Medical Practice Management · July/August 2005

14

Realign your job descriptions so staff members can

tice. Then make sure that only an hour's worth of work is

expected in an hour. (Many practices set up systems that

succeed at their primary focus.

require more than an hour's work from an individual and

Time Wasters

then wonder why they do not get the job done.)

At the end of the day, the job gets done, but if time

The Care Team

is being unnecessarily wasted, it needs to be reclaimed.

In developing the concept of managing patients

This allows the staff to be more available to help the pa-

through the office, the doctors at XYZ Ortho have cre-

tients and doctors. XYZ Ortho needs to rely more on elec-

ated a team concept. The typical team consists of:

tronic communication and less on the sneaker network.

· 1 doctor

The following ideas can avoid time-wasting activities:

· 1 scribe

· Everyone needs a place to call "home" (where is the

· 1 RN/surgical tech

float nurse's home?) and there should be a phone in

· 1 receptionist

that location.

· 1/3 insurance person

· Light signal systems should be used to keep the doc-

· 1/3 Worker's comp person

tors on track, so they can go to their next patients with-

· 1/3 file-room person

out seeking the nurse to ask for direction or going back

This team concept is important not only from the

to their offices to check the sheet.

office staff's point of view but the patient's as well. This

· Light signal systems should also be used to let staff

has the potential to bond the patient to the practice not

(float nurse, RN, x-ray) know when and where they are

just through the doctor, but also through staff. This is es-

needed.

pecially important in high-volume surgical practices. While

· Check-off order forms should be used to instruct the

the doctor may spend little time with the patient, the team

staff member (float nurse, RN, x-ray) about what is

has the opportunity to meet all the patient's expectations

needed without talking to the doctor.

of time and attention from the office. It also has the po-

· Electronic medical records (EMR) can supply some of

tential to get the right staff person to the patient at the

this capability. Just make sure you are not so fascinated

right time to deliver the right message. Such differentia-

by the technology that you create more work for oth-

tion can get some tasks, such as patient education, off the

ers. EMR is a tool, not a panacea.

doctor and onto a staff member. In observing the patient

Finally, recognize that different rates of production

flow at XYZ Ortho, we have concluded that this team is

govern the time allotment to a particular staff member's

more for the doctor's use than the patient's. Our obser-

job, and remember that any particular staff member has only

vations include:

60 minutes an hour in which to work. So if the job re-

· The receptionist has very little time and contact to

quires 80 minutes of work per hour, then you need to

bond. She is already pulled in too many directions. She

staff that spot with 11/3 people. Let us define what gov-

has to work through glass.

erns a particular staff member's production rate:

· The doctor has the time and opportunity to bond.

· Hourly. Hourly staffers work at the rate required by

· The scribe does not appear to bond with the patient.

the doctors' production. (In actuality, they should have

The scribe is a nonintrusive, transparent presence in

the ability to produce slightly more work per hour than

the exam room, taking the progress notes.

the doctor. That way, they can stay ahead of the doc-

· The RN can bond. RNs may help in the cast room (al-

tor.) If their hourly work is lower than the doctor's,

though this needs to be rethought). They also sched-

then the doctor's production also falls. Staff members

ule surgery, take patient phone calls, do prescription

who should be allocated based on the doctor's pro-

refills, and help in surgery. Giving the patient a specific,

duction rate include receptionists, room loaders,

familiar person to call with questions is a practice asset

cast/suture removers, and x-ray techs.

(although perhaps an expensive one).

· Half-day. These staffers work at the rate required by

· Business office staff have a little opportunity to bond

the half-day session volume. Patients may have to wait

with patients, primarily those with payment or insur-

a little for this staff member's availability. Such staff in-

ance problems. Giving the patient a specific, familiar

cludes surgery and test schedulers, and check-out

person to call with questions is a practice asset.

clerks.

· Weekly. These staffers work at the rate required by the

RN Functions

weekly volume of patients going through the practice.

Such staff includes insurance handlers, billers, and pre-

A special word about the RNs is in order. At XYZ

cert clerks.

Ortho, the RN has 10 half-days of production available.

Look at the clinic's expectations on time required

Of those 10, approximately four are spent in surgery with

for each person's performance. Eliminate waste so each

the doctor (in few of the practices we have observed do the

staff member has more time available to serve the prac-

doctors take an office staff member to surgery with them;