Haines/Systems Concept for Patient Management

11

Appointment

Doctor

Staff

Schedule

Output

Throughput

Input

Governing Activities:

Governing Activities:

Governing Activities:

Governing Activities:

Reception

Effective Scheduling

Check-out

Doctor Exam

Load Rooms

Appointment Template

Surgery/Test Scheduling

X-ray

Casting/Suture Work

X-ray

Figure 1. Medical Office Productivity Flow

tients that the doctors can reasonably manage in a given

the time in the exam room with other activities related to

period of time. Finally, input into the office is a function

that patient. They can "forget" the encounter.

of the appointment schedule. If the appointment sched-

The data shows that in at least one case, an individ-

ule (input) is not linked to the doctor's productivity (out-

ual doctor's patient throughput capacity can be increased

put), then there are bound to be mismatches--causing

nearly 25 percent by going from dictating to scribing.

the waiting room to overflow.

This brings up another issue. The scribe gives doc-

tors the opportunity to focus completely on their patients.

The doctors get to spend the majority of their clinic days

. . . the entire organization for operation

practicing medicine--not doing the grunt work that goes

of the medical practice should be

along with it. This is a significant quality of life issue.

organized around the doctors'

This does not mean everything is perfect. The doc-

productivity capabilities.

tor's specific patient management team consists of the

doctor and a scribe. They are "joined at the hip," going

Let's discuss each of these interrelated activities.

from patient to patient. But what happens when a cast

needs to come off or go on, sutures need to be removed,

DOCTOR OUTPUT

or x-ray needs to be notified to take a film? If the doctor

or scribe has to go look for the hall nurse (or the RN as a

Doctors should be able to go from patient exam to

backup) for help, this detracts from the doctor's effec-

patient exam. The doctors are responsible for the overall

tiveness.

result, so the more efficiently the doctors can do this, the

more effective they can be, the more care can be given,

The scribe gives doctors the opportunity

and the more revenue can be generated. Therefore, any-

to focus completely on their patients.

time a gap occurs, the doctor is the one left to fill the gap.

In XYZ Ortho, the gaps range from the doctor searching

Recommendation: Use scribes throughout the prac-

for forms, filling in forms, and removing sutures to search-

tice and implement communication systems so the doctor

ing for information in the charts.

and scribe are not away from their exam rooms trying to

find people or get goods.

. . . an individual doctor's patient throughput

capacity can be increased nearly 25 percent

OFFICE FUNCTIONS AND PROCEDURES

by going from dictating to scribing.

X-ray. Note that x-ray is listed in Figure 1 as both

The doctors at XYZ Ortho already do a very good

a throughput and an output activity. This is because some

job going from patient to patient. This is greatly enhanced

patients are x-rayed before they get to the doctor (through-

by the utilization of scribes (either court reporters or

put), whereas others are x-rayed mid-exam (output). In ei-

stenographers). The doctors can stay on task and stay fo-

ther case, if x-ray cannot keep up, the doctor's productivity

cused on the patient. When the doctors are done with

suffers.

their patient exams, they are done. They do not have to

Test and surgery scheduling. Scheduling for tests

"carry around" the memory that they have to follow up

and surgery is shown as a post-exam activity in Figure 1.