In Medical Practice Operations, Small Problems Add up

Consider these two simple definitions of leverage from Wiktionary:
• A force compounded by means of a lever rotating around a pivot.
• By extension, any influence which is compounded or used to gain an advantage.

The presumption is that gaining leverage by compounding effort and resources is always a good thing.  That's not always the case, and a typical medical office provides two examples of this.

Example 1: Appointment scheduling
Let's assume that appointments are scheduled at 30-minute increments, and last an average of 35 minutes.  Here's what a morning could look like:
• Patient 1: 8:00 to 8:35
• Patient 2: 8:35 to 9:15
• …
• Patient 8: 12:10 to 12:45 (Patient 8 was scheduled for 11:30)

This causes many problems for physicians, staff, and the practice. For physicians, there may be some time for lunch before afternoon clinic, but not enough time for what the physician intended to do during that break.

Staff will likely clock an extra 45 minutes each morning. In the course of a two-week pay period that translates to:
Per day: .75 hours X 2 = 1.5 hours
Per 10-day period: 1.5 X 10 days = 15 extra hours of payroll (plus taxes and benefits), maybe at overtime rates.

The reality is usually worse than this simple example: 
• You can rely on Patient 8, and maybe even Patient 7, to be disgruntled about their long wait time. This could require providing the patient some time to vent and giving the patient an apology. 
• Some of the visits probably exceed 35-minute average, enlarging the accumulated deficiency.
• Even when exam rooms are adjacent, it takes time to move from one to another, and how often does a physician get to move between rooms without being asked a question?

This is an example of negative compounding.  The office gets farther and farther behind.  The only thing that stops the bleeding is coming to the end of the patients scheduled for the day.

The solution is to schedule in line with realty. Whether realty is fewer patients per day, shorter visits with built-in transition time, or longer clinic hours, is up to the physician.

Example 2: Patient signatures
When a patient's signature is required for a new purpose, it is easiest just to add an additional form, right? Not necessarily.

The thinking is that this additional form ensures the patient signs a form that directly addresses the new requirement, the new form has no effect on existing forms, and you don't need to think too much about it. Maybe you should.

You might expect me to point to the costs of producing the extra page for each patient, but those are de minimis. More costs result from managing the extra page: getting it to the patient, making sure it is completed and returned, and securely storing it.  The only really significant cost is in locating missing and misplaced forms. If the rate of lost and misplaced forms is low, however, those costs don't amount to much.

The real costs, in terms of time, fall on your patients. They have to write their name, their DOB, and who knows what else, each time you have them sign a form. 

Other intangible costs fall on you.  Patients who are eco-sensitive are very likely to be bothered by your insensitivity to the environment.  And the different typefaces and formats of a plethora of forms give them a negative impression of your practice's professionalism.  You may not be paying your patients with money, but you are incurring the cost of a withdrawal from their positive impression of you.

The withdrawal is compounded because it happens with every patient, every time he is asked to deal with the form(s). As we all know, forms never go away so the compounding for each form goes on in perpetuity. 

The cost of developing a professional package of forms for patient use is minimal compared to that.

When leverage is compounding effort and resources for positive effect, the rewards are significant and the advantages add up quickly.  When negative, leverage just digs a hole.