How to Solve Your Medical Practice's Toughest Challenges

Kathy I. Moghadas, RN, CLRM, CHBC


October 11, 2017

In This Article

Why You Should Conduct a Practice Scheduling Study

Patient time management is certainly a challenge for many practices. Another way to achieve more effective patient time management is to schedule realistically. Sometimes the reasons for consistent delays are not apparent, and a practice scheduling study is warranted. The results of the scheduling study usually provide a clearer understanding of the true cause of the practice not staying on time.

A very useful and effective way to help get back on schedule is by conducting a scheduling study within your own office. Consultants such as myself call these studies "time/motion studies," "scheduling studies," or "patient flow studies." Healthcare architects will sometimes use these studies to design the best patient flow layouts. Here's why this is so important and useful:

Each practice, and perhaps each doctor within the practice, has his or her unique approach to the specific elements of a patient visit. The ultimate goal is to determine the pattern of patient care delivery, the time it takes, and the potential bottlenecks that cause delays and put the doctors behind.

Anecdotally, after one scheduling study I performed, we learned that the doctor loved and found his ultimate job satisfaction in conversing with his patients. He could spend 15 minutes discussing mutual topics of interest; his social time was his practice time. The poststudy conversation we had with the physician brought up the concept that he needed to accept responsibility for the type of practice he wanted to have and adjust his income and productivity expectations to meet his practice satisfaction needs.

Most practice management scheduling systems allow physicians to customize their scheduling templates. If, after a scheduling study, we learn that the problem lies with time spent with the patient rather than time wasted waiting for the patient to be roomed or failure to document in real time, it might be beneficial to change the scheduling template. In providing this schedule adjustment, the bottleneck can be minimized and then everyone's satisfaction improves.

When doing these studies, you will find that not every doctor works the same way. So how is it possible that a standard patient schedule will fit every doctor or every practice?

The first task is to break up the individual elements as they relate to the specific practice or doctor. So break up the individual stops that a patient makes once in the front door, such as registration, lab or metabolic measurements, rooming, nurse enters, nurse leaves, doctor enters, doctor leaves, encounter note is completed. Then patient leaves room, patient is at checkout, patient is out the door. Room is cleared, and new patient is in room.

Next, look at the steps the doctor takes. Does she sit in her office to review the note first? Does she then view slides or diagnostics before entering the room? Does she then see the patient face to face? Does she order postvisit testing, such as a blood draw? Does she document while in the room, or back at her desk? Keep in mind that what the doctor does ties up a room and might tie up a medical assistant, so we need to examine how the patient service flow is done. Not each doctor in a practice does these tasks in the same way. All of those variables need to have a time assigned, then be compared with what is scheduled.

You might find that some of these elements might not be done in real time and might not be factored into the patient visit. If finishing the encounter note is not done in real time, when is it done?

The chief complaint against this recommendation is that the practice income is dependent upon a certain number of patients to be seen per day. However, it's wise to balance that income-driven template against the amount of energy expended dealing with complaints from everyone. Switching templates makes the small dip in income well worth practice satisfaction. The other option, of course, is for the physician to make a conscious decision that it's worth focusing on more income, and to be less disappointed about chatting less with patients.


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