Have you ever peeked out of your exam room for a brief moment, just to see that you are behind and there are patients waiting impatiently? While it is easy to dismiss this as a common occurrence in medical practices, it is far better to implement changes to combat this issue.
Long wait times and inefficient process flow damage the reputation of the practice and deteriorate the service quality. They also result in lost time for patients (i.e. missed meetings, inconvenience, etc.), which can be quantified as a detrimental cost to the practice even if it may seem intangible. Because providing quality service is an outstanding competitive advantage every practice should strive for, it is crucial that we put in the effort to maintain a high standard.
The root cause of this problem can be diagnosed by two fundamental concepts in operations management: process and waiting time analysis. Luckily, there are a variety of ways to mitigate this issue, which I will cover in this two-part operations series.
Part I: Process Analysis
In simple terms, a process is defined as taking an input, going through a transformation process, and results in an output. The staff involved, such as the optometrist, the tech, or the optician, perform services on the patient so they become satisfied.
To uncover where the inefficient part of the process lies, we will diagnose the bottleneck by performing a process analysis. Although this exercise may feel technical and detached, the goal is to ultimately support your staff and relieve some stress they may have by having them work smarter, not harder, while also improving customer experience.
Step 1: Select and define a process you will analyze
Routine eye exams and contact lens checkups require very different procedures, so each service must be analyzed independently. In this article, we will consider a simplified case and examine routine eye exams among a tech, the optometrist, and an optician.
For no specific reason aside from keeping things simple, I have defined the start of our process of interest when the tech takes the patient back and starts running procedures. The patient is then passed on to the optometrist, who performs their duties. Lastly, the patient will go to the optician, who will perform their activities.
At this point, the patient has now completed the process. Creating a process flow diagram is an effective graphical tool used to map out the process in an organized way. The steps to create one has been covered in other articles here and can be found online.
Step 2: Evaluate how each staff works
When designing the process flow for a service, such as a routine eye exam or a dry eye visit, every staff member involved must be evaluated to help identify the bottleneck, which always dictates the maximum output rate. Specifically, we are interested in each staff member’s maximum rate that they can perform a service comfortably.
For example, let’s consider the routine eye exam example once more. If you schedule to have an exam every 20 minutes, that is a demand rate of 3 patients/hr. Let us assume that a tech can administer the preliminary workup in 10 minutes, an optometrist can go through the exam in 20 minutes, and an optician takes 15 minutes to capture a sale. This means the capacity rate of each of the staff will be 6 patients/hr, 3 patients/hr, and 4 patients/hr, respectively.
Step 3: Identify the highest implied utilization
We then must examine the implied utilization of each staff member, which is demand rate/capacity.
This is important because the bottleneck is always the staff member with the highest implied utilization.
As a result, the implied utilization in this case will be 50% (=3/6), 100% (=3/3), and 75% (=3/4), respectively. Because the optometrist has the highest implied utilization in this case, this person is the bottleneck and his/her capacity, 3 patients/hr, dictates the maximum rate that is possible for a routine eye exam.
In this scenario, the bottleneck’s implied utilization is 100%, so theoretically the optometrist will not be overworked and will be able to keep up with the demand. However, we will learn in the second part of this series that this is not how events pan out realistically, because there can be significant fluctuations in how long it takes to perform the exam as well as inconsistencies in on-time patient arrival. As a result, having an implied utilization of 100% actually turns out to be too high and a key cause of why there will be patient buildup and waiting in the office.
Now that we have identified where the bottleneck of the process is, we can make changes to alleviate the workload and aim to reduce patient waiting time and provide a smoother experience for both the patients and the staff.
Solution 1: Reduce the bottleneck process time
In the example above, the optometrist is the bottleneck. Take a look at the way you are running the exams. Are you spending too much time chatting with your patients when you first walk into the room? Are you finding that you often forget your BIO in your other exam room and have to run and get it? By scrutinizing your process in detail, you can pinpoint actions that are slowing you down and adjust to eliminate them to decrease your overall time per patient, giving you some breathing room between patients.
Solution 2: Cross-train staff
If you already have a streamlined process and/or are stressed by your workload, you may want to consider increasing your tech’s responsibilities to supplement your work — within reason, of course.
Maximizing face-to-face interaction with your patients is important.
However, training your techs to perform a wider scope of tasks, such as dilating patients or assessing their ocular motility, may prove to be useful so they can step in and help quicken the process when necessary.
It is also very beneficial to cross-train opticians and even the front desk to perform other tasks. For example, if a tech has an emergency and has to leave early or if several patients show up at the same time, cross-training a variety of staff can help keep operations running smoothly so ideally none of the staff will be overloaded.
Solution 3: Hire more staff
If you notice a regular pattern of patients waiting or stress and complaints from your staff, particularly the one who is the bottleneck, then these may be indicators that hiring more staff may be a wise move. The cost of hiring a new member is often trumped by the benefits associated, including better service quality, reduced waiting time, and happier and more productive staff.
In this case, the optometrist was the bottleneck; however, the advice I’ve provided here can easily be translated to other staff members who may be the bottleneck, depending on the service. Being more aware of the operations within your practice and noticing micro-level details via process analysis can improve the experience for your patients and your staff. It is always a smart idea to perform this exercise whenever you notice a tendency in falling behind in your schedule, patients waiting, or stressed out staff.
If you take the time to be observant and put in effort and care toward your optometry staff, then they will be happier and more motivated. Making these changes will also combat slowdowns to help your practice improve its reputation.
In the next article, I will cover the time deviations associated with providing service and patient arrivals to explain why you may still notice patients waiting, even after implementing solutions from this article. Stay tuned!
Watch this discussion between Matt Geller, OD, and Brett Kestenbaum, DPT of CovalentCareers, Inc. for more insight on when, why, and how to hire optometrists for your practice.