operations Archives - Capko & Morgan

“If it ain’t broke,” maybe you still should fix it

This meme popped up on one of my feeds recently, and whenever it does, it makes me smile (and think). It's a picture of a horse tied to a lightweight plastic chair. The horse is standing patiently and obediently, presumably unaware that he could easily shake off the chair, break it, or drag it along and run away if he chose to. The caption is always some variation of, "The thing holding you back might be all in your head." Time to break free? It's an idea always worth exploring in my opinion. Whenever working on an intractable problem, I always seem to find that testing some assumption or another can lead to a solution. It's natural for business owners and managers to rely on assumptions. No one has time to rethink every workflow or financial policy or technology strategy every day (obviously). That's one reason why unhelpful or outdated assumptions can be hard to spot. It's a challenge that affects everyone, but perhaps especially very busy people who shoulder a lot of responsibility. What's more, "if it ain't broke, don't fix it" or "that battle's not worth fighting" or "we tried that once and it didn't work"–some of the most common assumptions we make to help us keep things moving along—can be very useful maxims that help keep the to-do list manageable and avoid wasting energy. Even well-founded assumptions can outlive their usefulness as times change, though. And when they do, the same guideposts that once were so helpful can undermine progress. Part of my job as a consultant is to help practices identify and question their assumptions, to be sure they're still helpful. A mini case study I saw this play out recently with a practice that wanted to add clinicians but lacked office space, especially at the front desk. As a result of earlier expansion of the provider team, the front desk was already understaffed by at least fifty percent. ("We can't fix that. There's nowhere to put anyone else.") Despite this obvious constraint, the owners had an opportunity to hire two clinicians they really

By Morgan|2025-02-02T14:34:22-08:00February 2nd, 2025|

Cost-cutting: pick your battles wisely

We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to

By Morgan|2022-01-01T22:51:45-08:00October 15th, 2018|

Fix the problem, not the blame [practice management tip: operations and workflow]

“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their

By Morgan|2018-06-11T16:36:02-08:00June 27th, 2018|