by Rico Lopez, Senior Market Advisor at Kareo

In my first blog post, Take Control of Your Patient Flow (Part 1), we looked at a host of reasons why patient flow is important and how it can impact your practice. We looked at scheduling in Part 2, and now we are going to talk about your staff schedule and the value of cross training.

To fully maximize your staff time, you must first completed the previous section on analyzing your Appointment Schedule Template. Even if you feel confident that your appointment templates are solid, you will still need to perform the previous exercise to fully understand the prospective bottlenecks of your patient flow and how to appropriately allocate resources to minimize delays. You might be surprised what you find. I have worked with clients who realized after performing this exercise that they could actually see more patients with just some minor scheduling tweaks while eliminating major bottlenecks with simple staffing adjustments.

Maximizing the Value of Your Staff

1. Create a table to identify your existing staff, their certification/training, experience within your practice, prior experience and roles they are currently trained and can competently perform today.
   
2. Analyze your current staffing strengths and identify cross training opportunities. In the sample in Figure 1 above, I noted which role(s) each employee can cover today and I then I shaded (in blue) the 29 cross training opportunities. I am not suggesting that each employee should be cross trained in all roles for the practice – but the more flexibility you create with your staff, the easier it becomes to overcome bottlenecks in the practice.
3. Develop a cross training strategy. While it is not realistic to cross train all your staff within a few weeks, it is a good idea to schedule cross training of your staff during ideal times for the practice. Depending on the amount of cross training needed in your practice, it could take weeks or even months to get everyone fully trained. Prioritize the cross training based on the biggest impact to your practice.
4. Manage your staff schedule. In Figure 1 above, is it necessary to bring multiple staff members at 7:30? When does the practice really need them to come in? Are they needed more in the early morning or late in the day? What I have found in many practices is that some employers will adjust their employees work schedule to accommodate the needs of their employees without understanding the impact to the practice. Knowing your staff’s abilities (by creating the staff table above) and implementing cross training will provide you the flexibility to accommodate scheduling requests.

Identifying Bottlenecks

The last post where we created your patient flow worksheet and analyzed the downstream impact of your appointment schedule, should have given you some idea of the possible bottlenecks in your patient flow. The adjustments you made to your appointment templates as a result of your analysis will eventually provide relief.

There are other causes of delays in your practice other than those created by your appointment scheduling (we will discuss this in a future session). The key for now is recognizing when the practice begins to back up and determining the starting point of the bottleneck. Let me give you some sample scenarios that you will probably recognize:

1. Staff are waiting for patients to be handed over from the front desk and the doctor is waiting for patients to be placed in exam rooms and lobby is full of patients.
2. Patients charts are stacking up waiting for someone to call the patient, take them to vitals or the exam room for patient prep, half the exam rooms are empty and need to be cleaned/prepped for the next patient, provider and medical assistants are all preoccupied with patients in the other exam rooms, and the lobby is full of patients.
3. Beginning of the day or right after the office lunch break, there is a line of patients at the front desk and there are already several patients sitting in the waiting room.
4. Patients lining up at the check-out desk likely very frustrated and just want to leave but they still need to make follow up appointments and pick up additional paperwork.
5. Lobby is full of patients, charts stacking up, all exam rooms are full and provider is jumping from room to room with no end in sight.

Now that you are more aware of bottlenecks and are able to quickly recognize the issue, its time to talk about what actions you can take to relieve these delays. The first four bottleneck scenarios above can all be quickly resolved by reassigning resources to the area causing the backup. In some cases, it would only take a few minutes to get the practice back on track. The fifth scenario might warrant hiring another provider, but we will talk about that in another post.

Anticipating & Planning for Challenges

There will always be events in your practice that will cause delays to your patient flow. For some practices, this is accepted as status quo and just the way the practice functions. I am here to tell you – NO IT IS NOT! There are three things you can do–Eliminate, Anticipate, and React.

• Eliminate: If you already know about issues that causes delays in your practice, then what have you done to eliminate them? We will review this further in a future session and what you can do to identify and eliminate these issues.
• Anticipate: No one knows your practice better than you and I am sure many of you can even predict when and where these delays will occur. The items that reoccur daily or on a very frequent basis are the ones you will need to address. Anticipating the problem will allow you to assign resources in the right location at the right time. Here is an example of one item that most practices experience. First thing in morning when multiple patients arrive at your office at the same time many practices find that they are already behind at the beginning of their day. If this happens in your practice, then anticipate the situation and assign an extra resource first thing in the morning just long enough (~30 minutes) to help overcome the initial wave of patients. Now think of other scenarios in your office where you can almost anticipate delays and implement a solution to avoid future recurrence.
• React: Once you have addressed the anticipated delays, let us talk about the unpredictable. This is where recognition of the issue and full understanding of your staffs’ ability to cover other areas will come in handy. Don’t be afraid to move staff around throughout the day – making sure you that these adjustments will not cause a different delay for another area of the practice. Your staff will eventually begin to recognize these situations themselves and take the initiative to assist the other areas as soon as they occur without any instructions from you.

Changing the Culture

Just like any other business, one of your most important resources is your employees. Creating a working environment where their initiative and teamwork are recognized will promote an ideal scenario for any busy practice. Acknowledging employees who act on their own to back-up their struggling coworker will send a clear message to all of your employees.

Set goals and reward staff for meeting and/or exceeding them. One of the ones that my employees used to enjoy is the 5-Day Challenge. If the clinic finishes on time (you pre-define what “on time” means) for 5 days straight, then on the 6^th day we have lunch brought in for everyone. Lunch is an inexpensive payment for reducing labor (or even overtime) and increasing patient satisfaction and employee satisfaction.

Watch for my next post when we will talk about overbooking and address various practice policies including no shows and patients arriving late for their appointments.