Article Date: 3/1/2005

patient flow
Business 101: Maximizing Traffic in Your Practice

The final installment to our three-part series on business strategies. This month, learn how to optimize patient flow.
BY RICHARD S. KATTOUF, O.D., D.O.S., Warren, Ohio

Having developed two consulting and managing companies, many doctors approach me at seminars and ask me how to improve patient flow. I'll address this subject, but to give advice for a specific practice, I'd need to know:

► The size of the office

► The type and number of examination rooms

► The number of staff and explicit level of training

► Training schedule

► What duties ancillary personnel are in charge of

► What instrumentation ophthalmic techs use

► Whether any of the technicians perform refractions

► Information taken at time of appointment. (Many offices wait until the patient arrives to get personal data, which significantly slows patient flow.)

► Whether the office sends any forms to the patient's home to complete before the appointment. (This technique can have positive affects on patient flow.)

► Average amount of time for patient interaction in the office

► Whether the office runs behind schedule before lunch and at closing; average lag time

► If you see patients who don't speak English, do you have an adequate number of bilingual staff to accommodate them? A language barrier disrupts patient flow and service.

► consultant would need to know the details of the above-listed areas to customize a plan for optimizing patient flow for a specific client, like I said, but any practice can move toward achieving this goal by following generic pointers.

The road to optimization

The following bullets explain areas that any practice can tweak and improve on to optimize patient flow:

Leave no staffer behind. One of the most common problems in practices that have poor patient flow is having one staffer who's trained in all aspects of the office because there's no set training regimen. This situation forces new employees to learn "through the ventilation" system and constantly go to the trained staffer with questions and problems that the new employees haven't been trained to handle. Such an office environment destroys patient flow and overstresses the trained employee, who may leave because of the situation.

Space considerations. Offices that don't have enough examination and/or data entry rooms create a backlog of patients who are partially examined and escorted back to the reception room. This is a flow buster.

Training employees. Optometry schools train doctors of optometry to serve as diagnosticians. We need to train technicians to collect data and allow the doctor to evaluate the information. In many offices, doctors act as technicians for part of their work day. Sometimes such a setup is unavoidable in a "start-up" practice, but it's totally avoidable in a mature practice.

Most mature offices lack scheduled in-house training and a huge flow buster is untrained or undertrained employees. I recommend at least one hour of scheduled mandatory training for employees each month. Patient flow is great when you have multiple fully trained staffers. A big problem is a patient waiting for the one-and-only trained tech to perform a clinical or administrative task.

Effectively delegating to staffers. Whatever level of delegation you have achieved in your practice, continue up one notch. Just look at your ophthalmologic brothers and sisters. They delegate at the highest level. Note: Ophthalmologists have horrible scheduling habits that are flow busters.

The more you delegate, the more improved your patient flow. The highest level of delegation is techs performing refractions. This is a huge time saver and great for patient flow. Note: Optometrists historically refine the tech's work.

High-tech instrumentation. Autorefractors/keratometers, automated lensometers, computerized phoropters, noncontact tonometers, A-scans, telebinoculars, glucometers, sphygnomonometers, automated perimeters, video slit lamps, retinal imaging, optic nerve analyzers and retinal cameras can all improve flow. The reason is that staffers perform the tests and optometrists interpret the data.

Internal office practices. Making appointments and getting complete patient information on the telephone saves form time in office and improves patient flow. Also, sending forms to patients' homes or e-mail addresses before their appointments saves time and improves patient flow by reducing reception room down time.

If your office continually runs behind, then you're in need of improved intra-office communications between doctor and staff. Most offices lack a scheduled daily organizational meeting, which should take no more than 20 minutes, to refine the administration of the operation.

Time for a reality check

In my experience of observing hundreds of optometrists' and ophthalmologists' offices in operation, the common problems are lack of communication between doctor and staff, no set training schedule, lack of awareness on part of the doctor and low level delegation.

Doctors of optometry are unique in that they own, oversee and administrate a clinic and retail optical. The sooner that optometrists accept the fact that they must take on the responsibility of controlling their entire operation, the sooner the patient flow and financial issues will improve. The concept of the doctor rushing in and seeing patients and running out at the end of the day creates the flow and financial problems that are rampant in optometry.

Dr. Kattouf is president and founder of two management and consulting companies. For information, call (800) 745-EYES or e-mail him at



Optometric Management, Issue: March 2005