Improve Staff Performance at Your Medical Practice

Responsiveness, productivity, and accuracy are the basic performance requirements for medical office staff. Physicians are routinely frustrated because staff performance fails to meet these basic expectations.

The most frequent explanations fall into two categories: 1.) Staff is lazy and unprofessional; and 2.) Physicians are terrible managers. I am more inclined to believe the problem rests with a job design that prevents almost anyone from performing well.

The root problem is that, for most tasks, a high level of responsiveness is in direct conflict with productivity and high quality work. Every task requires a certain amount of immersion time, i.e., the time it takes to direct one's full attention to the task at hand. We sometimes call this "getting into the groove." An interruption pulls one away from the task, and another period of immersion is required to resume productive work. The length of the period of immersion varies directly with the complexity or intricacy of the task.

Productivity takes a direct hit with each interruption, because re-immersion time is all overhead that does not advance the work. Consider a nurse in the process of setting up a patient's surgery when the telephone rings and she must answer. When the call is complete the nurse goes back to the surgery and has to remind herself where she was in the process. Had she already placed a call for the anesthesiologist, or was she verifying the patient's cardiac clearance? It is fair to say that she should have notes that tell her exactly where she stopped in the process. Good notes mitigate the re-immersion period, but they do not eliminate it. Interruptions can easily double or triple the amount of time actually required to complete a task.

Accuracy is negatively affected because of time pressure. In the example above, the nurse probably knows or feels that she has only so much time to devote to the task. If she unconsciously shorts the re-immersion time to meet her time limit, she is very likely to miss a step or make another mistake. The rule of thumb is that interruptions double the number of errors.

The solutions are fairly simple and fall into four categories.

Separate the functions.

Avoid giving a single staff member both simple and complex tasks. Give the receptionist tasks that require the least immersion and re-immersion time in order to diminish the impact of her inevitable, frequent interruptions. Do not assign functions that require high responsiveness to staff charged with complex tasks.

Separate the work areas for high-responsiveness staff and high-complexity staff.

One purpose of the separation is to protect the high-complexity staff member from the ancillary noise and activity associated with a high-responsiveness staff member. A secondary purpose is to make it easier for her to avoid jumping in to help.

Carve the day into blocks of time.

Not everyone has enough staff to separate functions, and not everyone has enough space for physical separation. In that case, the only way to segregate different tasks is by time. Decree that a certain part of each day, or a certain part of a certain day each week, is to be reserved for a specific complex activity. During that time, everyone in the office does everything practical to avoid interrupting the staff member, up to and including putting the phone on forward.

Summary: Accept diminished productivity and a high rate of errors.

There may be compelling reasons that everyone in the practice needs to be immediately responsive at all times. If that is the case, it is important to understand the tradeoff and accept the consequences. Holding staff to standards that are impossible to achieve is both unfair and unproductive, and explains a great deal of medical office staff turnover.