Friday, October 18, 2013

Medical Office Design and Systems Concept for Patient Management

Medical office design
Medical office design expert Richard C. Haines Jr., invites us to see the medical practice as a business that dispenses a scarce commodity: access to the physician’s intellect, judgment, and skill. You can picture practice operations like a machine with a conveyor belt: items (patients) come in the front, the staff pre-assembles them (works them up), and the doctor finishes by treating them and sending them out the back.

Therefore, it might be helpful to step back occasionally; set aside the idealism and heroism associated with practicing medicine; and take a cold, analytical look at “the machine.” How can you repair, redesign, or fine-tune the operation to make your scarce commodity more available to patients who need and want your expertise?

The entire practice revolves around what the physicians do. Therefore, your physicians’ output acts like an engine’s “governor,” regulating the overall speed of your operation. In addition, each stage in the process has its own governing activities.

Input Stage: Appointment Scheduling

Your appointment schedule template governs the initial input by dictating when, what type, and how many patients should come in. When a doctor falls behind, waiting areas overflow, parking lots jam up, and tempers flare. Calculate each physician’s patient-per-hour rate then build your clinic template around that number - high enough to ensure a constant pool of patients for the doctor and light enough to allow for work-ins.

Throughput Stage: Reception and Work-up

Once the patients arrive, the intake process is governed by at least three more activities:
  1. Reception: Can your receptionists keep up with the patient flow? What interruptions (like telephones) hamper their efforts? Two ways to smooth the flow include separating check-in from check-out and diverting telephone duty to dedicated staff away from the front desk.
  2. Exam-room loading: Assign one primary person to keep exam rooms full of patients ready for the physician. An empty room creates a disruption in the doctor’s rhythm - a vacuum that can fill with distractions and halt production.
  3. Ancillary services: Poorly planned processes like x-ray, suture removal, laboratory tests and other diagnostics, or follow-up treatments can waste time, effort, or resources. Coordinate activities to keep patients flowing, rooms full, and doctors moving from patient to patient. Create “buffer zones,” such as sub-waiting areas associated with ancillary services, to make up for the variations in patient-flow rates.
Output Stage: Physician Exam/Treatment and Check-out

Analyze each physician activity in the patient exam/treatment area. You will find every activity fits in one of three categories:
  1. Activities only the physician can/should perform.
  2. Activities that the physician should delegate to support staff.
  3. Activities no one should bother with.
Look critically at each activity with objectivity and a willingness to modify behavior. Honest analysis and sincere desire to maximize output can overcome physicians’ traditional resistance to change. Other physicians have discovered dozens of ways to increase their productivity, such as:
  • Using medical scribes in the exam room in place of physician dictation or note taking (often effective in transitioning to EMRs);
  • Implementing color-light-coded communication systems to alert support staff from within the exam room; and
  • Using lower-cost “runners” on staff for moving patients and materials through the clinic.
The keys are creativity and openness to change. At the end of the process, governing activities can include post- and intra-exam ancillary services, procedure/surgery scheduling, patient education, financial counseling, and check-out with follow-up appointment scheduling. Apply the same scrutiny to these potential bottlenecks to smooth out the flow to the very end of the visit.

Finally, in your quest for a finely tuned machine, use sensitivity and care to avoid leaving patients with the impression that you’re running a mill, with patients for grist. Never sacrifice addressing their worries, needs, and comforts in the name of efficiency.


If you enjoy reading the blog entries in "Solving Problems in the Medical Practice" you may want to check out all the great products at Greenbranch Publishing.


photo credit: DennisSylvesterHurd via photopin cc