Increasing Efficiency: Secrets to Keeping Your Practice Running Smoothly

Since starting my practice from scratch 5 years ago, I’ve gotten a taste of the daily complexity that is running a practice. An incredible number of minute tasks must go right for each and every patient to have the experience we desire.

Maintaining a positive team culture, happy patients, and community involvement and outreach, all while keeping the bills paid and glasses turnaround quick is no small feat. The increasing numbers of emails, text messages, internal messages, phone calls, and faxes that come in have a detrimental effect on the effectiveness and productivity of the organization as a whole. It’s easy to miss sending out that prescription the patient requested or to overlook an incoming fax.

I believe that the solutions to these issues lie not at the individual level but at the organizational level. The systems we set up in our practices trickle down and affect all aspects of both the patient experience and our own experience in our workflow.

As a reminder, productivity is the amount of work that we’re able to put out, but efficiency has to do with the process by which that work is achieved. I believe that efficiency is the secret sauce that differentiates a practice that is just getting it done from one that is getting it done with a smile on everyone’s face.

In a recent article in the Harvard Business Review (my favorite place to be inspired), author Daniel Markovitz outlined what really matters when it comes to organizational productivity and efficiency.¹ I have applied some of his ideas to my eye care office.

Here are some key systems I’ve implemented to increase efficiency in my organization.

OFFICE DESIGN

Pay careful attention to the space you’re working with and your workflow within that space. This is a puzzle for each practice that must be optimized for your specific layout, equipment, and needs.

Some practical steps that we have implemented in our practice could be beneficial in almost any practice:

• We added a chart and chair to the workup room. This gave us one more tech workup area and freed up exam rooms to increase doctor efficiency while avoiding a bottleneck during the workup phase of the examination.
• We added an extra computer monitor to each room so that OCTs and visual field results can be displayed on one monitor and the exam record on a separate monitor. This way, I do not have to have several windows open on one screen, and the information I need is easily accessible.
• We set up a dry eye room separated from our regular exam rooms. This reinforces the need for me to bring patients back for a full dry eye evaluation rather than trying to tackle this complex problem during a comprehensive exam. This room is set up like a dry eye spa; it contains all dry eye–related items such as artificial tear samples, our intense pulsed light device, and so on. If I go rogue and start talking about dry eye in one of the other rooms, I am reminded that I don’t have everything I need there, and I could better serve the patient if I bring them back for a full dry eye workup. This strategy will work for whatever your office specializes in, whether it be specialty lenses, myopia management, glaucoma, or something else.

STRUCTURING THE DAY

We all get the same amount of time in a workweek. What differentiates a highly efficient person from others has to do with how they schedule their time. If I allow myself to have admin time between patients, it amounts to 15 minutes here, 20 minutes there, and ultimately several tasks get started but few get finished.

Consider these small changes we’ve made in order to optimize time and get the most done:

• Batching admin time has made a world of difference. A minimum of 2 hours in a block is my magic number. Everyone gets more done when they have ample time to focus without interruption. Note: Making the block too long can foster a tendency to squander time.
• We regularly audit appointment times. Have you noticed that full evaluations, glaucoma evaluations, contact lens evaluations, and dry eye visits take different amounts of time? Yes, many factors contribute to the amount of time a specific appointment takes. Still, an audit can tell you how much time each type of appointment generally takes, and this information can be helpful in building a schedule. At least once a year we audit our schedule and work backward to build the framework for how to schedule the day. When we make a change, this information is dumped into our electronic health records system so that our team automatically schedules patients in the most efficient way.

EXAM ROOM FLOW

As the sole doctor in my practice, I am acutely aware that all patients must flow through me. This means that I am at the highest risk of causing a bottleneck. How do I combat that issue? Through education and cross-training.

Here are specific goals I have for my team that can be implemented in any practice:

• Although I may not always have a dedicated scribe (though a girl can dream), my team can help me get info into the record when needed. To achieve this, I concentrate on teaching them eye care terms and showing them where I record specific things in the chart. This is a slow process, but I now have a team that can help scribe in certain circumstances, which increases my efficiency. For those with a bigger office and budget, a full-time scribe is a dream come true!
• In our dry eye specialty practice, we spend a lot of time discussing dry eye. Patient history-taking is extensive, and treatment plans are complex, which means that these appointments eat up a lot of time. That is why I implemented a treatment counselor, much like those that cataract surgeons use prior to surgery. I make my diagnosis and lay out my treatment plan, and then my treatment counselor goes over the details with the patient while I move on to the next patient.
• I admit, contact lens fittings interrupt my exam flow and slow me down. But now I never miss a beat during my exams because I have my team grab the lenses for me. I determine the diagnostic lenses I want, call out to my team, and they silently come into the room to glance at what I wrote down. The correct lenses will then magically appear on my desktop by the time I’m ready to insert them. This saves at least 2 minutes during every examination.
• We all know the importance of a good handoff. I call out when I’m starting binocular indirect ophthalmoscopy, and my team knows to come into the room silently after 2 to 3 minutes. I then lay out my assessment and treatment plan with my assistant in the room. Because my optician has now heard everything the patient heard, no additional time is spent trying to figure out my recommendations. This results in a better capture rate and, more important, a patient who feels well cared for. My optical staff, thanks to all the cross-training, can then counsel the patient on follow-up care, recommend products, and answer questions while I dash to the next patient.

PROCESSES LIVE IN DOCUMENTS, NOT HEADS

As much as I would love to have the same group of individuals working together with me for the next 30 years, I know there will inevitably be turnover, as with any practice. To avoid the headache of having to teach the same skills over and over, I’ve put all of our systems in writing. This ensures we all do things the same way and, when someone new comes along, they are trained in the same manner as everyone else, ensuring consistency and efficiency for years to come.