Physicians Practice - February 2008 - (Page 16)

P eARLS CREATING AN A+ PRACTICE B Y J U D Y C A P KO PHYSICIANS ADVISORY BOARD David Albenberg, MD Access Healthcare, Charleston, SC Michael F. Bonazzola, MD Oregon Health & Science University Medical Group, Portland, OR Juliet Breeze, MD Richmond Bone and Joint Clinic P .A., Richmond, TX Robert C. Goldszer, MD, MBA Brigham and Women’s Hospital, Boston, MA Scott Meyer, MD Greater Northwest Medical Group, Arlington Heights, IL William Smits, MD The Allergy & Asthma Center, Fort Wayne, IN I recently visited a busy, primarycare practice where the physicians were struggling to stay on top of the workload. “There just aren’t enough hours in the day,” the manager said. “These doctors have too much to do in too little time.” Not true. The culprit was in fact low-quality clerical and clinical staff performance, and it was costing them plenty! There were gross inconsistencies across the staff in how administrative tasks were performed, from ﬁlling out a disability form to collecting information for a phone message. Clinical staff charting was a problem as well: Sometimes the medication ﬂow sheet was updated. Sometimes it wasn’t. Sometimes it was just plain wrong. Patient visits were truly a mixed bag — charting vitals, noting the reason for the visit, and preparing the patient for an exam were rarely executed in the same way. Naturally, these physicians felt no conﬁdence in their staff. This meant the doctors had to spend endless hours double-checking and reworking many tasks supposedly done by the staff. There were long wait times for patients too, some of whom became so disgruntled they took their business elsewhere. And the workdays that never seemed to end resulted in excessive overtime costs, disenchanted staff and physicians, and unhappy patients. This practice was in trouble. I worked with the manager and physicians to put together a plan that streamlined processes, developed simpliﬁed written guidelines for performing support tasks, and revised job descriptions to clearly deﬁne each person’s responsibilities. We also 16 | PHYSICIANS PRACTICE | FEBRUARY 2008 defined measurable performance outcomes for each staff position, tying them directly to the job description and discussing them during the annual staff performance reviews. Next, I coached physicians on how to delegate tasks, provide constructive criticism, and hold staff accountable for performing tasks — all based on standard, deﬁned procedures. The physicians learned how to guide and train new employees to ﬁt in with these policies. In addition, we instituted a customer service training program that rewarded employees according to patient satisfaction. It may seem like a lot of work to put this type of structure in place, but it’s the right way to do business, as there is much to gain when quality is consistent. Remember, your staff wants to serve the practice well, but they can only do it with proper training and a full understanding of their jobs and your expectations. Several months down the road, these physicians decided to examine variables in their clinical decisionmaking. They developed clinical indicators they could measure and report on. The result? Attractive performance bonuses from several of their third-party payers. Quality counts. Get on board with implementing internal quality initiatives throughout your practice and start reaping the rewards. BUSINESS ADVISORY BOARD Susan Allen Oregon Health & Science University, Portland, OR Rebecca A.H. Anwar, PhD The Sage Group, Philadelphia, PA John Barrasso, MD Wyoming Medical Center, Casper, WY V. Alin Botoman, MD Holy Cross Hospital, Fort Lauderdale, FL Barry Brennan Miami Children’s Hospital, Miami, FL Greg Bruce UMC Health System, Lubbock, TX Patrick Cawley, MD Medical University of South Carolina, Charleston, SC Wanda English Shands at the University of Florida, Gainesville, FL Richard Gangemi, MD Rochester General Hospital, Rochester, NY Hewitt Goodpasture, MD Via Christi Regional Medical Center, Wichita, KS Darren R. Haskell, MD St. Luke’s Hospital, Chesterﬁeld, MO Larry Hopperstead, MD Central Maine Medical Center, Lewiston, ME Allen B. Hornell, MD ETMC Regional Healthcare System,Tyler, TX Timothy Huffcutt Saint Joseph’s Hospital, Marshﬁeld, WI Peter J. Jacoby, MD, FACEP St. Mary’s Hospital, Waterbury, CT Jean Kostelansky Northwestern Memorial Hospital, Chicago, IL Michael Kryda, MD Ministry Healthcare, Saint Joseph’s Hospital, Milwaukee, WI Leonard Lichtenfeld, MD American Cancer Society, Atlanta, GA Jim Lindsey, MD SETON Healthcare Network, Austin, TX John Mackel, MD Saint Francis Medical Center, Cape Girardeau, MO Lorraine L. Manzella SUNY Upstate Medical University, Syracuse, NY Hagop Mekhjian, MD OSU Medical Center, Columbus, OH Daniel M. Navin, MD Munson Healthcare, Traverse City, MI Harold Pillsbury, III, MD UNC Hospitals, Chapel Hill, NC J. Robert Polk, MD Saint Alphonsus Regional Medical Center, Boise, ID Thomas Pow, MD Lakeland Regional Health System, St. Josephs, MI Kevin Ruggles, MD Rockford Health System Rockford, IL Stephen Smith, MD The Nebraska Medical Center, Omaha, NE Ronald W. Swinfard, MD Lehigh Valley Hospital, Bethlehem, PA R. Stephen Taylor, MD Piedmont Hospital, Atlanta, GA Donald Thomas, MD Kingman Regional Medical Center Kingman, AZ Jerome Thompson, MD UT Medical Group, Memphis, TN J. Stephen Wikle, MD, MPH Hoag Memorial Hospital Presbyterian, Newport Beach, CA Michael Wong, MD Roswell Park Cancer Institute, Buffalo, NY Sally Wright, MD Swedish Medical Center, Seattle, WA Florencio Yuzon, MD Community Health Partners, Lorain, OH John M. Zerwas, MD Memorial Hermann, Houston, TX Nathan J. Zuckerman, MD Lourdes Medical Center of Burlington County, Willingboro, NJ • Judy Capko is a healthcare consultant with more than 20 years of experience and is the founder of Capko & Company (www.capko.com). She is the author of the top-selling book, “Secrets of the Best-Run Practices.” She can be reached at judy@capko.com or 805 499 9203. WWW.PHYSICIANSPRACTICE.COM http://www.capko.com http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - February 2008

Physicians Practice - February 2008 Contents The Bigger Picture: Your Future is in Your Hands Letters Physicians Practice Pearls: Creating an A+ Practice Noteworthy Cover Story: Conquering Time: 5 Keys to a More Efficient Practice In Balance: A Family Affair Technology: Making EMRs Work in the Exam Room In Practice: "I've Got Some Bad News" The Tech Doctor - The EMR: Savior or Poseur? Ask the Experts NEW! Healthonomics: How to Handle Health Savings Accounts The Administrator's Desk: Finishing School for New Managers Human Resources: Is Your Partner Impaired The Great Practice Makeover: Too Well-Liked for His Own Good? Coding Idealab: 'Why I Blog' Classifieds Advertiser Index

Physicians Practice - February 2008

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