The reason for standardizing the way we move patients through the practice is because of the high cost of variation. Alternatively, establishing processes creates predictability where it’s needed most, between physicians and patients, as well as between those same patients and the medical office staff. It improves organization and the overall efficiency of the practice. Allow me to explain.
I once consulted for a practice hoping to grow to three dozen physicians. Two groups of six docs, each, planned to merge into the group and, interestingly, they worked right across the hall from one another. My role was to manage the transition by establishing work flows and processes. Right away, I learned the corridor separating the two medical groups was the dividing line. And, it wasn’t difficult to see the difference between the two practices from the moment I walked into each of their patient care areas.
Walking into Medical Group Number One, I found a quiet, calm and, frankly, empty reception room. The patients were all being seen and staff were busy, either talking the phone regarding patients, completing work in charts, or walking down the hall toward a specific task. It was all very organized. Standing at the check-in counter, I could imagine how satisfied their patients must be with the efficiency and service at Group Number One.
At Medical Group Number Two, chaos reigned in the waiting room. Let’s be clear, it was a waiting room, not a reception area. With twice the staff, those on the phone were chastising the patients for calling in to get their lab results, because, of course, they didn’t know when those would be received. There were others searching for someone who could schedule a physician’s next appointment because only a specific person could do so, and still, others were on-the-hunt for some missing item or record. Everyone did have one standard practice, they were all complaining of stress. That was true for everyone: Patients, staff, and physicians, alike.
The difference? The first practice had good processes, standardized policies and procedures. The staff followed them and followed through with their promises, which included consistent, clear directions for patients. Practice Number One had half the staff, happier patients, and staff, and operated in a quiet, calm, organized environment. All of this administrative efficiency was due to the physicians agreeing on how-to set up and run the practice, consistently.
In Practice Number Two, I determined that the phrase “My Medical Assistant” was code for a separate, unique, process and plan of action, per physician. At practice Number Two, the standardization came in standard replies including the phrase I-don’t-know: “Let me find someone to help you; and I don’t know how to schedule for that physician.”
The very real object lesson while standing in that corridor between medical groups is this: If everyone does things similarly, then any patient can be helped by any member of the staff. The process for setting things up is the same.
I learned that along the way, the docs in Medical Group Number One had asked one another: “So, same type of patient – help me understand why each of us manages that patient differently from one to the other?”
Let’s be clear: The specific treatment, per patient, may differ. However, the actual process of scheduling and treating a patient, as well as following up to meet their care needs, can be the same. The process of efficient and effective workflow in the practice is the area to focus on reducing variation.
It gets back to answering the question: “Can somebody help me?” and the correct answer is “Sure, anyone can help you.” If there is some standardized process, the question can be answered by the first person on the phone, rather than having to put someone on hold, then seek out two or three other people, as was the case in Medical Practice Number Two.
I’m always amazed when I advise a small practice and look at job descriptions. There are only three or four people in the office, why are they so different? I’ve come to believe that these job descriptions end up defining what it is the staff member WON’T do. Unfortunately, these result in people not being aware of how the whole process works, and how to actually help the patient. So, I follow three rules when helping to standardize medical practice operations:
- First and foremost, it’s about communication: The physicians, the staff and the patients all need to be in possession of the same information in order to work well together.
- Agree on a process that everyone can follow, and then stick to it: It’s not okay to create a patient policy and procedure handbook if you don’t actually use it. Moreover, if a physician in the practice does not want to do something that way, then resolve it and create a new consensus on how-to do things.
- Take a moment to conduct patient and provider education: It might be in the patient and provider handbook, but ensure you include that information on your website and possibly also in a brochure. Review it with them and ask if they have any questions. At Medical Practice Number One, the employees knew their “never” events: Never say to the patient “call us” for routine lab results and never say “call us” for prescription renewals. Patients were told what to expect, where to go for help and the staff followed through on their promises. All evidenced because phones weren’t ringing off the hook from patients calling with questions.
So, you wonder, how did things work out between Practice Number One and Number Two? Well, after the physicians and staff took a few tours of each other’s practice environment, the switch came quickly enough. Not without a few fits and starts; a few folks agreed to the new processes and didn’t follow them, at first, and a physician could be heard saying the phrase “My Medical Assistant,” now and then.
After a while, the pieces fell into place creating consistent efficient workflows throughout the entire practice resulting in happier patients, staff, and physicians. Can we succeed in the new business of health care? Of course, we can. And, it all happens when good workflow processes are in place, creating lower staff turnover, and happier physicians.