Practice Management Alert

Hint: Patient satisfaction is all about setting expectations.

In a medical practice, order of operations is everything, said Sarah Bowen-Johnson, CPC, CPMA, CPB, in her presentation “The Art of Operations” at AAPC’s 2024 HEALTHCON. “It is everything to make an office function and to function successfully from A to Z. It’s never the same on a daily basis.”

Here are some of the steps Bowen-Johnson suggested you can take to make sure your practice and staff are in top form.

Understand the Relevance

Operations run the gamut of situations in a medical practice, Bowen-Johnson said, from human resource (HR) issues to patient or provider issues. They are affected by the types and depth and length of relationships providers form with patients, from primary care physicians (PCPs) who see multiple members of a family over years versus specialists who may simply treat and solve a condition and never see a patient again.

Operations are, of course, also affected by the ownership and management of a practice or facility. When a provider owns a practice independently, they adjust rules or norms per their wishes, and operations may be driven more by preference than money. A facility-based practice, which is owned by a hospital system, may not be quite so money-driven either, Bowen-Johnson said, because the hospital tends to take in revenue downstream. Practices owned by private equity companies may be organized more around seeking revenue than simply providing patient care, which can affect many small and large decisions about the way a practice is run.

“Not only do you have to know it, you have to implement it, and then you have to make sure it works and make sure that everyone gets along all at the same time. All on any given day!” Bowen-Johnson emphasized.

Acknowledge Patient Satisfaction as a Business Cornerstone

Patient satisfaction: “We always want our patients to be happy. We always want to make sure that they have a good experience — that they talk about the good experience that they had,” Bowen-Johnson said. “That’s how we grow a business.”

Do this: A big part of patient satisfaction is meeting — or exceeding — patient expectations. Bowen-Johnson said the best way to do that is by laying out expectations ahead of time. “Have everything written out for them, either on your website, new patient paperwork, or telling them at the front window. Have everything all there, all laid out, so [patients] know what the expectations are for the visit,” she noted.

This approach is helpful to iron out a lot of wrinkles in patient interactions. For example, no-shows can be a big source of frustration for patients and practices alike. You can save everyone a lot of angst if you have clear policies about what constitutes a no-show or a late cancellation, whether patients are expected to pay some kind of fee or face some kind of penalty, and if there are exceptions. Thinking through situations where no-shows might arise and deciding, in advance, if some circumstances may be excused, can take some emotion and tension out of the resulting interactions.

Another way to think about setting and communicating expectations is training patients. Bowen-Johnson pointed out that a patient who is asked for their insurance card at every visit will be sure to have it every time, which will save the front desk staff some stress if their electronic health record (EHR) system goes down right before a patient’s visit.

Strategize Scheduling

Scheduling has an outsize impact on myriad aspects of your practice, from workplace stress to patient satisfaction to revenue.

“Your front office can make or break your practice; it is the hardest job. I mean, besides the medical stuff, it is the hardest job in the practice,” Bowen-Johnson said.

Having the focus and skills to talk to patient after patient, in person and over phone, while being continuously interrupted, and collect and input all information correctly, is tremendously difficult. Figuring out how to design operations to maximize accuracy and efficiency, as well as patient satisfaction, is a tricky prospect.

However, there are some strategies scheduling staff can use to help streamline operations, and maybe even curb contagion.

Practices have various approaches to scheduling, and you should do what makes the most sense for your providers’ and patients’ habits. Time slot scheduling, where you schedule each patient for a specific time, can go really well if everyone shows up on time and appointments don’t go late, but one appointment that goes over can snowball into a lot of disgruntled, long-waiting patients as the day progresses. Block or wave scheduling, where multiple patients are scheduled for a time slot and are seen as they arrive, can work well for a provider but also leave patients feeling miffed if they end up waiting longer than they expect.

Bowen-Johnson noted that the primary care practice where she works uses a hybrid scheduling system, where they try to see their well visits in the morning, sick patients in the afternoon, and patients with respiratory infections at the end of the day. This means less exposure for the more vulnerable patients in their practice, and helps the providers manage various types of appointments, too.

Scrutinize Workflow and Adopt Some Redundancies

Bowen-Johnson recommended that staff learn to lean on checklists, both for rotating duties and for those which are assigned permanently to a particular person or role. Make and follow checklists for daily tasks, like opening or closing the practice, as well as responsibilities that need to be accomplished weekly or monthly.

While most people don’t enjoy micromanagement, communicating expectations is key, and delegating specific responsibilities can be helpful for everyone. Bowen-Johnson assigns some individuals the responsibility of managing inventory and ordering particular supplies, so she knows who to check in with if there’s an issue. She also rotates some staff, like nurses, so they don’t become overly accustomed to a particular provider or get overwhelmed by the personality of a provider.

Bowen-Johnson also noted that cross-training some staff can help prevent staffing gaps. She cross trains her front office staff, so she’s sure that the referral coordinator knows how to run reception. “If, for some reason, somebody’s out, if there is an emergency, I need everyone to know how to do it. I’m not saying they’ll do it for a long period of time, but just that they know the bare minimum, so you can get through the day.”

Bowen-Johnson does the same thing for the treatment area, making sure all the clinical support staff know how to take vitals, show patients to exam rooms, and get the information the provider needs before they walk into the room, too.

Bottom line: Thinking through each step of the many processes that occur in a practice every day can make staff and patients’ experiences more efficient and less stressful.