How to Turn Your Office into Your Most Valuable Practice Tool

The right tool makes all the difference! I’ve said that a thousand times over the years working on cars, motorcycles, my house, appliances. And just like its true for those things, it’s true for your practice as well.

Tools are made for a specific purpose and your office should be designed specifically around your needs. A well deigned tool(practice) enhances and improves the outcome, not deters from it. And in today’s environment of increasing costs and reimbursement not keeping pace, having the right tool is crucial.

To transform your office into a well-functioning practice tool you must first objectively assess your practice to determine how well it serves providers, staff, and the patients. This assessment will then allow you to determine your needs to transform your practice into that well functioning practice tool you need.

Assess your office

There are lots of articles out here about patient flow, patient experience, etc. But when was the last time you went to the doctor for the experience? Probably never. Patients go to the doctor to get an issue addressed. They want to get in and out and get their problem solved. This means a practice that is productive so patients can get appointment in a reasonable timeframe, and a practice that runs on time, so patients do not have long waits.

Patient do not control their time in your practice, therefore tracking their time does not give you the correct data you need to make changes. To see how well you are doing, do a time study on your providers and staff to see how their time is consumed. Pay particular attention to times they have no patient, doing things below their skill level (doctors escorting patients out for example), or things that just waste their time such as walking to communicate.

Track the time each of these events take and place each task and time into one of two categories,

• Things the providers Have to do (practice medicine)
• Things the providers do but do Not Have to do (escort patients, enter info into chart, go get things).

Compare the total time versus just the time the providers Have to do to see how much time is being lost. This lost time is often what is causing the provider to run late, patients having long waits, patients to no show/cancel appointments. What things are causing this lost time will be different for each practice, but the solutions all follow the same concept. A well functioning practice has the Input-Throughput-Output systems in sync. Meaning the providers’ Output Capacity (patient per hour rate) is optimally supported by good Throughput (staffing model, flow processes), and Input (appointment template).

Now that you have the potential patient per hour rate of the providers you can use that rate, and the weekly provides schedule to determine practice patient volume and the needs you have for Throughput and ow to design your Input.

Project Your Needs

Staffing Needs

Staffing needs are determined both per provider and practice wide. For instance, the number of support staff an individual provider needs can be projected by timing the pre provider work up time required per patient and multiplying that by the hourly rate of the provider.

The practice wide staffing that deal with patient in the office need can be projected by using the weekly schedule to determine the overall patient volume per session or per day and multiplying that by the time per patient at each task (check in, testing, checkout, surgery scheduling, etc.).

A note on the weekly schedule. As you look at the overall volume if you notice large swings in the total hourly volume from session to session, assess how many providers are in, who is in and can this be rearranged to smooth out the peaks and valleys in overall patient volume.

Space Needs

Projecting space needs is complex, due to patient volume, services provided, equipment, staffing needs, etc. As far as exam room need goes, two factors determine that per provider: average number of minutes the provider spends per visit, and time it takes the staff to ready a patient in the exam room the provider just left (room turn over time). For example:

This indicates that if the provider sees 5 patients per hour, they spend on average 12 minutes per patient. The turnaround time for a room is 10 minutes. Therefore 2 rooms mathematically would support this patient volume-turn around scenario. But remember, these projected times are averages, so at times things will go faster or slower. If the provider time and the turnaround time gets close, as it is here, we would recommend a third exam room to make sure there is always a ready patient or the provider.

A second example of space needs projection based on patient volume is the waiting room. Take the session with the highest total hourly volume of all providers in at the same time, double that to add in 1 family per patient, subtract the number of exam/treatment/triage type rooms you have that patients would occupy and if you have any internal sub-waiting areas subtract out ½ of those seats. This gives you the number of seats you need, with a little extra for personal space, in your main waiting room to support the patient volume you are projecting to see.

Input

One of the most common issues practices have is getting the appointment template in sync with the rate the practice can move patients through, and the providers’ output rate. When not in sync, logjams and long waits happen and/or times providers have no patient ready.

As we mentioned before, knowing the patient per hour rate is critical in making all the upstream from the provider decisions. For the appointment template, you want it to bring patients in slightly faster than the provider can see them to give staff time to prepare the patient and account for the variations from the average. To do this, assuming 4 hour sessions, take the hourly rate of the provider and multiply by 4. Divide that number by 3 to determent the rate to schedule patients over the first 3 hours of the session. This brings the 4 hour session of patients in over the first 3 hours, keeps the patient’s wait short, and allows the practice to end the session on time.

Other items to consider when designing the appointment template are the visit types (length of visit) and how those types of visits are arranged. For instance, you do not want several long/new type visits in a row because that slows the intake/through put down and if a no show happens a large portion of time is empty. Mix short, medium, and long visits so there can always be a patient available to be prepared and seen.

Conclusion

In all production type processes there is a constraint. That constraint is what governs the overall production. In medical practices you want that governor to production to be the provider. That is why when assessing your practice concentrate on the provider’s time, and make all decisions based on “does his help the provider spend more time with patients?”. Following that philosophy will guide you to successfully transforming your office into an invaluable practice tool.

About the authors: Larry R, Brooks, AIA, and Tim Griffin, AIA, Practice Flow Solutions, Inc. www.PracticeFlowSolutions.com, 678-935-7911