J.I.T. AND MEDICAL OFFICE PROCESS EFFICIENCY
[By Dr. David Edward Marcinko FACFAS MBA CMP]
Much of what is done in Just In Time labor control is aimed at reducing the doctor’s wait time (radiographs, accu-check sugar levels, urine cultures, blood tests, injections, cast changes, etc.), the patient’s wait time (check-ins, check-outs, insurance verification, pre-certification, etc.), the move time (procedure set-up time, referrals, transportation, etc.) and quality time (education, emotional support and hand-holding); increasing actual patient physician service treatment time.
This can be expressed as the sum of four parts:
Treatment Time
(+) Wait Time
(+) Move Time
(+) Quality Time
_____________________________
Total Time: (Efficient or Inefficient)
Only the patient’s treatment time (doctor-patient interaction) adds value to the medical service. Wait, move and quality time are all non-value added services and should be eliminated to the extent possible, as they represent needless expenses. All can, and should be performed, by non-physician personnel.
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Tasks to Delegate
The following represent tasks that the doctor can easily delegate in order to increase his or her office time efficiency:
* Patient scheduling, routine telephone calls, office directions, pre and post operative orders, triage, referral and pre-certification and prior-approval forms and faxes, co-payment recoupment and office visit charges, pharmaceutical representatives and detail people.
* Initial historical review, vital signs, insurance updates, telephone call-backs, and data gathering information on all patients.
* Injections, allergy testing, PAP smears, cultures, blood tests and phlebotomy, , gram stains, specimen preparation and other similar routine procedures.
* Prescription writing, acne medication, dermatological preparations, refills, pharmacy interaction and drug interaction explanations.
* Minor procedure assisting, suture removals, x-rays, casting, pathology and laboratory reports, ultra-sound, physical therapy and bandaging.
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Tasks Not to Delegate
On the other hand, the following tips to improve physician time management might prove useful:
* Focus on patient and avoid interruptions in the examining room which should not have a telephone or intercom system; a light or sound signaling system might be considered instead. Listen carefully and repeat phrases back to patients in order to enhance communications and reduce errors. Reduce socialization time at work, the office or hospital setting.
* Schedule patient/physician call backs in specific time clusters; and/or consider a car phone or portable telephone or other personal digital assistance electronic device. If you have an open door office policy; keep it closed until all calls are returned. Inform your staff to avoid appearing unfriendly.
* Make a short, intermediate and long terms task list of goals to be accomplished every day. Complete all of the important tasks, and keep track of those yet to be done. Stay flexible. You want to drive the list; not have the list drive you. Avoid an over-achieving mentality. Save something to do tomorrow.
* Make proper time estimations using the Two-and-a half Rule, since it involves allocating an extra amount of time to perform given tasks, caused by interruptions, unplanned events or other minor problems. In this way, your daily priority task list will be more realistic.
* Use stock letters, paragraphs and/or “macros” in your dictation system. The use of computerized charting notes is fine as long as the potential for litigation and defending such “canned assembly-line” notations is considered.
* Avoid practice management, office or business meetings in the evening or after office hours. Rather, hold them before hours in the morning or during lunch time. Have food catered for a staff treat but do not loose the focus and real purpose of the meeting.
* Review the telephone log and the next day’s schedule before departing for home or the hospital.
* Use the Rule of 7’s, and realize that if there are more than seven people involved in a committee or office project, there are probably too many. Also realize that when you are appointing committees for TQI endeavors, remember that 5-7 people will provide the same results as a larger group. If you are a key player, then by all means stay involve. If not, minimize your participation, since the rule reduces some of your non-medical functions. Forget perfection.
* Follow the time efficiency philosophy of professional managers, and “do, delegate or dump” non-medical tasks; and handle paperwork or other chores only once.
* Reduce the number of needless office, hospital or surgery center meetings; speed read non-medical literature and reduce your material (operating assets) office needs.
* Keep your office staff and family informed of your desire for office and time efficiency; do not forget your loved ones, religious affiliation, personal or physical (exercise) needs. Maintain a healthy, happy and psychologically fit lifestyle.
Results of JIT Implementation
When correctly applied, JIT labor and inventory controls may reasonably be expected to yield the following benefits:
1. Greater doctor and employee productivity through improved office physical layout.
2. Reduced treatment and business management time resulting in the potential to see more patients, or the same number of patients with less time urgency and personal stress.
3. Inventories of durable goods are reduced and expensive storage space is made available for revenue generating activities.
4. Patient quality and services are rendered in a cost effective and value added manner.
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RESPONDING TO DIMINISHED PATIENT VOLUME
The most appropriate response to diminished or declining patient volume is the transformation of as many fixed office costs as possible, to variable costs. This cost reduction strategy does not call for cost cutting per se, but for a change in the relative ratio of fixed to variable costs. It can be accomplished by (1) using temporary staffing, with its associated risks and benefits, (2) outsourcing as much as possible, with its associated risks and benefits, (3) leasing or renting rather equipment rather than buying, and (4) using JIT purchasing and labor.
Assessment
The reviewed time management techniques represent powerful techniques for increasing practice profits in the competitive environment. Implementation will decrease personal stress and assist the efficient physician develop the most economically profitable service and operational flow process possible for the office.
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: Practice Management | Tagged: DIMINISHED PATIENT VOLUME, JIT, Just In Time | 3 Comments »
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