Please patients, save money with efficiency
Study links well-organized office’ to satisfaction
Physicians stay on time and sometimes see patients early. Staff handle whatever task is required at the moment. Managers maintain standards and monitor performance.
Those qualities and other operational efficiencies led to an average annual savings of $450,000 to $700,000 per clinic, according to an analysis of the better performers in the ambulatory clinics benchmarking project of the University HealthSystem Consortium (UHC), an organization of university-affiliated health systems based in Oak Brook, IL, that collaborates on research projects. (For a list of key findings, see p. 138.)
Productivity and customer service went hand-in-hand. Physicians saw more patients, and those patients were happier, says Danielle Carrier, MBA, program director in operations improvement for UHC.
In fact, UHC’s patient satisfaction survey showed that a well-organized office was one of the leading factors influencing patient satisfaction ranking even higher than waiting time, Carrier says.
What made the difference? In one word: staff.
Better performers had more staff per physician full-time equivalent. Staff had flexible schedules and performed multiple tasks. And staff often teamed up with a particular physician or set of physicians. (For a related story on re-engineering to improve staff utilization, see p. 139.)
"Staff longevity ended up being a major factor," says Carrier. For example, a physician’s secretary who was familiar with the patients could handle many of the calls and even triage which ones needed the attention of a nurse or physician.
"You didn’t necessarily have to have an RN [assisting the physician]," she says. "You could have a medical assistant if that assistant was comfortable with that physician’s work style, and the physician was comfortable with the medical assistant’s effectiveness."
The UHC project studied four clinic types:
1. general internal medicine;
2. family practice;
3. orthopedics;
4. hematology/oncology.
Clinics varied in their use of residents and the involvement of teaching, with nonteaching sites showing higher levels of efficiency.
When the Internal Medicine Group formed as a new, nonteaching practice at the University of Kentucky in Lexington, managers took along staff who had worked with the physicians and were high performers. Then, the clinic set strict standards for performance. For example, all phone calls must be answered within three rings; patients must wait no more than 15 minutes to see their physician.
"We educated our staff on what we want and we constantly monitor," says Kathleen Greene, clinic manager.
Staying on time rates as a top priority for the University of Kentucky’s Internal Medicine Group.
Each day, medical records staff pull charts for the following day’s patients. Then, clerical staff arrive at 7 a.m., even though the first patient won’t come until 8 a.m. They complete as much pre-registration as possible, so information such as address and phone number simply needs to be verified when the patient arrives.
Flextime helps accommodate that schedule. Since the clinic is busiest early in the week, and those employees work 7 a.m. to 5 p.m., they receive alternate Friday afternoons off. Meanwhile, clinic staff ask patients to arrive for their appointments at least 15 minutes early to allow time for registration.
Physicians have productivity standards; they are expected to see an average of 12 relative value units (RVU), which translates to about 12 patients per half day. RVUs assign greater weight to patients or procedures that require more time; for example, checking for an ear infection would have a lower RVU than a physical exam.
The physicians see scheduled patients every 15 minutes, except at the 45-minute mark. That extra slot every hour allows for patients to be scheduled for longer visits or for urgent cases to be added. A physician’s assistant covers a call-in clinic, where patients can receive a same-day appointment.
With all those efforts, the Internal Medicine Group has average wait times of seven minutes or less. "I have some physicians who routinely see their patients before their appointment," says Greene.
Design aids patient flow
At University Orthopedics and Sports Medicine at the University of Cincinnati, cross-training and a physical redesign have helped streamline the flow of patients through their appointments.
Some tasks, such as X-ray requisitions and chart preparation, have been shifted from clinical staff to medical secretaries. "By changing that flow, the patient is continually being treated and not sitting and waiting for someone to pick up the ball," says practice manager Linda Stamper.
The practice has three receptionists: One sends patients to X-ray, one handles appointments for physicians, and one handles physical therapy appointments. Now, those three are interchangeable. They help each other out and understand the importance of such issues as making sure patients have correct referrals that include physical therapy so patients’ treatments aren’t delayed.
A floor plan redesign helped improve communication among staff. The secretaries’ desks are now near clinical staff and physicians. The billing staff work directly behind front desk people, so they are available to talk to patients about billing and coverage issues.
Transcriptionists were once in the center of the room but now are located in a remote corner so noise around them is minimal.
"By changing everything around, we actually gained additional space for five staff," says Stamper.
Design contributed to efficiency for other UHC better performers, as well. For example, one practice had two different halls, each with a different team of physicians. The patients could then be directed to the appropriate team.
"There wasn’t any overall design that came up [as best]," says Carrier. "But the overall performers tended to say the design had an impact on their flow."
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