The Problem

Given the variation in patient loads during the day, it would be ideal if staffing could be arranged to be proportional to the workload.

Staggered shifts and rotating lunch and breaks all arose to respond to changes in workload, and an essential part of high-efficiency offices is the willingness for each member of the team to cross-train for the other’s job and cross-cover for them when necessary.

I have often seen a patient arrive at a clinic, come to the receptionist desk, and be told “the receptionist will be back in a minute to check you in” rather than simply handing this new patient the paperwork needed to start the registration process.

There are some management styles that are downright antagonistic to creating a smoothly operating team and these are most prevalent in the largest corporations managing large numbers of clinics.  Office staff management operating autonomously from medical provider management is a good example.   Regional medical directors are responsible for overseeing the providers in their section.  Administrative management is a separate arm responsible for front and back-office staff and operations.  This generally means there is little input from providers as to improving office operations and office staff management has little to say about medical provider operations.

As a result of this separation, each group has a different “boss” responsible for setting performance goals and performing evaluations, and cooperation between these two groups may not be a high priority of either group.   In some outpatient clinics where the x-rays are done by a radiology group serving both an urgent care / occupational medicine clinic as well as the other primary care or specialty providers in the same building, there may be a third management group supervising the x-ray technicians.  These x-ray technicians must serve all customers, and may not be able to respond promptly to occupational medicine patient time constraints.

This bifurcated or trifurcated management structure tends to work against close cooperation between the groups when cooperation is essential to maximize the operational efficiency of the clinic.

When problems occur, there is also a tendency to point the finger at “the other group” as being primarily responsible for long waiting room times.  While not desirable, it is only human nature and to be expected when separate management arms are used to working autonomously.

The Solution

  1. Delegate one person to be a team supervisor to focus on issues requiring close cooperation between the two groups and develop team goals, such as reduced appointment turn-around times and improved patient experience ratings.
  2. Monitor performance goals with objective data.  This might be as simple as documenting on the face sheet of the chart the time various persons interacted with the patient.
    • When the patient is registered, the time is recorded on the chart face sheet, along with the time that registration has been completed.  This might include time taken by the patient to fill out various forms in the waiting room
    • The nurse records the time the patient is taken to an exam room, and the time that patient is ready to see the provider.
    • The provider documents the time they start seeing the patient and the time their visit was completed.
    • The front office staff records the time they completed the patient discharge from the clinic.
  3. Each side will then recognize their responsibility and contribution to eating goals.  The phrase “that is not my job description” will then rarely be heard.

When visit turnaround time is slow, a review of the face sheet times will provide an accurate assessment of where delays are occurring so they can be most effectively addressed.  Without objective data from the time taken by each person interacting with the patient, the tendency will be to not acknowledge responsibility for delays and to engage in finger-pointing.