Systems Concept for Patient Management

Richard C. Haines, Jr.*

I

n this article, the author provides guidance relating to the flow of pa-

tients, staffing, and communications issues that can greatly enhance

the productivity and profitability of a medical practice. These sugges-

tions can improve the satisfaction level not only of patients but also of

providers and their entire staffs.

The author cites the example of an orthopedic practice, but the guid-

ance can be broadly applied to all venues of medical practice.

Key words: Medical practice; medical practice management; medical practice

staffing.

Editor's Note: The author specialize in medical office planning and design. Over many decades, his firm has served

hundreds of medical practices, large and small. He shares the distillation of their concepts of practice methodology to guide

physicians and managers to reassess their own modes of operation.

ther bad nor good. It is just the function that governs the

A medical practice essentially represents an assemblage

production rate capacity of the complete system. In the

of systems. These systems check patients in, move patients

practice of medicine, this primary constraint is access to clin-

from one service to another, get diagnostic information on

ical medical judgment, the physician. Many people in the

patients, and research patients' problems. The list could

medical office perform important functions, but those

be endless. The medical office facility is merely the means

functions occur because of, and at the rate supported by,

to keep the weather from interfering with the smooth op-

those making clinical medical judgments.

eration of the systems, a practice tool that should be in-

vested in, just like exam tables, x-ray machines, and cast

saws. When done right the smooth operating systems al-

CASE STUDY

low everyone's job to be done more easily, and everyone

XYZ Ortho needs to view itself as a "business." This

has the opportunity to achieve higher levels of produc-

does not have to be in the commercial sense, as in selling

tivity and patient service.

a product, but in the sense of dispensing a scarce com-

Therefore, an understanding of the systems that

modity: access to a doctor's intellect, judgment, and skill.

drive the practice and have an elemental impact on its per-

So the essence of the "business opportunity" can be de-

formance is critical.

fined as the ability to optimize the individual doctors.

There are three major systems in a practice: flow sys-

Often, this optimization does not occur.

tems, staffing systems, and communication systems. In

The medical office can be viewed as a machine. It

addition to understanding these systems, one has to have

consists of a series of discrete activities that happen in a

a hierarchical concept of the relative importance of dif-

consistent and predictable order. Items (patients) come

ferent systems. Then, decisions can be made about which

in the front, are acted on (by staff), and are sent out the

systems should have priority over others.

back (by the doctor). To help the office achieve a smooth-

In the creation of a system of interrelated functions,

running character, the volume of activity at all the differ-

at least one of those functions will emerge as the critical

ent links needs to be understood so they can be integrated.

constraint to production. Constraint in this context is nei-

Patient throughput can be arranged as shown in

Figure 1. What this means is that the entire organization

for operation of the medical practice should be organized

*President, Medical Design International, 2100 East Exchange Place, Suite

400, Tucker, GA 30084; phone: 770-939-7950; fax: 770-939-7522; e-mail:

around the doctors' productivity capabilities. Staffing for

www.mdiatlanta.com.

patient throughput is a function of the volumes of pa-

Copyright © 2005 by Greenbranch Publishing LLC.

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