Cutting Down On Wait Times Without Sacrificing Quality

Patrick DeHeer DPM FACFAS

Medicine is a volume business. In order to have a financially thriving practice, clinicians need to see more patients. More patients equal more revenue. This is a dirty little truth that anyone in medicine knows but is very reluctant to talk about because it is not politically correct.

The problem with a high volume is patients spend more time waiting. I have always inherently been aware of patient wait times. The longer patients wait, the more pressure I feel. Recently, I asked patients to fill out a survey with the following questions:

1. What are the three critical elements necessary in order for you, as a patient, to consider your office visit an A+ experience?

2. What are three experiences that have caused or could cause you to consider an office visit as a negative experience?

3. What three elements of your experience must be in place in order for you to refer friends or family to Hoosier Foot and Ankle?

The results of my survey were quite clear. Almost everyone said being seen on time is a requirement of a great experience. Typically, they associated long wait times with a negative experience. Many other things also ranked high, such as the doctor’s knowledge, feeling like they were being listened to, a clean and modern office setting and feeling like they had adequate time with the doctor.

I have been closely monitoring check-in and check-out times. They have been averaging about 45 to 50 minutes for established patients and 75 to 90 minutes for new patients. I have a goal of 30 minutes for established patients and 60 minutes for new patients. The million-dollar question is, how do you see 50 or more patients a day within these established goals while not making patients feel rushed during their visit? It is a question I have been deliberating for several weeks with a significant amount of research on effective strategies.

I read an article last week with a similar study that had slightly lower importance for wait times (see http://www.ama-assn.org/amednews/2012/10/01/bisa1001.htm ). In this study, patients considered wait times important or very important for patient satisfaction 83 percent of the time. Ninety-seven percent of those polled said a doctor's knowledge, expertise and training was important or very important. Ninety-five percent cited time spent with the doctor was 95 percent.

Let me be clear. Seeing fewer patients is not on my agenda to solve this problem. In addition to being a physician, I am an entrepreneur and as chief executive officer of my corporation, my sole responsibility is to my shareholder (I have 100 percent of the shares in my corporation). As a shareholder, my primary concern is that of profit margin for the corporation in which I have invested.

Do not mistake the business portion of this equation with not caring about patients because I absolutely do care about every one of my patients when I am in the role of the technician (physician). For more information about entrepreneur, manager and technician roles in a business, please read The E-Myth Revisited: Why Most Small Business Don’t Work and What to Do About It by Michael E. Gerber.

Efficiency is of the utmost importance to taming this monstrous problem. The key to efficiency is adequate, trained and engaged staff. The time spent with the patient must be uninterrupted and the doctor must be fully engaged with the patient to solve his or her problems.

I plan on having a staff member come into the room with me while I see the patient. Therefore, I never have to leave the room for any reason and do not waste time to retrieve an injection, test result or instrument. It is not uncommon for me to be 10 to 15 minutes late getting to the office, thereby starting the day off on the wrong foot and snowballing the wait times as the day progresses. I have to drive about an hour or more to each of my offices. I am working on actually getting there early.

If we can start the day off ahead of schedule, the chance to run on time greatly increases. The same goes for my staff. My staff also needs to look over the schedule the day before to prepare, thereby anticipating the schedule. The really big thing for me is taking time to chart between patients. If I do not do this, I end up charting in the evening or on the weekends, taking away from my personal life. My goal is to hire a medical scribe to chart as I see the patient. I have had difficulty finding candidates to fill this position but I will not give up until I do.

That is my plan and my goal for check-in and check-out times without lowering the number of patients I see daily.

I am asking you, my readers, for your opinions and suggestions. I would like to make this an open forum discussion. We are both entrepreneurs and physicians. Until you run your business like a business, you will never reach your goals.

Best wishes and stay diligent.

Comments

I can really relate to this post. What I did regarding the charting dilemma was convert my two main medical assistants into part-time scribes. One MA will "room" the patients, autoclave the instruments and take X-rays. The other MA assists me and does the notes. After a chunk of time, the MAs reverse roles. I complete the notes during lulls and at lunch. It is a really sweet feeling walking out the back door at 5:15 with all the medical records done for the day.

Thanks for your thoughts about the importance of improving efficiency/profitability and patient experience simultaneously.

I appreciate your focus on process improvement (e.g., well trained engaged staff, starting on time, advanced prep, proper room setup) and measurement (capturing check-in and check-out times). I’m not sure how granular your cycle time measurement is but in my experience, if you capture all the steps in the process – check in, rooming, exam, procedure consents, visit summary, etc. – you’ll have an even better picture of the process and the actual length of time patients spend waiting with a staff person and with you.

This analysis reveals where waste and delays occur, whether it’s in a handoff or a particular task. It also allows you to see your actual vs. scheduled time with the patient, potentially showing the need for a different visit increment or updated scheduling guidelines. (It’s surprising how often this one is overlooked!) If adding resources (like a scribe) improves profitability and patient experience, then it’s a great solution. If it improves physician productivity and/or satisfaction, it may still be the right solution. Either way, continuing to measure and streamline your patient flow process is a win-win for doctors and patients.

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