patient flow

Does “personalizing” the patient experience sound impossible?

Personalized, customized service has become the norm in our lives as consumers. We've come to expect even everyday items like coffee and sandwiches to made to our specific preferences. But when we're talking about the administrative side of the patient experience, customizing can seem like a much bigger deal. With so many other demands on our medical practice processes, is the idea of personalizing beyond our reach ... or even a little nuts? It may seem that way, but it doesn't have to be. The wonderful thing about offering more choices in how to do business with your practice is that so many of the options patients seek can be cost-saving for you. For example, studies have shown that consumers prefer to pay bills electronically over sending checks. The trend towards paying online, on-the-go, at any hour of the day has become so pervasive, many people don't keep stamps or even checks on hand. If you're not allowing your patients to exercise this preference, instead hoping they'll mail a check (or only taking credit card payments by phone or in person at the office), you're making it harder for patients to pay. That probably means you're getting paid more slowly -- and at higher cost to your practice. But what happens if you do offer patients the ability to receive statements electronically and make payments that way, too? When patients can pay electronically, it's easy for them to do it immediately -- even if they receive your bill at 10:00PM. They avoid the unpleasant feeling of being behind on their bills, and your staff avoids the more unpleasant task of calling them to collect. And you'll get paid faster -- at less expense, since staff won't have to spend time on the phone with the patient or stuff an envelope with a statement. Best of all, when you implement an option like a payment portal or automatic debit, your patients will thank you for it, even as they're paying you more promptly and reliably. Electronic patient payments are just one of several examples of technology-enabled services that conserve staff resources

By |2022-01-01T22:51:47-08:00February 12th, 2018|

Toast, workflow, and the quest for practice productivity

Looks better than mine, even w/o butter.* I observed something this morning when making toast.  I don't make toast often, but when I do, I tend to let it go for a few minutes before heading back into the kitchen to check on it, hovering outside the toaster oven to make sure I grab it when it's "just right." Now, like you (I suspect), I tend to be a little annoyed by wasted time. Standing next to the toaster oven, tapping my foot impatiently, that's definitely wasted time.  So I have developed a habit of "prepping" for the toast by scooping up the butter I'll use on it and putting it on my plate.  But today it finally dawned on me that this prep routine (which I've done for years) really saves no time at all. It's no quicker to pick the butter up off plate and put it on my toast than it would be to just take the butter out of its own container and spread it; the step of transferring it to the plate in advance is meaningless.  (In fact, when I do this the entire process usually ends up taking longer, since I rarely get just the right amount of butter on my plate -- a mistake I wouldn't make when just buttering the bread from the tub.) Of course, I do get a personal payoff from this little activity: I am less bored while I wait for my toast. But even though I feel like I'm doing something, it actually makes me no more (and usually a bit less) productive. Naturally, when I realized this, my mind immediately jumped to practice workflow, and how easy it is to be deceived by activities that feel like progress but actually have no effect -- or even slow things down. My favorite one of these, a subject that we wind up discussing with almost every practice we work with, is the central vitals station. Transferring patients from the reception area to the vitals station, then from the vitals station to the exam room, is one of

By |2022-01-01T22:51:56-08:00March 1st, 2016|

It’s everyone’s responsibility, yet no one’s doing the job

Are some jobs at your medical practice just too urgent or important to assign to specific people? That's the argument some practice managers and physicians make, e.g: "Phones need to be answered by the first available person, whatever their job" "Everyone should keep an eye on the fax machine, and deliver faxes they see piling up" "Let's all keep an eye on the reception area, to make sure no one's waiting too long" "It's the entire team's job to make sure the patient bathrooms are clean and stocked" When the entire team is engaged on these important, urgent tasks, the theory usually goes, there will always be someone available to do them, right when the need arises. Everyone will have an equal stake in making sure they'll get done -- right? Alas, no. Have you ever heard the amusing little story about four people named Everybody, Somebody, Anybody and Nobody? It goes like this: There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.* There is a lot of organizational insight packed into that little verse. When something is everybody's job, it's effectively nobody's job. Nobody is actually accountable to do the work, and everybody can rationalize that they thought someone else would do it. When everyone has other work to do that they believe is important, they'll be more likely to assume someone else will take care of the group responsibility. We have worked with several practices that have applied this "everyone's job" idea and been very unhappy with the results. Laurie, they say, why aren't the staff answering the phones? We tell them over and over that everyone has to answer the phones! Instead, our messages are piling up, patients and other doctors are complaining, and nobody's getting the help they need when they call.

