Haines/Systems Concept for Patient Management

13

The existing work-in demand for the office, by day

put them back in the waiting room. They sub-wait pa-

of the week and time of the year, needs to be determined.

tients in the two dressing rooms. One of the x-ray techs

Then blanks should be left in the on-call doctor's sched-

reported that while wearing a pedometer, she walked seven

ule in anticipation of those work-ins.

miles in one day while processing patients. (Note that

nothing gets done while walking, so the time spent walk-

ing those seven miles is wasted to the practice.)

STAFFING ISSUES

Recommendation: There needs to be a buffer zone

An efficient staff is an important part of a productive

(i.e., sub-wait seats) between x-ray and the waiting room

medical practice. They are in the practice to help doctors

and the exam rooms. This way, patients will not get con-

get their jobs done and help patients get seen. For this to

fused as to where they are in the queue. The staff will have

be successful, staff members have a right to expect:

more control over the patient flow into the exam rooms

· Adequate space and equipment to do the job expected.

and they will walk less.

· Adequate systems to support those tasks.

· Adequate numbers to accomplish the tasks in the time

APPOINTMENT SCHEDULE INPUT

expected.

Providing a positive work environment for the staff

The smooth flow of patients through a doctor's clinic

is essential for a viable office, but it is easy for conflicts of

day is a never-ending struggle. The governing document

expectations to creep into the daily workflow.

to control this is the appointment schedule. It dictates

Every staff member must have a primary focus that

when, what type, and how many patients should come in.

takes precedence over all other duties. In the following

If the staff has no idea how many patients the doctors can

job descriptions at XYZ Ortho, this means:

reasonably see in a given time, then the appointment

Receptionist. Greets the patient. Gets the patient

schedule is little more than a spreadsheet with names. This

ready to go back to the clinic. No phones. Currently, mul-

is especially evident when a doctor is double- and triple-

tiple activities can pull the receptionist away from the pri-

booked. Furthermore, if a doctor habitually runs late, this

mary focus.

causes all sorts of additional problems. The appointment

Float nurse. Gets the patient into the exam room,

book brings the patients in on time, but if the doctor is not

ready for the doctor. No long, time-consuming tasks. If the

there to unload the waiting room on schedule, the wait-

float nurse is to remove casts and sutures (someone other

ing room overflows, as does the parking lot. The office

than the doctor needs to do this), then the float nurse

falls behind, and then the staff gets stressed. If the delay

should not be used to load doctors' exam rooms.

is unavoidable, reschedule patients or discuss the options

X-ray tech. Returns the patient to the exam room

with them.

for the doctor to finish the exam. Typically the exam room

A doctor's patient-per-hour rate (and coordinated

should not be held for the patient who has gone to x-ray.

to the appointment schedule) is typically determined while

(At XYZ Ortho, if two patients are ordered to x-ray and

using a scribe. If the scribe does not show up for work on

one is being scheduled for surgery, the doctor is down to

a particular day, the doctor's rate of hourly production

working out of one exam room.) With a sub-wait at x-

can fall 10 percent or more. Meanwhile, the appointment

ray, the x-ray staff and the float nurse can stage patients into

schedule is still bringing patients in at the predetermined

and out of the exam rooms efficiently. Furthermore, this

rate--a disconnect.

sub-wait allows the x-ray techs to spend more time tak-

Also, one doctor is dedicated as the on-call doctor.

ing x-rays, rather than walking around.

This doctor is typically booked a full schedule, and then

Check-out. Greets the patient, collects the cash,

unscheduled work-ins are added. Under the best of cir-

and/or makes the reappointment. No phones.

cumstances there are no work-ins and the doctor sees pa-

tients on time. As soon as a work-in shows up, things

Stat vs. Nonstat Functions

begin to fall apart.

Recommendation: On an annual basis, each doc-

It is easy to create a job performance expectation

tor's typical hourly patient output should be quantified. This

that has inherent conflicts for successful performance. This

then needs to be coordinated to the appointment sched-

happens at XYZ Ortho. For example:

ule. (Patients should be brought into the practice slightly

· If one staff member is given two stat functions, such as

faster than the doctor can see them. This way there is al-

loading the exam rooms and taking off a cast, then the

ways a pool of patients waiting for the doctor.) So if the

staff member is bound to fail at one of the tasks.

doctor's typical rate of patient management is six patients

· If one staff member is given a stat function and is re-

per hour, perhaps the appointment schedule should be

sponsible for a long function as well, such as schedul-

set up to bring in seven. The office should have a backup

ing surger y and removing sutures, then the staff

scribe to pinch-hit when a doctor's regular scribe is out.

member is bound to fail at one of the tasks.