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By contactus@soshealthcaremanagement.com
March 19, 2019
Category: Problem Solving
Tags: tips   efficiency   management  

Mrs. Jones stormed out of your office today because she waited too long to be seen! Suzie called in sick leaving you short-handed! You overhear an argument escalating at the front desk about an overdue bill! Mr. Johnson returned his night splint and wants his money back because he claims it did not help him! What next?

This was definitely not the kind of day you expected when getting out of bed this morning. You planned to treat patients and improve lives, not dowse fires all day. It is no surprise to have occasional problems throughout the day. That’s Murphy’s Law. However, when 80% of your day is spent putting out office fires, leaving only 20% to focus on productivity, you need to do something – quickly – before those flames burn out of control.

The most common approach is to address that crisis immediately and move on. If you fit that description, you probably know that dealing with the calamity du jour at the moment it happens does little to solve the underlying problem and is the most disruptive. I often ask, “why is it easier to react, (i.e. ‘stop, drop and roll’) when managing a problem, than it is to actually fix it?” There is no denying the “stop, drop and roll” method works in a real life emergency fire situation – thankfully I have no personal experience. However, stopping production, dropping whatever you’re doing and then just rolling with each disaster as it happens generally results in unwanted and repeated interruptions. This is a reactive approach and changes nothing.

Let’s say a patient presents with a dirty, angry, open, oozing wound. The immediate approach to stop the bleeding might be to apply a bandage. Yet you know that simple first aid alone is not a good solution. It is fairly certain this patient will return with a worse condition because the underlying problem (the infection) was not addressed. A more proactive approach would involve managing the infection; specifically, cleaning and dressing the wound and taking necessary measures to prevent further contamination. Similarly, burning problems at work are also not eliminated by quick, easy fixes and are rarely a “one and done” solution. It’s pretty certain that those smoldering ashes will only re-ignite and create a worse situation next time around. Do you really want to deal with the same problems over and over again? Clearly, that is a waste of valuable doctor time.  In fact, if one does not work to prevent these hypothetical fires; they are practically guilty of arson.

Don’t fight fire with fire. Instead, consider these three strategies towards a more proactive fire-fighting approach.

  1. Be a leader. Only you can prevent fires. With leadership comes the responsibility to create a healthy business and you cannot do that if you are always in crisis mode. So, before any proactive approaches to in-office fire prevention can be offered, it is important, first and foremost, to understand that not every disruption is a catastrophe. “Catasrophizing” is nothing more than a reactive attitude, sure to cause confusion and does little to help finding answers. Yes, it is difficult to think about permanent solutions and big picture stuff when the flames around you are dancing out of control. After an incident real firefighters have a debriefing to identify what went right and what went wrong. Sometimes applying a quick fix when real crisis strikes allows you to move past an unpleasant situation, ok then debrief. Identify what you can do different or better in the future and how to prevent the errors from happening again. Don’t ignore it or stop trying to find an answer. That is the difference between survival mode and making actual progress.
  2. Put Together an Operational Framework, outlining the way certain conditions need to be handled. In other words, plan ahead to avoid the inevitable. For example, you know that Mrs. Jones (and likely other patients) are upset when made to wait for appointments and will likely walk out. Can this be prevented? Maybe reviewing your scheduling patterns or re-thinking time spent chit-chatting is in order. Is treating every condition that your patient complains about or allowing patients to arrive 45 minutes after their scheduled appointment the main reasons for daily backups? If so, what policies can be initiated to better handle these simmering situations before they flame up? Benjamin Franklin’s common sense strategy, “an ounce of prevention is worth a pound of cure”, comes to mind. Focus on what is really important vs. what is the worst-case scenario.
  3. Communicate and Delegate Responsibility, to others in the practice so that they can take control of certain situations and run interference for you. Not every situation needs your immediate attention; so instead of dealing with every unexpected hot spot on your own, ask for help. Let staff handle them based on your well-thought out standard operating procedures by communicating (via training) these pre-determined decisions and preferred problem-solving techniques. Then, discuss outcomes with them (debrief) to assure that the best approach was followed. A successful consequence of delegating is a great outcome as a result of planning/training…and you were never even aware of it.
By lynn@soshealthcaremanagement.com
July 16, 2014
Category: Efficiency
Tags: stress   customer service   Schedule  

