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  • 5 Tips for Improving Workflows in Your Clinical Practice

    You’ve just entered clinical practice, and you’re busy! As a result, the majority of your attention is focused on your patients, their diagnoses, treatment and management

    Unfortunately, you probably don’t spend much time thinking about the system and workflows in your practice.

    When I first entered practice, I stepped into the office on my first day and just expected things to “work.” I sat down at my slit lamp and waited for patients to show up. Luckily, the front desk staff and technicians had pre-existing processes in place for checking in and working up patients. Little did I know, there were a multitude of clinical workflows set up that were helping support me, but there were others that I found out later needed to be changed.

    Clinical workflows are the processes by which you and your staff manage patients, both inside and outside of the office. Examples include the method of letting technicians know that a patient is ready to be worked up, how support staff manage ophthalmic imaging and testing and how calls are answered and directed. If you spend time focusing on improving workflows, your patients and your practice will benefit.

    1. Stop to Consider the ‘Pain Points’

      We’ve all noticed that certain aspects of our days cause frustration. Maybe you have found yourself frequently sitting around waiting while patients are dilated but awaiting their OCT. Perhaps it takes too much time to walk to the waiting room to grab a patient and guide them back to the exam chair. 

      Whenever these pain points come up, don’t merely huff and puff about the inefficiency. Instead, jot down the issue so that you can start brainstorming solutions to the problem. The first step in fixing a problem is identifying the problem.

    2. Focus on Solutions

      Once you wrap up your clinic and have a moment to breathe, look back at any pain point that popped up. You know your clinic and your staff well, so start brainstorming ways that the entire office can help rectify the issue and move toward a solution. Instead of walking to the waiting room yourself to grab patients, perhaps you could ask your front desk staff to pull patients back to a room after 15 minutes of dilating, or your technicians could automatically room patients after they perform any testing. Every problem can have multiple potential solutions. Now is the time to jot as many ideas down as you can.

    3. Work With Your Team to Identify a Fix

      Members of your office staff are in health care because they want to help people. No one comes into the office to do things inefficiently; people want to do the right thing. Therefore, your team members will be useful in helping figure out which of your solutions seem most viable. 

      More importantly, they can quickly identify which solutions just won’t work based on the requirements of their individual jobs and roles. Your team members will likely be vital to implementing any solution, so getting their input and buy in will help make sure it is a success. Finally, most of your team has likely been working in ophthalmology for a significant amount of time; ask for their opinions and input. They may have already figured out the solution! Don’t discount your team members.

    4. Measure the Outcome

      Congrats on making a change! Your solution may be the best thing to happen to your practice. However, if you don’t measure the impact it has, you’ll never know. 

      From the outset, select a few metrics that can be easily measured over time, and compare the metrics from before any change to the metrics afterward. This may be counting the number of times in a day you have to personally grab a patient from the waiting room, or the number of patients seen in a typical day. Remember, change can be hard, and results might not happen overnight, so give things time to work and results to show up.

    5. Go Back to the Drawing Board

      Did your proposed solution fix the problem? Did it expose further issues? Did your staff find it too challenging to implement? Once you’ve got the data, go back to the drawing board and figure out if any additional changes are needed.

      This overall activity should be seen as an iterative process. In fact, in the world of quality improvement, this process is known as a PDSA cycle (plan-do-study-act) and repeats itself in search of continually improved outcomes.

    You may be new to your practice, but it is never too early to identify ways that you can take better care of your patients, and work more effectively with your clinical team. Using this method over the past few years, I have been able to implement after-hours ophthalmic testing for patients, improve scheduling of follow-ups of patients at our institution's ophthalmic emergency room and created EMR dot-phrases (blocks of text that act as a template for common visit types) used by technicians and residents to streamline patient exams.

    So go out there, find the pain points, start implementing changes alongside your team, and measure the impact. You’ll be practicing more efficiently in no time, and your patients will be happier as a result!

    Grayson Armstrong.pngAbout the author: Grayson W. Armstrong, MD, MPH, is a comprehensive ophthalmologist, medical retina specialist, and director of ophthalmic emergency services at Massachusetts Eye and Ear in Boston. He is a Harvard Medical School ophthalmology instructor who served as director of the eye trauma service from 2019-20. Dr. Armstrong completed his residency, chief residency and fellowship in ophthalmic telemedicine at Massachusetts Eye and Ear and Harvard Medical School. He joined the YO Info Editorial Board in 2022 and is a member of the Academy’s Leadership Development Program XXIV, Class of 2023.