By the Numbers

Perk up your practice tempo with greater operational agility

Combining strategic nimbleness with operational agility will help your practice thrive.

“Jack be nimble, Jack be quick, Jack jump over the candlestick.”
– Nursery rhyme

“Quickness is the essence of the war.”
– Sun Tzu

As professional fees languish in the years ahead, the winning practices will be those that can extract the most value out of their increasingly costly resource base. What’s needed is more patient throughput per exam room per hour. More phone calls answered and cleared in a day. More insurance claims filed per shift.

The standards are rising. Margins are getting squeezed. The acceptable work pace a decade ago, for doctors and staff alike, is now pokey. Here are 12 ideas toward a zippier practice.

1. Realize that everyone else takes their signals from you. As a leader in your practice, foster a sense of urgency. This can be expressed in numerous ways. Do not stroll down the hallway, stride. Encourage brief, to-the-point responses from your people. Provide quick, unwavering answers to staff questions without waffling. Give people realistic deadlines and goals, but here and there also hand out “push” goals that might be barely attainable but help the most promising members of your team grow faster. Do not verge into “frantic” territory. Try your best to combine the serious serenity of your high school principal with the tempo of a triple espresso.

2. Arrive at the office early and start in high gear. How early? At least 30 minutes before your first patient’s appointment. This will be a challenge if you are not a morning person. But in our experience, sluggish practices are generally owned by sluggish doctors who arrive 30 minutes (or even 3 hours!) after their first patient has been worked up. Only after you are disciplined personally as the practice owner is it fair for you to ask all staff to arrive on time and move briskly.

3. Time is money. Help staff understand the value of time and create a culture that squeezes as much value as possible out of every hour. In the typical solo practice, it costs more than $300 per hour to keep the doors open. Multiply that figure times the number of doctors in your practice, and convey the urgency of using every hour to good purpose. (This does not apply only to lay staff; that subspecialist you employ is costing you $10 a minute in lost profits every time they stop to check their email.)

4. Do not let urgency crowd out the endless pursuit of perfection. A common observation is that clients will ramp up their patient volumes, but their average collections per patient visit falls because they do not take the time to order special testing or help borderline patients consider surgery more thoughtfully.

5. Compress old, accustomed time frames. When is the next available routine appointment in your template? How much staff time does it take to check in and register a patient? How long after a patient is seen by you does it take to check the patient out and make a new appointment? Post and submit a claim? Dictate a consult letter? Make a list of routine work like this you believe you can accomplish in less time, and then start working from the top of the list to speed up operations. (After you get through the list, be sure to recheck periodically to assure that staff remain in high-tempo mode.)

6. As the saying goes, work expands to fill the available time. If you are overstaffed (or under-busy as a practice), you and your people will be conditioned to move at a slow pace. You can improve this by decreasing staffing levels and/or increasing patient volumes. And you do not need to make any permanent changes to prove just how effective these two moves might be. If you suspect you have one excess front desk clerk, sideline your weakest receptionist for a month (putting them on a special project), and observe whether they really are nonessential.

7. Enforce personal responsibility. Businesses do not get things done, people do. When you give a specific task to two people (or worse, the assembled staff at a practice meeting), then nobody is responsible. Every important project should have an “owner,” a deadline and written progress notes so that the project owner can report formally on how they are coming along, with deadlines less likely to drift.

8. Consistency is a friend of speed. If every tech informally develops their own idiosyncratic way of working up patients, it is guaranteed that all but one (or maybe none) are preparing patients for you in the best, fastest way. As a supervising physician or managing partner, encourage staff to write down the one agreed best way to do everything. Then personally observe staff as they go through their paces: Are they following the agreed approach or drifting into old habits?

9. Remember the maxim, “Everything that can be measured can be improved.” Whether you are measuring big things such as project deadlines and annual profit margins or small things such as workup times or refracting accuracy, develop agreed standards and targets.

10. Be on the lookout for low value activity. You may have casually asked a staffer years ago to track visits per day or per week, data that have no practical value except on a spot-checking basis. Ask your people often, “Is there any part of your job that represents wasted time or busywork or an outdated approach that we should eliminate? How much time would this free up, and how would you use that time to better help our patients?”

11. Replace poorly functioning work tools: slow computers, outdated software, creaky photocopiers or testing equipment on its last legs. Saving a few hundred dollars on delayed replacements can cost thousands in staff inefficiency and reduced job satisfaction.

12. Getting faster is uncomfortable. You and your partners — and your patients, too — will obviously be rewarded by a brisk pace. How about staff? Not so much. They will have to work harder and more intensely and intentionally. So you need to be sure to reward gains in operational agility. If your efforts allow you to see more patients with the same number of staff, consider a one-time discretionary bonus, selective raises or a modest adjustment in wages across the board.

Of course, to be operationally nimble you also need to be strategically nimble. The majority of large practice boards and nearly all smaller-scale practice owners operate their organizations with no formal strategic grounding. “Strategy” and “tactics” are often confused. Strategic goals such as “grow our practice by 10% per year in net collections” need the support of tactical objectives: “Ramp up outreach and general consumer advertising to add 100 incremental new patients a month and outfit three more lanes.” If you can combine strategic nimbleness with operational agility, your practice will be unstoppable.

