Zeroing In On Your #1 Practice Challenge

Illustration: Lee Sauer

At the start of last week’s conference, I asked attendees to fire up the conference app by answering a few polling questions. When I asked people to choose their top three concerns from a list of eleven, “staff/operational efficiency” came out far and away as everyone’s biggest issue. 58 of you, in fact, put it in your top three. And when we asked people to rate their number one challenge, staff/operational efficiency was again at the top.

This validates what we keep hearing from our membership: that you are struggling to keep your head above water as you manage shifting priorities, bursting schedules, and staff productivity, day after day after day.

We’ve had a lot of moving parts in cardiovascular services these last few years - regulatory changes, a move from private practice to integrated programs, the slow shift toward value vs. fee for service payment. There has been a lot of uncertainty. And with that comes not only the question, “how do we implement all of this?” but this even more challenging one: “what should we implement, given that everything keeps changing?”

If you can’t see the forest for the trees, it’s hard to know where to focus your time and energy to do things better. If you’re constantly juggling a packed appointment schedule, it’s hard to develop a new satellite clinic, plus manage to the current budget, plus lead the implementation of time of service collections. (If just reading this is stressing you out, you might find some solutions in my previous post: Feeling the Signs of Burnout? 5 Things You Can Do.) 

But the truth is, if you are not operating at high efficiency it means your team is wasting time and probably frustrated with the system. And if you’re managing unhappy people, everything starts to go downhill from there. Which makes it hard to create the “patient-centricity” that Ginger Biesbrock talked about in her session on Friday at the Spring CV Transforum. You can’t go from ground zero to patient centric without an infrastructure that works for physicians, staff, and patients.

At the conference, three colleagues and I led the tactical, pre-conference session, Practice Operations Nuts and Bolts, which focused on front-end workflow, schedule optimization, patient follow up, and revenue cycle. There were a lot of pearls in this course, but they can't all be implemented at the same time. As you prepare to make operational improvements to meet changing landscape, consider zeroing in on these three major issues, which establish a foundation for efficient and patient-centric care.

1. Strengthen your governance and leadership. 

As my colleague Joel Sauer likes to say, "Without these, nothing else matters." For any strategic vision or operational change project to stick, you've got to have engaged physician leaders, aligned decision-making processes, and a culture of accountability. There must be trust among physicians and stakeholders and a process for addressing deviations from rules and group norms. 

When was the last time you took a look at your governance agreement and accountability standards? Have you put them in writing? Do you anticipate any pushback from key physicians that might make modifications difficult? Mitigate that last issue before launching major changes. Success requires strong leadership support, especially if timelines lag and staff push back or quit. You won't get to the finish line without it.

2. Fix your access and scheduling issues.

We know this is a big challenge for many members, especially those that have larger panels than physicians can humanly handle. The answer lies in rethinking the way the practice schedules and delivers appointments. The old way no longer works.

In a value-based care environment, getting an appointment in a reasonable amount of time and having a pleasant experience are paramount. You can start addressing the access issue by asking referring physicians how easy it is for them to refer patients. Is there a centralized concierge line to accommodate same-day appointments when referring physicians call? What do their patients tell them about their experience with you? Further, what's the patient's experience when they call, email, or register on the portal? How do they rate your team and physician once they are in the office? Have you conducted a patient survey to find out?

From the patient's perspective, communication and convenience are important parts of their care. Can patients text their physician between appointments? Can they schedule an appointment in the evening or on a weekend? This is especially appreciated by patients who must be accompanied by their working, adult children.

These are just a few examples of how administrators and physician leaders must begin to think if we are going to deliver the access patients want. Putting the right processes, technology, and people in place to achieve them are important steps toward patient-centricity.

3. Take a hard look at patient throughput.

Workflow is a big issue for most practices, and I suspect a reason that operational efficiency ranks for members as a #1 concern. Because the issue is so big, it's also challenging to change.

When front end operations falter, everything else falls apart. So, start by looking at what happens before the patient arrives. Is the patient pre-registered so the team can verify eligibility and ensure you've got the right referrals and authorizations? Have you set the right expectations with patients about paying their bill?

So many patients have high deductible health plans that collecting after insurance pays is no longer cost-effective. Are staff trained with scripts to discuss this before the patient arrives, as well as handle questions and objections? Do they handle this conversation with compassion and a service-orientation or tell patients, "that's our policy?"

Service-orientation is an essential component of patient-centricity, but it's difficult to achieve with most front desk teams. The chaos, overload, and high turnover of these staff make it hard for them to deliver great service. Are you working on ways to change this?

Next, take a look at the schedule. How long does it take to get a new or an established patient appointment slot? Are you leaving ample open slots for work-ins? Are you using technology to confirm patient appointments, so the schedule isn't thrown off kilter by too many no-shows? And don't forget to evaluate whether you've set up scheduling protocols and templates correctly. Having a reasonable schedule template to follow makes it easier for the team to keep things from getting jammed.

Operational and staffing changes are big and they take time. You can’t fix everything at once. So, pick the operational improvements that have the highest value for your organization and best fit for the culture and zero in on those first.