Efficient use of a practice’s staff time = greater profitability.
That’s an equation that every doctor and manager knows to be true. But awareness of that fundamental link between superior productivity and increased revenue isn’t enough. The challenge is to fully realize efficiency within your own practice. Nowhere is this more a challenge than in a practice’s technical department. Since patients and problems can gobble up precious time beyond your control, it is all the more crucial to ensure that everything within your ability to fully affect is handled as efficiently as possible.
In Greg Brinton, MD’s May 2008 Techniques article on office culture, he states that “Doctor time is what brings income into our practice, so we must constantly think of ways to conserve that limited commodity.” And, as we all know, fewer patients means less revenue. The key to improving doctor throughput is to delegate as many steps as possible to technicians. However, the doctor’s efficiency can only be fully realized with adequate support.
If your practice is typical of many, hiring and retaining qualified technicians continues to be an ongoing challenge. When you couple the recruitment challenge with the increasing cost of practice — payroll being the largest contributor to practice expense — the clear solution is efficiency. To this point, the challenge is to improve the efficiency of doctors and technical staff.
If the technician or doctor often has to leave the exam room for key items, such as a fresh bottle of Fluress, consent forms, plugs, etc., this precious commodity is being wasted. Such inefficiency will affect your schedule, putting you behind or forcing you to pad the schedule to accommodate your disorganization.
Realizing efficiency requires a commitment to developing and maintaining systematic and repeatable processes. In order to support quality care in a timely fashion, this goal must be communicated to and carried out by each member of your technical staff. The linchpin of a system of efficiency is the template, a model for carrying out proper care or procedures.
Common Use of Templates
While every ophthalmology practice encounters unique cases that require an entirely new approach of care, the vast majority of what you do is something you’ve done before. That’s good news. After all, repetition not only results in quality improvement, but also can and should improve your efficiency. To fully realize the pinnacle of productivity, however, you must harness that knowledge and create templates so you can apply that information to future, similar procedures.
We all use templates in some ways. For instance, a clinical schedule is a type of template that helps you manage time. Why do you do this? It’s not because you want to be controlling and tell Ms. Jones that you can only see her for her OCT on Mondays, for example. No, it’s because you want to try to see the most patients you can in the least amount of time. By creating a schedule for time, you maximize your efficiency.
Templates are commonly used by the administrative staff of an ophthalmology practice. For instance, the business office also has some prominent template examples within its practice management system, such as the “patient information/demographic” area of your system. The insurance department functions almost exclusively in templates, with its use of billing screens, data information screens and myriad insurance forms. And yet, for some reason, the technical department often only uses templates in the broadest of circumstances.
Expanding Clinical Use
While technical departments likely use templates in their printed or electronic medical records exams, they often reinvent the wheel and rely on memory when performing procedures beyond the fundamental exam.
For years, my own practice’s technical department only used the following templates:
- Contact lens algorithms,
- Minor surgical procedures performed in the office (chalazion removal, superficial keratectomy, YAG lasers, etc.), and
- Medical history-taking.
While these were helpful, it took us a while before we fully realized the power of templates in improving the technical department’s efficiency. The key was extending their use to include the treatment for common disorders, such as corneal abrasions, uveitis, conjunctivitis, keratoconus, etc. We began to develop many templates like these for our technicians and now offer more than 20 templates. This use of templates has expanded further in our clinical use, resulting in even greater efficiency of our technical department.
Years ago, when our practice first started offering laser vision correction, we would occasionally forget to complete some part of the exam or counseling. But we developed a template for these consultations as well. For instance, our exam sheet now includes every step required to give a comprehensive refractive evaluation, including an area to remind the surgical coordinator of all of the medications needed, from Celebrex and Vigamox to preservative-free tears and vitamin C. The technician is required to initial each area of the form to indicate that it was complete to ensure accountability.
We also have a surgery data form for cataract surgery and another for cornea surgery. Each lists all the important questions to ask to do best for our patients and our practice. Developing and implementing all of these clinical templates was a crucial component of creating a system of efficiency for our technical staff.
The best chefs don’t just run around their kitchen looking for the tools and ingredients they need to create their scrumptious meals. Instead, they prep as much as possible prior to whipping up their culinary creations. The same should be done prior to your clinic day. Technical staff should arrive 30 minutes prior to the first appointment of the day. They should use this time to prepare the exam rooms by uncovering, cleaning and calibrating equipment and evaluating all of the rooms to ensure they’re clean and fully stocked.
A manager can insist that the exam rooms are organized and maintained, but many of these duties can be subjective — and things get missed. That’s why templates are so necessary in exam room organization as well. Practices that have specific templates for cleaning rooms and stocking supplies are prepared to get the most out of their clinical days. They must also, though, include a scheduling template for how often these organizational or maintenance templates should be used. For instance, you’ll need to determine how often machines should be calibrated. Or, for cleaning duties, you must distinguish the daily tasks from the weekly tasks. Creating these organizational templates — and making sure your staff is fully aware of the expectations inherit in them — is another crucial step to maximizing your technical staff’s efficiency.
While we all know that efficiency is one of the primary requirements for successful practice management, many people think organization is a mysterious talent that some people possess and others lack. But as internationally renowned organizing and time management expert Julie Morgenstern puts it, increasing your efficiency and organization boils down to doing things in the same, predictable way.
Expanding the use of templates in your practice will help reduce time lost while staff wonder what they should do next as they’re carrying out a duty or performing a procedure. It also will reduce the likelihood of mistakes or omissions, which can compromise quality care. Incorporating more templates into your technical department will improve your practice’s overall efficiency and care, thereby increasing your revenue and improving your reputation. And that’s something that every ophthalmology practice aspires to achieve and maintain.
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About the author: Traci Fritz, COE, is a practice administrator in Clinton Township, Mich., and a member of the AAOE board. This article was previously published in the July 2008 issue of Techniques.