Delayed schedule. Irritated patients. Late workdays. Costly overtime. Disgruntled staff. Stress... You don’t have to be Sherlock Holmes to figure out that something is wrong. All these signs are the classic symptoms of poor scheduling, but that’s only one diagnosis. And sure, patients expectbackups… occasionally. However, when waiting becomes a repeat performance, with no effort to fix it, all that good customer service your practice offers to romance your patients goes out the door, along with the patient. Is there a reason for this? Of course there is. Things don’t just happen in a vacuum… they are the byproduct of our actions. Doctors say they want more efficiency in the office. However, without the willingness to embrace change when fundamental management remedies are suggested, it continues to be the same-ole, same-ole. (Re-enter delayed schedule. Irritated patients. Late workdays. Costly overtime. Disgruntled staff. STRESS.) I believe Einstein said it best. “Insanity: doing the same thing over and over again and expecting different results.”So why is it, that despite the fact that everyone (staff, patients, doctor) benefits from an on-time schedule, worthwhile solutions are glazed over with excuses and the bad habits continue to (ineffectively) run these practices?  

It’s impossible to summarize all the reasons why medical offices keep patients waiting in a one-page blog (there are many!), but since treating (unscheduled) multiple conditions is one of the biggest culprits, it gets top billing. Now, before you get defensive and go all “I do it because I care about my patients”on me, understand that this is not about caring for your patient. Of course you care. No one is disputing that. There is an effective way to handle this scenario and a not so effective way and unfortunately, more often, the not so effective way dictates protocol. What I mean by that is making exceptions for one person usually has a trickle-down effect. While it’s nice to make that “caring” exception for a patient, it is unfair to the others who are on time, also needing care and left sitting in the reception room, AKA “the waiting room”.

I’m confused by this “extra care” because I can tell you that (unless time allows), my dentist sticks to the one tooth I was scheduled for. Not two teeth and not, “Oh, BTW can I get a cleaning while I’m here?”Do I think he’s a bad dentist because he didn’t alter his schedule for me? And would I even consider going to another dentist for that reason? No, because the expectations for this appointment were met. I was taken promptly, received the attention and care I was scheduled for, the patient’s appointment before me did not spill over into mine and I left on time. If I had an additional problem that needed to be addressed, it really should have been MY responsibility to call in advance, explain it to the receptionist and have my appointment expanded or rescheduled if need be to allow time to treat multiple conditions. At the very least, I should expect to make the new, painful condition my priority at this visit and schedule another to replace my original appointment.

Of course emergencies do occur and must be addressed immediately, but not every (unscheduled) event treated as an emergency, really is…an emergency. Naturally, if time allows, special attention can be given to non-emergent conditions as well, however it’s important in this instance, to educate the patient that this may not always be the case or they will come to expect it every time.

Here’s the misconception. Blowing holes in your schedule for one or more patients doesn’t make you a hero, a better doctor, more likely to increase revenue or retain a patient. So, in order to keep flow in tact (and truly keep everyone happy), it’s sensible to hear and examine the patient’s new complaint and treat if it’s emergent or if time really does permit. Otherwise give them a patient-based response; “It’s nothing serious, Mrs. Jones but I’m glad you brought this to my attention. Here’s what we will do today to make you comfortable…I want you to take note of how that feels over the next couple days/week and before you leave today, see Sally at the front desk and have her schedule you for a visit so that we can give you the proper amount of time to follow up and more comprehensively exam and treat it.”

There is no denying that good customer service and patient care is what we all strive for, but not if it means stepping on one patient’s toes to accommodate another’s. Patients want to know that everyone is treated fairly and given the same respect. Again, there are many reasons why a schedule can take a nosedive and as I said at the onset, this is only one; a problematicone that has proven to cause unnecessary disruption. If you commit to making an effort to fix one problem at a time, I promise you…things will improve.  

By lynn@soshealthcaremanagement.com
July 16, 2014
Category: Human Resources

Too often, I find there to be a huge misunderstanding about employee wage classification and so this month’s blog provides a very narrow look into FLSA (Fair Labor Standards Act) rules that affect you as an employer. FLSA Compliance is something you should take seriously. In 2008, the Department of Labor (DOL) recovered $220 million in back wages and employees are filing record number of lawsuits under state and federal wage and hour laws.

The rules tend to be a bit confusing; however, start by no longer referring to your employees as “salaried”or “hourly”because in doing so you might make certain inaccurate assumptions. Instead, the proper way to classify employees should be “exempt”or “non-exempt.”What’s the difference? A non-exempt position must be paid at least minimum wage on a salary, hourly, piece rate or commission basis and subject to the overtime rule while exempt status is reserved for TRUE office managers. I emphasize “true” because classification does not revolve around an employee’s title; rather, around their job duties and many “office managers” are not given the level of responsibility necessary to fit this job description. Just because a staff person is assigned the title “Office Manager” or is “salaried”, that does not necessarily qualify them for exemption. To clarify: an exempt employee must be salaried; however a salaried employee may be non-exempt. Non-exempt is the proper classification for the overwhelming majority of podiatric staff. 

