By the Numbers

Moving beyond ‘hacky sack management’

Five steps can get your meetings back on track and away from 'passing the ball.'

A hacky sack is a small, round bag which is kicked into the air as part of a competitive game or as a display of dexterity.
– Wikipedia

If you are of a certain age and had a lot of time on your hands in college, you probably remember playing the game of hacky sack as a freshman. In this game, several friends gather in a small circle and attempt to pass a bean-filled 2-inch ball from person to person, using only their feet, with players showing off their signature moves before relinquishing the ball. Even the best players look about as coordinated as nudists on a fire ant mound, with much shouting and cursing thrown in for good measure.

Which reminds me of a recent ophthalmology practice staff meeting I attended.

The administrator “launched the ball” and said, “We’ve really got to get control over our excessive patient waiting times. The average patient now takes 2 hours to be examined in our practice.” At this signal, the other 15 people in the room passed the ball around:

“Only 2 hours — is that excessive?”

“I agree. I’m surprised it’s not 3 hours. We are very thorough.”

“I can’t possibly work patients up any faster.”

“You’re right, this is a doctor and a front desk problem — not a tech problem.”

“The main reason we run behind is not enough exam rooms.”

“You’re wrong. We run behind because the doctor is too social with his patients.”

“And he arrives 30 minutes late most mornings.”

“I’m not sure we can cut any corners with friendliness. You guys just have to speed up.”

“Our template is jammed up. We schedule too many patients.”

“It really bugs me to get home late every night when clinic runs behind.”

“I agree. Let’s push all testing to a subsequent visit. Except emergencies, of course.”

“Half of our techs smoke. Those long cigarette breaks are killing efficiency.”

“Maybe if we quit cramming so much testing into a single visit, we wouldn’t run late.”

“Maybe we should visit a couple of practices and see what they do.”

“Great idea. My cousin works in a great practice in Miami.”

“We don’t have time for road trips. Let’s just do a time study.”

“I once read an article about that. Sounds kind of complicated.”

At which point, the meeting was out of time, and the conversation was tabled to the next monthly staff meeting. There was no resolution of who was to do what by when on the still-unresolved waiting time problem, which I was told was an old, old issue, discussed at every monthly staff meeting without closure. Which, in turn, meant that nobody really wanted to go to staff meetings anymore.

“Hacky sack management” is a lot less fun than the college game. And far most costly. And much more common than you think. It is probably present in your practice to at least some extent, from the board room to the smallest departmental meetings. Meetings result in more round-and-round than forward progress.

Here is how to break the habit in five simple steps:

1. Only hold a meeting when there is a written agenda that describes a realistic number of problems that the attendees should not only discuss but also get closure on.

2. Make sure the meeting is actively chaired. The meeting leader should introduce each successive topic clearly and objectively: “Next up is the matter of activating another exam lane. We now have five lanes when benchmarks show we need six for current patient volumes. Techs are standing around waiting for a lane to open. Equipping a sixth lane will cost $25,000 if we buy reconditioned equipment. But this investment will allow us to see at least two more patients per clinic day, which will boost profits $60,000 or more per year. Let’s discuss and get closure on this matter today.”

3. Commit to achieving one of four endpoints with each problem-focused agenda item:

  • The endpoint of an agreed solution, derived during the meeting;
  • The endpoint of tasking one or more meeting attendees (or outside parties) to come back with a proposed solution;
  • The endpoint of clearly tabling the discussion until some agreed date in the calendar;
  • Or the endpoint of declaring that the problem is not going to be solved — it will simply have to be lived with (just as some patients have to live with their health conditions).

4. Don’t agree on a policy or a course of action without clarity about who is responsible and their specific deadline. This is a direct analogy of clinical care, right? At the end of every patient visit, as the provider, you nominate quite specifically who is doing what next. The patient is going to commence daily lid scrubs. Your chairside assistant is going to give the patient sample drops to use as needed. The front desk is going to reappoint the patient in 4 weeks. And at the next visit, the tear function test is going to be repeated, and you may be instilling punctal plugs if indicated.

5. Make sure that the group-agreed course of action on each germane agenda item is memorialized in writing (just as it is in each patient’s chart). This can take several forms on the business side of your practice: follow-up minutes, a task posted to an internal to-do list, a policy and procedure manual revision, or a directive to outside vendors.

P.S.: If you discuss this column with your management staff, please be sure to include a viewing of the film clip at www.wimp.com/the-greatest-hacky-sack-routine-of-all-time. Watching even the most talented hacky sack player cavorting and contorting (as you may be doing now at your current staff and board meetings) will make you want to move beyond this awkward approach to running a practice.

