Have you tried the experiment in which a person drops a dollar bill and you attempt to catch it? If so, you know how frustrating this can be. The time required for the information to travel from the retina through the brain to the motor endplate of your finger muscles is greater than the time it takes for the bill to fall beyond your grasp. However, if the person dropping the bill counts down before releasing it, you will always catch it because anticipation allows you to correctly activate your muscles.
Similarly, if you have played baseball, you remember being taught as a fielder to know before every pitch exactly what you are going to do with the ball if it is hit or thrown to you. If you do not do this, then you will be trying to field the ball and think what to do at the same time, which leads to errors and game-changing moments.
The point of both examples is that whenever performance is important and competition is keen, the ability to anticipate what is about to happen can make all the difference. Success or failure is determined by who is ready to act before the starting gun goes off.
Anticipation and your practice
What if I asked you apply this mindset to your practice’s appointment mechanism? Would it be obvious to you that your expensive call center, where patients use a telephone to call and request appointments during business hours, is hopelessly slow, error-prone, archaic and destructive to the practice’s financial performance and customer satisfaction? If this is not obvious, I hope it will be soon. Consider the last time you were a customer and had to call any business during their business hours, wait on-hold for several minutes and talk through what you wanted with an operator. Then, compare that to your experience using the internet to buy a book, a plane ticket, a hotel room or to rent a car. Of course, health care is more complicated than renting a car, which is why non-cognitive online appointment systems are not the answer to the problem. But, the business-savvy surgeon will recognize there must be a hybrid way to get the best of both worlds.
Consider your appointment system from the perspective of a process engineer. When your appointment clerk answers a patient’s call, what anticipatory information does he or she possess? Of course, the answer is “none.” She is starting from scratch. Her task is to verbally gather the information she needs (slowest method possible), apply her judgment and her knowledge of the practice’s offerings, decide upon an action strategy and implement a plan — not unlike the aforementioned baseball analogy. It is a complex job that is iterated at least dozens and up to hundreds of times by every clerk, every day. Your practice’s revenue performance is completely dependent upon that clerk’s actions — an hourly employee with little financial stake in the practice’s performance. What if the clerk does not fully share the practice’s value judgments and she uses her own internal compass to make decisions? Who pays the price for this invisible and unaccountable betrayal?
Be ready and capable
Sir William Osler said, “Listen to your patient. He is telling you the diagnosis.” He was correct: If your practice’s website or app anticipates the problem and asks the right questions of the patient before your clerk gets on the phone, he will tell you everything you need to execute the play correctly and quickly, maximizing your practice’s productivity and patient satisfaction. You will now have an accountability system where you can track the performance of each of your clerks.
Endemic, unsolved productivity problems that occur many times every day cost your practice more than big, rare problems because the former go unnoticed and unfixed during long periods of time. Certainly, the evolving health care ecosystem provides no shortage of big worries — Medicare Access and CHIP Reauthorization Act of 2015, Merit-based Incentive Payment Systems, HIPAA, revenue cycle, the list of macro problems created by the government and payers goes on and on. Take a moment to examine the most basic aspect of your business — converting appointment demand into revenue-producing encounters. Your appointment center needs to be ready and capable whenever the pitch is thrown.
John “Jay” Crawford, MD, is a partner at Knoxville Orthopaedic Clinic and founder of nextDoc Solutions, a software company that builds custom apps for orthopedic surgery practices. His primary interest is helping private-practice orthopedic surgeons discover and implement strategies to ensure robust and sustainable business performance in a consumer-driven health care environment.