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,
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:
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.