patient through a visit. They tend to be that portion of the operational flow that ties different staff, providers, and areas of the clinic together. For instance, communications systems allow receptionists to let MAs or x-ray staff know a patient has been checked in. Poor systems of walking a “chart” to a ready rack wastes time. But electronic methods of printing some type of visit sheet to the MA or x-ray staff’s station is more efficient.
Electronic communication systems can efficiently let the providers know which room is next, x-ray to know where to get a patient, providers to call staff to a room, etc. All while not wasting time of the providers and staff walking to deliver information and or orders.
Another System would be how a patient is physically moved through the visit. For instance, how is x-ray ordered and when is it done during the visit? Taking a patient to an exam room for the MA to gather info then order an x-ray, delays the x-ray, ties up an exam room and often keeps the providers without a patient ready. But if protocols are set in place to automatically get x-ray first, the patient can go straight to x-ray after checking in. The receptionists would notify the x-ray department instead of the providers MA. This speeds up the process and does not tie up valuable exam rooms while a patient is in x-ray.
The idea in setting up the systems of your practice, is what can be done without having to walk and talk? Let the computer system, software, light signaling system, do the communication for you so staff and providers can spend more time with patients.
Space
Space, the last S in the Production Chain, but often the first one architects want to design. The Space can not be sized and designed until the other S’s are understood because the need for and the layout of Space should be a reaction to the Operational Flow and Systems of the practice and Style of the providers.
Determining the amount and complexity of the space needed is the first step. That is based on the patient volume the providers are projected to see, the number of providers in clinical the same time, staffing model, services provided, and any nuances of the practice. The space needs is identified by developing a Space Needs Assessment spreadsheet listing every space, the size of each space and how those spaces are related.
This Space Needs Assessment spreadsheet is the guide to planning the layout of the space. A view of the mountains is nice and makes the space feel better, but planning decisions should be based on one question, “does this allow the provider and staff to be more efficient and better serve patients?” Getting the best patient, staff and provider flow is the goal of the layout. That layout can then be wrapped with attractive architecture and interior decorating. That gets you the best of both worlds, attractive and productive.
Summary
The 4 S Production Chain approach works whether you are assessing your current office to determine if it best suits your needs or designing a new office. It is an approach that takes an extensive knowledge of how orthopedic practices function and how patient/staff/provider flow, and space affect provider productivity.
Practice Flow Solutions has over 65+ years of working with practices of all specialties that has gained us the extensive knowledge that it takes to provide this type of service. We welcome the opportunity to put that knowledge to work for your practice.