Some employers assume that because their business is small, they are not covered by the rules of FLSA. Unlike most state and federal employment laws, the FLSA rules do not depend directly upon the number of employees. While proper exempt/non-exempt classification may seem vague, the repercussions and penalties for non-compliance are very real. Keep in mind too that non-exempt employees who volunteer to take work home, work through lunch, work overtime and waive OT pay for doing so; although tempting, is not legal.

Finally, please note that State law supersedes Federal, so e.g., in cases of OT and Comp Time, you should refer to your own state jurisdiction. Heed the warning. While these issues might not ever present a problem in the “harmonious” workplace, they could become a bone of serious contention in the event of a parting of ways.   

Download a free slide presentation created by the US Department of Labor that helps explain more about FLSA federal law at:   http://www.dol.gov/whd/regs/compliance/fairpay/presentation.ppt   

By lynn@soshealthcaremanagement.com
July 16, 2014
Category: Staff Management
Tags: communication   job   Boss  

Over the years, I’ve had the opportunity to work with two good “bosses” – but not every employee is as lucky as I was. I’ve experienced the good and seen the bad. I refer specifically of those employers who want nothing to do with helping to guide/counsel/train their staff…yet demand very high, sometimes unrealistic expectations from them. They insist on perfection instead of excellence; make zero attempts to communicate, remain inflexible and persistently “manage” with power and control instead of guidance and leadership. Then they wonder why they have a revolving door of staff. Instead of looking inward to find solutions, a more common rationale is…“Good staff are hard to find in this area,”…yet, coincidentally, another podiatrist six blocks down seemed to have triumphed over that debatable barrier.

I started thinking of some of the more familiar good and bad “on screen” bosses that we’ve been exposed to. The good ones make you smile…George Bailey in “It’s a Wonderful Life,” Sheriff Andy Taylor in the Andy Griffith Show and how about Jack Warden’s character in “Big” - dancing on the floor piano with employee Tom Hanks? Who wouldn’t want to work for them? The bad bosses were bad in so many different ways…intolerable, mean, slimy, clueless…among them were Ebenezer Scrooge in a “Christmas Carol”, Dabney Coleman as Franklin Hart in “Nine to Five” and perhaps the most obnoxious space cadet boss, Bill Lumbergh, in the classic “Office Space.” “Yeeaahhhh, thaaaannnks.” Keep in mind that bad bosses are not limited to men. Meryl Streep and Sigourney Weaver’s characters in “The Devil Wears Prada” and “Working Girl”, respectively were just as obsessed with power trips. Help me out…what other “good and/or bad” bosses from movies and TV fame can YOU think of? Which ones can you relate to? 

How long will your patient patiently wait before being called into the treatment room? Consider this little factoid. The division of motor vehicles is #1 on the list of places where people get irritated waiting. Guess who is #2?

Sadly, we (doctor's offices) have a reputation of making patients wait and for the most part, we’ve earned it. A patient might expect (and be willing) to wait a “reasonable” time (anywhere from 15-20 minutes); however, lengthy wait times will decrease patient satisfaction and may discourage other patients from coming to your practice. Let’s face it…no one wants to wait 1-1½ hours before seeing the doctor regardless of the reason. And they shouldn’t HAVE to! Patients who are subject to such treatment on a regular basis will eventually lose their patience and you will lose their respect. They will leave before even having the chance to meet the doctor. Those that stay may speak highly of the services they received, but will also counter that with negative comments about their waiting experience. 

And if you’re not on time…what’s the biggest reason? We welcome your comments... 

Apparently, a foot massage is a very “touchy” subject so I thought I’d throw it out there for discussion and get your thoughts on the topic.  I recently posted on Facebook about my dental appointment where they offered a paraffin treatment for my hands and… a foot massage while they cleaned my teeth! As a patient, I was blown away by their customer service and quite frankly, it did just what good marketing is supposed to do. I told 10 people who told 10 people...etc. My post was quickly challenged by one of my DPM readers, “we shouldn’t lower ourselves to providing foot massages. It sends a negative message to the public that the podiatrist is no different than the pedicurist. Things like this are why our profession is “oppressed”; constantly fighting for status.” 

