How to Conduct a Staffing Analysis

There's no one-size-fits-all approach to a strong staffing model. That's one lesson Kimberly Gooden has learned during the more than two decades she has spent as practice administrator at Dermatology Consultants, P.C., a practice with three locations in the Atlanta metropolitan area. "Physicians are happier when they are able to utilize their staff in a way that's more efficient for them," says Gooden, who manages seven physicians, five physician assistants, and 79 support staff. "We do try to make sure that they have as much autonomy as possible, as long as it is efficient." Some of her physicians, for instance, prefer working with the same medical assistant throughout the day, while others enjoy switching assistants as they change exam rooms.

But it's not just physicians' preferences that require Gooden to take a flexible approach to her staffing model. When the practice implemented an EHR last year, Gooden hired more medical assistants to assume some duties as scribes. And when the practice became part of an independent practice association in which patient satisfaction plays a major role (if patient satisfaction metrics are too low the practice will experience monetary penalties), Gooden began using patient satisfaction reports to identify areas that needed improvement and to train staff to move customer service to a higher level. For instance, staff is focusing more on interactions with patients while escorting them back to the exam room during appointments.

Gooden's practice is not the only one experiencing big changes. Many of you are encountering new technologies, healthcare reform initiatives, and shifting reimbursement models. Just like Gooden, it's critical to assess your staffing model and priorities to ensure your staff continues to meet your changing needs.

That's where a staffing analysis comes into play. It's one of the most effective ways to determine if your practice has the right number of employees, and if your staff is doing the right things. We asked medical practice consulting experts to share some of their favorite staffing analysis strategies.

Prepping and planning

As with any major project, an important first step of the staffing analysis is to determine who will lead the project. While the office manager or administrator is the natural choice, Kenneth Hertz, a Medical Group Management Association (MGMA) principal consultant, says practices should encourage other staff members to get involved. "This is an opportunity to take some people in your practice that really shine, that have great promise, and to give them an opportunity, with coaching and mentoring, to really significantly help the practice and to get everyone involved," he says. "Maybe we need a front-desk person, maybe we need a billing person, maybe we need a clinical person, maybe we need a medical assistant or [a licensed practical nurse] or [registered nurse] ... We need to get them together and say, 'Look, this is what we're trying to do: We're not as efficient as we need to be and can be, and we'd like to get everybody to work together on this.'"

While physicians should not be in charge of conducting the analysis (this would be an inefficient use of their time), they should be aware of the project, its purpose, and its progress. This will help secure physician buy-in after you've completed the analysis and it's time to take action, says healthcare consultant Deborah Walker Keegan.

Once leadership and physicians are onboard, be open with staff about the project. Since they may equate "analysis" with "layoffs," encouraging transparency will help keep rumors and fears from escalating, says Richard Crici, chief executive officer of RJ Crici Consulting, Inc. "I don't think it would be a good idea to mention the fact that we're not cutting jobs, or we're not doing this to cut jobs, because you may in fact conduct this analysis and then it may lead you down that road," says Crici. "The better approach would be to say, 'We're conducting this staffing analysis because we want to make sure that we've got the right people, in the right places, with the proper tools to be as efficient as possible.'"

Getting a general overview

One of the primary purposes of a staffing analysis is to determine if your practice has the right number of staff. This is critical as reimbursements continue to decline and overhead increases. "If you have too few staff, you are not going to have high productivity of the physicians because [you're] going to see the physicians doing more things themselves," says Keegan. "If you have too many staff, your overhead related to staff is going to be very expensive." That excess overhead, in fact, could add up to some big consequences. As Hertz points out, the cost of personnel is likely the largest single budget item in a practice's overhead.

Keegan recommends consulting benchmark resources, such as the MGMA's cost survey reports and its "Performance and Practices of Successful Medical Groups" report, to compare your staffing numbers to practices of similar specialties and sizes. "I'm not going to use those as arbitrary numerical goals for staffing; I'm just going to take an assessment of where are we in comparison with our peers and best practice performance," says Keegan. "That is going to allow me to look at areas of opportunity and say, 'Oh my gosh, we' re real different in nursing,' or, 'We're really different in the front office,' or, 'We' re really different in patient accounting or billing, let' s now really take a deeper dive.'"

While benchmarks can provide insight into areas you may want to focus most closely on during the analysis, every expert we spoke to cautioned against rushing to conclusions if your staffing numbers are a bit different than the averages. "It's very difficult, I think, to establish benchmarks across the board because every practice is going to function differently," says Christine Mobley, president of healthcare consulting company C Mobley & Associates, LLC. "There [are] a lot of factors that really are individualized across each practice."

Evaluating roles and responsibilities

The second purpose of a staffing analysis is to determine if staff is tasked with the right responsibilities. A great place to start is by assessing the responsibilities associated with key work flow processes within your practice, says Hertz.

One simple way to do this is to write the name of a process (such as answering phones) on top of a long sheet of paper, tape the paper to a wall in a staff area, and ask staff involved in that process to write down each role and responsibility associated with it. "All of a sudden you look and you go, 'Wait a second. We're doing this; we ought to do that,'" says Hertz.