“Jack be nimble, Jack be quick, Jack jump over the candlestick.”
– Nursery rhyme

“Quickness is the essence of the war.”
– Sun Tzu

As professional fees languish in the years ahead, the winning practices will be those that can extract the most value out of their increasingly costly resource base. What’s needed is more patient throughput per exam room per hour. More phone calls answered and cleared in a day. More insurance claims filed per shift.

The standards are rising. Margins are getting squeezed. The acceptable work pace a decade ago, for doctors and staff alike, is now pokey. Here are 12 ideas toward a zippier practice.

1. Realize that everyone else takes their signals from you. As a leader in your practice, foster a sense of urgency. This can be expressed in numerous ways. Do not stroll down the hallway, stride. Encourage brief, to-the-point responses from your people. Provide quick, unwavering answers to staff questions without waffling. Give people realistic deadlines and goals, but here and there also hand out “push” goals that might be barely attainable but help the most promising members of your team grow faster. Do not verge into “frantic” territory. Try your best to combine the serious serenity of your high school principal with the tempo of a triple espresso.

2. Arrive at the office early and start in high gear. How early? At least 30 minutes before your first patient’s appointment. This will be a challenge if you are not a morning person. But in our experience, sluggish practices are generally owned by sluggish doctors who arrive 30 minutes (or even 3 hours!) after their first patient has been worked up. Only after you are disciplined personally as the practice owner is it fair for you to ask all staff to arrive on time and move briskly.

3. Time is money. Help staff understand the value of time and create a culture that squeezes as much value as possible out of every hour. In the typical solo practice, it costs more than $300 per hour to keep the doors open. Multiply that figure times the number of doctors in your practice, and convey the urgency of using every hour to good purpose. (This does not apply only to lay staff; that subspecialist you employ is costing you $10 a minute in lost profits every time they stop to check their email.)

4. Do not let urgency crowd out the endless pursuit of perfection. A common observation is that clients will ramp up their patient volumes, but their average collections per patient visit falls because they do not take the time to order special testing or help borderline patients consider surgery more thoughtfully.

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5. Compress old, accustomed time frames. When is the next available routine appointment in your template? How much staff time does it take to check in and register a patient? How long after a patient is seen by you does it take to check the patient out and make a new appointment? Post and submit a claim? Dictate a consult letter? Make a list of routine work like this you believe you can accomplish in less time, and then start working from the top of the list to speed up operations. (After you get through the list, be sure to recheck periodically to assure that staff remain in high-tempo mode.)

6. As the saying goes, work expands to fill the available time. If you are overstaffed (or under-busy as a practice), you and your people will be conditioned to move at a slow pace. You can improve this by decreasing staffing levels and/or increasing patient volumes. And you do not need to make any permanent changes to prove just how effective these two moves might be. If you suspect you have one excess front desk clerk, sideline your weakest receptionist for a month (putting them on a special project), and observe whether they really are nonessential.

7. Enforce personal responsibility. Businesses do not get things done, people do. When you give a specific task to two people (or worse, the assembled staff at a practice meeting), then nobody is responsible. Every important project should have an “owner,” a deadline and written progress notes so that the project owner can report formally on how they are coming along, with deadlines less likely to drift.

8. Consistency is a friend of speed. If every tech informally develops their own idiosyncratic way of working up patients, it is guaranteed that all but one (or maybe none) are preparing patients for you in the best, fastest way. As a supervising physician or managing partner, encourage staff to write down the one agreed best way to do everything. Then personally observe staff as they go through their paces: Are they following the agreed approach or drifting into old habits?

9. Remember the maxim, “Everything that can be measured can be improved.” Whether you are measuring big things such as project deadlines and annual profit margins or small things such as workup times or refracting accuracy, develop agreed standards and targets.

10. Be on the lookout for low value activity. You may have casually asked a staffer years ago to track visits per day or per week, data that have no practical value except on a spot-checking basis. Ask your people often, “Is there any part of your job that represents wasted time or busywork or an outdated approach that we should eliminate? How much time would this free up, and how would you use that time to better help our patients?”

PAGE BREAK

11. Replace poorly functioning work tools: slow computers, outdated software, creaky photocopiers or testing equipment on its last legs. Saving a few hundred dollars on delayed replacements can cost thousands in staff inefficiency and reduced job satisfaction.

12. Getting faster is uncomfortable. You and your partners — and your patients, too — will obviously be rewarded by a brisk pace. How about staff? Not so much. They will have to work harder and more intensely and intentionally. So you need to be sure to reward gains in operational agility. If your efforts allow you to see more patients with the same number of staff, consider a one-time discretionary bonus, selective raises or a modest adjustment in wages across the board.

Of course, to be operationally nimble you also need to be strategically nimble. The majority of large practice boards and nearly all smaller-scale practice owners operate their organizations with no formal strategic grounding. “Strategy” and “tactics” are often confused. Strategic goals such as “grow our practice by 10% per year in net collections” need the support of tactical objectives: “Ramp up outreach and general consumer advertising to add 100 incremental new patients a month and outfit three more lanes.” If you can combine strategic nimbleness with operational agility, your practice will be unstoppable.