Make it work better: 3 tips to improve efficiency
Improvement must be a constant process
Improving the efficiency of your occupational health program should be an ongoing effort that does not stop just because some improvement is seen. Occupational Health Management asked experts in occupational health for their best advice on how to improve efficiency, and these are the tips they say will improve any occupational health program:
1. Take a hard look at how your staff works as a team.
It can be misleading to focus entirely on individual tasks and measures of efficiency, cautions William B. Patterson, MD, MPH, president of New England Occupational Health Center in Wilmington, MA. Your occupational health program cannot work at peak efficiency if the staff meaning everyone from clerks to physicians does not work together in a cooperative way, with the same goal in mind.
"This is not always an easy thing to measure, but you have to look at things like how much people are committed to a quality job," Patterson says. "How much do they care about the success of what they’re doing? Do they tolerate second-rate work or do they try hard to get the job done right?"
It is the job of managers to set a high standard in terms of working efficiently and cooperatively with others, plus reaching for a high quality outcome. "You have to lead by example," Patterson notes. "If you’re not working efficiently and trying to get the most out of your program, why should the people who work for you?"
To determine how well your staff works as a team, one of the best methods is to hire an outside business consultant, Patterson says. Most smaller programs will find that cost-prohibitive, but Patterson says some larger ones will have the resources. He says it is a worthwhile expenditure if you can afford it.
In the meantime, Patterson suggests concentrating on a continuous quality improvement (CQI) approach. While CQI is a complex business principle, Patterson notes that it is highly dependent on a cooperative team approach among staffers. Adherence to CQI will almost certainly improve the efficiency of a program, he says.
To concentrate on productivity and efficiency, Patterson suggests asking these questions about your program:
• Is the work organized in a logical and efficient way?
• Have we eliminated as many barriers to errors as possible?
• Have we invested in continuous training?
• Are there ways to automate or provide tools that will improve productivity?
• Does the psychological and physical environment contribute to a good work atmosphere and attitude?
• Are we properly evaluating and monitoring employee performance?
2. Survey your clients about how you might improve your program.
Inefficiency will be recognized immediately by your clients. If you are not serving clients in the most efficient way possible, they probably have recognized that and are unhappy about it even if they do not complain. They may not have a ready solution for how you can become more efficient with a certain task, but they can at least let you know where you are dropping the ball.
One of the best ways to zero in on client dissatisfaction is with an occasional survey. Patterson’s program recently developed a survey that highlighted areas in which clients were not entirely satisfied. A second survey six months later showed that the program had improved in those areas. (See pp. 40-41 for the survey Patterson’s program used.)
3. Cross-train your staff to get the most out of them and improve patient satisfaction.
Cross-training staff members is a proven way to improve efficiency in any business, and an occupational health program is no different. Having staff members trained to do as many tasks as possible lessens the chance they will be twiddling their thumbs while important tasks have to wait for someone else.
That idea has proven successful at Sherman Benefit Manager, the occupational health program at Sherman Hospital in Elgin, IL. The off-site program has used comprehensive cross-training to make the program as efficient as possible over the past six years. Some licensing requirements limit how far cross-training can be employed, but other than that, nearly any task in the program is up for grabs, explains program director Pam Fischer, RN.
"Nobody ever looks at me and says, That’s not my job,’" Fischer explains. "That attitude is just not accepted around here."
Everybody pitches in
Fischer’s program encourages every staff member to participate in whatever tasks they are qualified to do. That means that Fischer will answer phones when things get busy, for instance, and any staff member can make patient appointments with the program’s computerized scheduling system.
Most of the clerical staff can do a drug screen if necessary, and the program’s accounting director is certified to do breath alcohol testing (BAT).
"I know that sounds a little funky, but she was very excited about getting certified because she knew she could help us out when we got busy," Fischer says. "We don’t have her or the clerical staff doing drug and alcohol screens all the time, but when a company decides to do random testing that day and sends in 20 people at once, it is a big help to have the staff trained for it."
The Sherman program also makes liberal use of nursing assistants and licensed practical nurses to avoid hiring more registered nurses than necessary.
Radiology technicians are trained to do workers’ compensation assessments, something Fischer says many people find surprising. Since the program must have a radiology technician available at all times for X-rays, it only makes sense to have that person trained to do other tasks. Like other staffers, the technicians are generally pleased to be able to do something productive in their downtime, she explains. Staff turnover has been 13% over the past six years.
But the cross-training does not come into play only in the staff’s downtime. In some situations, staffers must drop what they are doing in their primary function, such as accounting, to perform a patient-oriented task, such as a BAT. The decision is made on an individual basis, but patient/client satisfaction is one of the most important factors. If the receptionist notices patients are backing up, she may notify Fischer, who will send out word that everyone needs to help, in whatever way possible, to get things moving.
Patients often will not know that the person performing an assessment is not a nurse, and the cross-training has never resulted in any complaints from client companies or patients. Fischer notes staffers are careful not to do anything they are not trained to do.
The cross-training has been effective in making the program "lean and mean," Fischer says. In the six years since opening, the program has gone from seeing about 300 patients a month to seeing about 1,200 a month. But in that same time, the program’s full-time-equivalent (FTE) employees have only increased from six to eight FTEs, spread over 22 people, for a program that is open 64 hours a week. That is a 300% increase in patients but only a 33% increase in FTEs.
Also, average patient waiting time has been kept down to 10 minutes.
"The goal is to operate efficiently with the least number of FTEs and maintain patient satisfaction an extremely important part of this," Fischer says. "We just can’t stand seeing a staff member sitting around while a patient is waiting for something."
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