In addition to charting the responsibilities associated with key processes in your practice, ask staff involved in each process key questions, says Keegan, including:

• How could this work flow be improved from the patient's point of view?

• How could we reduce the number of steps involved in this work flow?

• How could we use technology to improve the process?

• Is there a way we can do the work earlier?

The latter question will indicate how reordering work flow (and therefore staff responsibilities) can boost efficiency, says Keegan, pointing to the example of performing patient financial clearance prior to a patient's visit.

"…We know that we've already done insurance verification, eligibility verification, [and] identified the time of service dollars that we needed to collect," she says. "Then we're going to need [fewer] staff resources on the back end trying to collect from patients once they receive statements."

Identifying tech opportunities

You'll notice that one of the questions Keegan recommends asking staff deals with technology, and there's good reason for that. How your practice is using technology, and whether it should acquire new technology, are critical considerations when conducting a staffing analysis.

If your practice has acquired new technology but it has not adjusted staff responsibilities to accommodate that technology, it is likely not operating as efficiently as possible. For example, work flow should change dramatically when a practice switches from paper records to EHRs, says Hertz. "The way you interact with, the way you get information from, [and the way you] access information, is very different in each of those technologies," he says. "If you don't change the process ... then you're putting that kind of square peg in a round hole."

Also, consider whether new technology could improve processes and eliminate staff responsibilities, says MGMA healthcare consultant Cindy Dunn. For instance, if your receptionist is drowning in phone calls, adopting a patient portal so that patients can make inquiries online could help.

One more tech area to assess: Whether your practice should change or supplement its current technology. For example, consider a practice that has implemented an EHR. Rather than having lab results automatically transferred to the EHR, the practice has results faxed to the front desk and front-desk staff sorts the results and distributes them. While staff is distributing the results, the practice lacks front-desk coverage. "You might look at that and say, 'Well that's a staffing problem, I think we need more staff,'" says Hertz."What you really need is to say, 'Wait a second why isn't that going right into our EHR?'" Adding an interface to the EHR, he says, could solve the problem.

Stepping up performance

Another area to assess when conducting the analysis is, of course, staff performance. While not every staffer will be a "star performer," you should shoot for about 75 percent to 85 percent of your staff members to fall into that category, says Hertz. "You're going to have some that are not, but that's where mentoring and coaching comes in."

Prior to assessing staff performance (Hertz recommends using performance evaluations based on job descriptions) ensure you are providing staff with every opportunity to succeed. If technology is operating slowly, for instance, it's unfair to criticize staff for taking longer than expected to complete a task. Or, if you've acquired an EHR, it's unfair to judge staff for not using it properly if you have not provided adequate training.

Crici, who says interviewing staffers is critical to a successful staffing analysis, says asking staff members a set of universal questions can reveal needs you are failing to fulfill, opportunities for training, strengths and weaknesses to build on, and more.

Questions he recommends asking include:

• Do you feel like you're qualified to do this job?

• What do you bring to the table that we should be really taking advantage of?

• What are we not doing that we should be doing to help you maximize your potential?

• Are there any areas that you would really love to explore?

• In what areas would you like to grow?

• Do you have the proper tools to do your job?

Calculating workload ranges

As practices face declining reimbursement and increasing overhead, it's critical to ensure they are operating with the right number of staff. While assessing industry benchmarks can help practices determine how their staffing numbers compare to practices of similar sizes and specialties, another useful method is to assess staff workload ranges (how long it takes staff members to complete a particular task, and therefore, how much work can be performed by a single staff member each day).

"What we've done is sat down with staff in many, many practices to identify the expected volume of work that can be performed by a single staff member in a productive day," says Keegan. "We can then build the staffing model based on the work."

So how exactly can your practice get started? Keegan points to the example of a staffer who works in reception answering the phones. Sit with the staff member and jot down the different types of phone inquiries she receives each day (new patient appointment requests, established patient appointment requests, and so on). Then determine the average amount of time it takes her to complete each call. You might find that it takes an average of four minutes to answer a call from a new patient, and an average of 2.5 minutes to answer a call from an established patient.

Depending on the average number of new patient calls and established patient calls your practice receives daily, you can then determine how many staff you need to manage the phones each day, week, year, etc.

When compiling workload ranges, don't forget to account for unexpected tasks that might arise, lunch hours, vacation time, sick time, and so on.

Taking action

Once you've completed the staffing analysis, it's likely you will have identified some key action items. But rather than rushing to make big staffing changes, Keegan recommends a gradual approach. For instance, if you want to change a particular work flow process, and therefore, the roles and responsibilities associated with it, she recommends starting with a pilot. "I'll have some practices just have a certain pod in the practice ... do things differently," says Keegan, adding that it's important to check in weekly to assess how the change is affecting the practice. "If it doesn't work, we'll try something else."

In Summary

Conducting an effective staffing analysis can help you determine if your practice has the right number of staff, and if your staff is doing the right things. Here's how to get started:

• Consult industry benchmarks to compare your staff to similar practices.

• Consider how staff roles and responsibilities relate to work flows.

• Determine how technology affects staff members' roles.

• Interview staff to identify strengths, weaknesses, and opportunities.

• Evaluate staff performance based on job descriptions.

• Take action.

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the November/December 2013 issue of Physicians Practice.