Maximizing Physician Productivity

BY RICHARD C. HAINES

An individual doctor’s personal productivity is controlled
by four factors: the doctor’s Style, the practice’s Systems, Staffing to support the doctor, and Space to support the doctor.

   The doctor’s style has to do with the way he or she likes to manage the patient. This is often the most difficult aspect of the doctor’s practice setup to change, and oftentimes the least productive element to try and change.     The systems which support the doctor can be easily

 

  In direct support of the doctor, the technicians also need
adequate space to prepare and process more patients per
hour than the doctor can produce. This preparation space
can be either integrated with the doctor’s exam module or be
distinct from it. Regardless, it does little good to have a doctor
capable of seeing six patients per hour and staff only capable
of preparing four.

CLINIC-WIDE SCHEDULING

Doctors typically have specific expectations regarding
their weekly access to the clinic. For many ophthalmology .

altered and easily accommodated by the doctors and the staff. Doctors generally accommodate changes to their systems, as long as it makes life easier.

Staffing is a touchy item.
The doctor’s ability to be
really efficient in a managed
care environment oftentimes depends critically on how well he or she has delegated to ancillary staff. This can be
difficult for some doctors to do.

 practices, this equates to six half-days of exam time each week

    If this is the case and if the practice has four doctors in it, then it can be easily seen that the office needs to provide 24 half-days of examination time per week to serve its doctors.
   If that same clinic is only
open Monday-Friday, mornings
and afternoons, then the
number of doctors in the clinic
at any time would average
2.4 (24 divided by 10 = 2.4).

The final element for consideration is space. If the
doctor does not have enough exam rooms, he or she cannot
generate the patient throughput and optimize practice efficiency.
There is a synergistic relationship among the four S’s.
To help a doctor achieve his or her potential, all the elements
need to be understood and integrated to allow the doctor to
smoothly go from patient side to patient side with the least
amount of down time in between.

THE DOCTOR’S WORK AREA

  Whenever a doctor shows up to work, he or she has a
right to expect adequate space and adequate staff to meet his or her potential. A retina doctor may need his or her exam rooms set up differently than a cornea subspecialist. Each doctor needs the number of rooms that his or her patient output demands. This is a discrete quantity of space and should not vary depending on how many doctors are in the office. It is the doctor’s job to see patients; it is the clinic’s job to see that there are adequate patients, adequate space, and adequate staff to do that job.

 

 

 

 

 

 

 

 

 

 

This means that the office should provide three exam
modules for the physicians and schedule either two or three
doctors in the clinic every day of the week.
An undisciplined schedule for such a clinic might have
one doctor in one day and four doctors in another day.
Comparing that to the maximum of three as shown in the
example above, the undisciplined schedule is wasteful. Not
only is more space needed for that fourth doctor, but also for
the staff to support that doctor and the space to support the
staff. But, there is a hidden implication to this as well. With
the undisciplined schedule on a four doctor day, ancillary
services will tend to be overloaded. Then, on a subsequent
day when there is only one doctor in, those same services are
way under-utilized. By normalizing the schedule of access of
physicians, patient loads on ancillary services can be more
predictable and staffing can be more regular.

STAFFING

Doctor productivity can be harmed by inadequate or
inappropriate staffing. In much of the literature being written.      

Continued below


Physician Productivity: Style,Systems,Staffing,Space

for doctors today, there are constant references to staffing
reductions. Even if the staff member is not fully busy,
sometimes the value of the physician’s time they free up is
greatly in excess of their salary.
    Another issue has to do with doctor interruptions. When
staff has a problem (it may be a phone call from a patient or
some other issue), their first reaction is often to pass
responsibility for that issue on to the doctor. A lot of these
issues could be solved other ways than by just asking the
doctor. Instead, the staff should be responsible for managing
most problems that are within their capabilities. Those issues
that have to be directly addressed by the physician, get
addressed with the doctor at specified times when the doctor
allows himself to be interrupted.
    It is not uncommon in observing staff to realize that they
may spend a total of an hour a day doing nothing more than
walking from one place to another within the facility. Not
only is the staff not productive during this time, but they are
also generally not available to assist the doctor. So, in order
to keep the staff working in one place, and to keep them
available for the doctor, look for ways to move information
that does not require the staff to get up and move.

PATIENT PER HOUR RATE

The rate at which a doctor puts patients out of his or her
service dictates the minimum rate that the patients should be
brought in to his or her service. It will also determine the
number of chairs the doctor needs in the waiting room to
support his or her patient flow, the number of parking spaces
required in the parking lot and the number of check-in and
check-out people necessary. This patient per hour rate

 

 

 

 

 

 

 

 

 

 

should be reassessed every year to identify any changes that
are necessary.

COMMUNICATION SYSTEMS

   Ineffective communication systems in a practice often
rob a doctor of the opportunity to smoothly flow from one
patient to the next with minimal interruptions. If the doctor is
to smoothly move from patient side to patient side, then all
forms of “interruptions” need to be minimized. For instance,
doctors often leave the exam room and look for their tech in
order to assist the doctor, issue a verbal instruction, or find
what room to go to next. This loss of productivity can be very
damaging to a practice and can be easily eliminated by
systems.
    For instance, if the doctor is in the exam room and needs
assistance, the doctor can activate a light signal system to
summon a staff member to the room. This way, no matter
where the technician is working, he or she knows that they
are needed by the doctor and can proceed to assist the
doctor. When a doctor is done with one exam and wishes to
go to the next patient, he or she does not need to find the staff
to find out which room is next. By activating the room
sequencing light system by the door to the patient room, the
light by the room of the next patient in sequence begins to
flash and the doctor knows right where to go to stay on track.
    While these techniques are simple, they minimize the
need for the doctor to have face-to-face communication
with staff between one patient exam and the other, thus
increasing the doctor’s effectiveness and the staff’s effectiveness
at the same time.
About the Author: Richard C. Haines is president of Medical Design International, located in Tucker, Georgia.