A hacky sack is a small, round bag which is kicked into the air as part of a competitive game or as a display of dexterity.
– Wikipedia

If you are of a certain age and had a lot of time on your hands in college, you probably remember playing the game of hacky sack as a freshman. In this game, several friends gather in a small circle and attempt to pass a bean-filled 2-inch ball from person to person, using only their feet, with players showing off their signature moves before relinquishing the ball. Even the best players look about as coordinated as nudists on a fire ant mound, with much shouting and cursing thrown in for good measure.

Which reminds me of a recent ophthalmology practice staff meeting I attended.

The administrator “launched the ball” and said, “We’ve really got to get control over our excessive patient waiting times. The average patient now takes 2 hours to be examined in our practice.” At this signal, the other 15 people in the room passed the ball around:

“Only 2 hours — is that excessive?”

“I agree. I’m surprised it’s not 3 hours. We are very thorough.”

“I can’t possibly work patients up any faster.”

“You’re right, this is a doctor and a front desk problem — not a tech problem.”

“The main reason we run behind is not enough exam rooms.”

“You’re wrong. We run behind because the doctor is too social with his patients.”

“And he arrives 30 minutes late most mornings.”

“I’m not sure we can cut any corners with friendliness. You guys just have to speed up.”

“Our template is jammed up. We schedule too many patients.”

“It really bugs me to get home late every night when clinic runs behind.”

“I agree. Let’s push all testing to a subsequent visit. Except emergencies, of course.”

“Half of our techs smoke. Those long cigarette breaks are killing efficiency.”

“Maybe if we quit cramming so much testing into a single visit, we wouldn’t run late.”

“Maybe we should visit a couple of practices and see what they do.”

“Great idea. My cousin works in a great practice in Miami.”

“We don’t have time for road trips. Let’s just do a time study.”

“I once read an article about that. Sounds kind of complicated.”

At which point, the meeting was out of time, and the conversation was tabled to the next monthly staff meeting. There was no resolution of who was to do what by when on the still-unresolved waiting time problem, which I was told was an old, old issue, discussed at every monthly staff meeting without closure. Which, in turn, meant that nobody really wanted to go to staff meetings anymore.

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“Hacky sack management” is a lot less fun than the college game. And far most costly. And much more common than you think. It is probably present in your practice to at least some extent, from the board room to the smallest departmental meetings. Meetings result in more round-and-round than forward progress.

Here is how to break the habit in five simple steps:

1. Only hold a meeting when there is a written agenda that describes a realistic number of problems that the attendees should not only discuss but also get closure on.

2. Make sure the meeting is actively chaired. The meeting leader should introduce each successive topic clearly and objectively: “Next up is the matter of activating another exam lane. We now have five lanes when benchmarks show we need six for current patient volumes. Techs are standing around waiting for a lane to open. Equipping a sixth lane will cost $25,000 if we buy reconditioned equipment. But this investment will allow us to see at least two more patients per clinic day, which will boost profits $60,000 or more per year. Let’s discuss and get closure on this matter today.”

3. Commit to achieving one of four endpoints with each problem-focused agenda item:

  • The endpoint of an agreed solution, derived during the meeting;
  • The endpoint of tasking one or more meeting attendees (or outside parties) to come back with a proposed solution;
  • The endpoint of clearly tabling the discussion until some agreed date in the calendar;
  • Or the endpoint of declaring that the problem is not going to be solved — it will simply have to be lived with (just as some patients have to live with their health conditions).

4. Don’t agree on a policy or a course of action without clarity about who is responsible and their specific deadline. This is a direct analogy of clinical care, right? At the end of every patient visit, as the provider, you nominate quite specifically who is doing what next. The patient is going to commence daily lid scrubs. Your chairside assistant is going to give the patient sample drops to use as needed. The front desk is going to reappoint the patient in 4 weeks. And at the next visit, the tear function test is going to be repeated, and you may be instilling punctal plugs if indicated.

PAGE BREAK

5. Make sure that the group-agreed course of action on each germane agenda item is memorialized in writing (just as it is in each patient’s chart). This can take several forms on the business side of your practice: follow-up minutes, a task posted to an internal to-do list, a policy and procedure manual revision, or a directive to outside vendors.

P.S.: If you discuss this column with your management staff, please be sure to include a viewing of the film clip at www.wimp.com/the-greatest-hacky-sack-routine-of-all-time. Watching even the most talented hacky sack player cavorting and contorting (as you may be doing now at your current staff and board meetings) will make you want to move beyond this awkward approach to running a practice.