I’ve worked in and with MANY successful practices and never thought our profession was oppressed. In my thirty-some years of giving foot massages to very appreciative patients, there was never one who came to our office because they confused us with the pedicurist.  We were very secure in the fact that we had a highly successful, busy practice because of the medical and surgical podiatric services we provided. We used this time to treat AND educate our patients, simply because awareness leads to better outcomes. This is critical in growing and influencing the type of practice you want. We also understood that educating patients helps build the reputation of our practices, the DPM, and the role of podiatric medicine.

Giving foot massages is not the way some podiatrists want to go; I get it! Customer service can be achieved in many ways. When I get the oil changed, I’m offered the USA Today; I don’t mistake them for a news stand. Coffee shops include Wi-Fi; I’m aware they specialize in lattes, not internet technology.  Is podiatry’s identity challenged just because the staff offers a foot massage? Do we have to choose between providing quality medical/surgical care and/or quality customer service? My experiences tell me that both can be delivered simultaneously.  If defining our profession depends upon whether or not we choose a foot massage as an added customer service, then we are in trouble.  It makes our patients happy and the smiles on their faces mean we've not only touched their soles....but also their souls. In the end, isn't that what patient care is all about? My view is there’s nothing bad about feeling good during an office visit. Just my opinion. Your thoughts? 

By lynn
May 14, 2012
Tags: training   protocol   emergency   safety  

If there's never been a time in your office where you've had to deal with a medical emergency, you are lucky. But what if that changes tomorrow? Will you be prepared? Whether you face a case of syncope, a Diabetic insulin reaction, anaphylaxis, seizures or cardiac arrest, your team should develop an emergency plan describing how to handle each situation. Here are some basic drills:

  1. List and have handy some important phone numbers so all personnel can get them quickly
  2. In the event of an emergency, each staff person should be assigned specific duties. No one should have to ask, "what should I do?"
  3. All emergency supplies should be kept in the same area. This is so no lost time occurs during a crisis.
  4. Certify yourself in CPR. All office staff should work towards certification and this should be encouraged and supported by the doctor.
  5. Frequent drill enactments of all types of medical office emergencies should be practiced. 

Have you ever had to deal with a medical emergency in your practice? Share what happened, how it was handled and what was the outcome of your teams actions. What kind of emergency protocol do you have put in place?  

By lynn
May 14, 2012
Tags: efficiency   staff   training   opportunities  

Is this a concept you've considered in this time of economic frailty? Is cutting staff your first knee-jerk answer to reducing your overhead? If you want to work SMART...that is, reduce doctor's time with patients, so that the practice can see more patients and increase practice revenue without compromising comprehensiveness....and do these without burning out or spending every waking hour at the office...consider an alternative option! Taking the time to train, develop and integrate your staff more effectively into your treatment protocols can result in improved efficiency and financial rewards. Increasing their role and utilizing them in the most productive way possible is a plus for everyone - the practice, the doctor, the patient and your staff. What are you waiting for? For training opportunities available to you...see our Staff Training and Office Productivity Workshop

By lynn
May 14, 2012
Category: I think it's funny
Tags: stress   fun   job  

We deal with stress every day - some good some bad. Even in the most difficult of times, things get SO absurd that they are actually funny. I can think of a time when my SOS partner and I were under the gun to get copies made for a presentation we were giving. Naturally, it was last minute, so the pressure was on. It was late. We were tired and so we went to the nearest copy center to see about getting our handouts made. Luckily they had a new copy machine that collated many pages together and its purpose was to make things simpler for us. Well, we were getting the job done when all of a sudden, it started speeding up and before we could say Kinko....paper was flying all over the place. It was like a page out of I Love Lucy. We laughed so hard we cried. We got it together and got our copies made...but it's those kinds of things that help release endorphins and make you think...are things REALLY that bad? Have you ever found yourself in a situation that was so stressful....it made you laugh? 

By lynn
May 14, 2012
Category: Staff Management
Tags: training   tasks   delegation  

Start by asking yourself...What tasks can I delegate? Not everything can (or should) be delegated. Carefully select those jobs that can be quickly taught and which you are personally comfortable letting go of. Once staff has become more confident and can prove to you that they are able to handle lesser tasks, move on to bigger ones. Eventually, based on their level of proficiency, you'll want to delegate specific tasks that allow you both to generate revenue simultaneously, e.g. while you are giving an injection, they can be taking an orthotic foot impression or apply and instruct a patient in night splint wear. Proper delegation is more than just assigning work to someone else. It's not only letting go of a task; it's also transferring the decision-making responsibilities along with it. It's about empowering and trusting people..Delegation is NOT passing things on because you don't want to do them, they are too difficult or too boring! Are there concerns about delegating tasks in your practice? 

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