By |2022-01-01T22:51:58-08:00November 29th, 2015|

Could an incentive ‘nudge’ improve your medical practice patient flow?

The idea of 'nudging' in behavioral economics gets a lot of play in healthcare. But most of the attention is on the public health/patient side -- i.e., how to persuade patients to do what public health administrators believe is best for them.  These ideas often focus on negatives and can be controversial -- prompting cries of 'nannying' and 'coercion.'  But some fascinating recent research by Balaji Prabhakar of Stanford shows that positive, incentive-based nudging can help reduce traffic and even help people have a little fun at the same time -- and it got me to thinking, should we take a look at this type of positive nudge as a way to improve medical practice workflow? If you have a minute, take a look at this brief article on the Stanford Business School site -- it explains how Prabhakar was inspired to try to help address the insane traffic problem he observed when visiting Bangalore on business.  A commute of 9 miles to his client's office in one of the busier areas of the city took employees an average of 71 minutes!  Prabhakar thought a scheme of incentives might help persuade employees to commute at off-peak times. His goal was to apply a key insight from his work as a computer scientist: that reducing peak load by just 10% would dramatically improve other metrics like wait times.  Could this insight also help your practice? Prabhakar used an interesting incentive to encourage off-peak commuting: lottery entries.  Each early arrival earned an entry into a weekly lottery -- so more early arrivals meant more chances to win. This was a positive approach (unlike some nudges that are perceived as punishments), and it helped make the program fun and created weekly excitement. So what if your practice wanted to reduce congestion -- say, due to late-arriving patients?  What about rewarding patients who arrive on time with a thank you and a scratch ticket or other small gift?  And are there times of day that are harder to book at your practice?  Perhaps a little reward for patients that can come in at those less

By |2022-01-01T22:52:07-08:00April 30th, 2014|

An operations management classic

I recently heard about a classic book from the eighties that apparently was all the rage among business students and aficionados back in the day, but that somehow slipped by me. Since it was about operations management, and presented in an unusual format -- a novel -- I felt compelled to check it out. Now that I have, I think medical practice managers should, too.  It's called The Goal, by Eli Goldratt, and it tells the story of a plant manager named Alex Rogo who must turn around abysmal performance in his manufacturing plant.  Despite achieving 'efficiencies' in many steps of production, the plant's productivity overall has deteriorated to the point where orders are backed up for weeks, and the company's salespeople can't reliably forecast when orders can be delivered (and so can't really sell any new orders, either).  If Alex can't fix the plant, it will be shut down. Alex is mentored in the book by a professor named Jonah, who guides him in the process of understanding the plant's constraints -- bottlenecks -- and how to increase their throughput.  By analyzing what really drives (or holds back) production in his plant, Alex learns that many of his most relied-upon assumptions aren't correct -- and develops a better way to improve his plant's productivity. I happened to be reading this book while working with a medical practice that was having workflow problems, and the parallels were striking.  This practice was proud of its wonderful system for triaging patients -- but, the system was so efficient, patients were waiting for ages in exam rooms for their providers.  The practice had over-optimized in triage, creating huge bottlenecks down the line at the exam rooms -- and, no benefit whatsoever to patients and no improvement at all in the number of patients seen!  They needed to look at their "plant" with fresh eyes, just like Alex did, to see that overall process efficiency is dependent on the performance of the slowest link in the chain.

By |2012-06-27T14:26:42-08:00July 3rd, 2012|
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