BUSINESS: efficiency





Work smarter to improve your patient experience while increasing revenue.


If you have patients scheduled every 15 to 20 minutes and your resources are strained to the point at which you feel you must expand or hire more staff, you are probably satisfied with the state of your practice.

However, if you could see things from your patients’ point of view, would you think your practice is running as efficiently as possible? They may not if they often sit alone in an exam room for 10 minutes and have to take an hour off work to see their eye doctor. In fact, our O.D. consultants have found that long waiting times trigger more patient complaints than almost anything else.

While you don’t intend to keep patients waiting, circumstances, such as one late patient or a backlog at pre-testing stations, regularly create non-productive, negative waiting moments in many practices. This does more than leave a bad impression — it has a direct effect on practice revenue. In fact, high optical capture rates and higher dollars spent per patient are directly related to shorter time elapsing between the patient entering the practice and reaching the optical, according to the OD Lean Consulting Program from The Vision Care Institute, LLC.

Here, I discuss the most critical areas found by ODLean consultants for optimizing time management within a typical practice and how to address common problems that may negatively impact your patient flow.

Front desk scheduling

Scheduling strictly based on managing the doctor’s time is a routine mistake. In reality, the schedule controls how all shared resources within the practice are utilized, including the technicians, opticians and diagnostic equipment.

Here are three common scheduling problems and our consultants’ recommended solutions:

1. In a multi-doctor practice, all doctors start seeing patients at the same time. As a result, the pre-test area becomes overbooked.

Solution: Stagger each doctor’s start times so that the chance of having an available pre-test room when a patient arrives is increased.

2. Schedulers slot patients into the next available appointment irrespective of the type of appointment. This creates bottlenecks when several patients in a row go through pre-test or enter the optical shop at the same time while leaving underutilized resources at other times, such as medical appointments that primarily require the doctor’s attention.

Solution: Create a schedule template that spreads contact lens, glasses, medical, special tests and non-revenue checks evenly throughout the day to ensure that practice resources and staff don’t become overloaded. An example of a mixed schedule might be:

    1. Glasses

    2. Glaucoma

    3. Glasses

    4. Contact lenses

    5. Dry eye

Medical cases that don’t require pre-test or optical keep doctors fully loaded while creating space for other areas to catch up. The doctors’ time might be the same for each appointment type, but staff demands are different. A “level-loaded” template also helps to ensure that each day is consistent, repeatable and predictable.

3. Your practice fails to account for the daily pattern of non-scheduled patients. This includes glasses and contact lens pickups, repairs, non-prescription purchases and frame shopping.

Solution: Design a schedule template that accommodates your peak walk-in periods (typically around lunch hour and after 3 p.m.). For example, don’t schedule spectacle-wearing patients at 12:15 p.m. if you have heavy walk-in traffic that keeps your optician busy around the lunch hour.

Clinical flow

After the schedule has been optimized, consideration should be given to reap the benefits of and aid patient flow through the clinic. Here are three common problems that impact clinical flow and our consultants’ recommended solutions.

1. Dilated patients result in multiple touches by the doctor and “back flow” into the exam room.

Solution: Our consultants have found the single biggest opportunity to promote good clinical flow is to move patients through the practice in one direction, which minimizes the number of times the doctor has to see the patient in the exam room. Therefore, consider instillation of dilating drops prior to the doctor exam. By timing the process just right, the doctor can finish the clinical exam then take fully dilated patients into the dilated fundus exam without additional wait time. This approach typically reduces patient wait time for the dilated patient, as well as patients on the schedule immediately before and after them.

2. Roughly 50% of patients take longer than the allotted scheduled time. Since many doctors work right up to the edge of the scheduled time, this can be a recipe for falling behind schedule.

Solution: Ensure that the average time spent with a patient is about 20% shorter than the rate at which patients are scheduled to arrive in that room. For example, if a doctor is scheduled to see patients every 15 minutes, they should actually spend about 12 minutes on average in the exam room.

3. Patients’ time spent with technicians and doctors is not balanced. For example, if technicians work up a patient much faster than the doctor can conduct a full exam, patients have to wait. Conversely, if exams are finished more quickly than technician workups, the doctor waits for patients.

Solution: Neither of the above situations leads to efficient patient flow, so balance the time the patient spends with the technician and the doctor by delegating more tasks or adopting mixed-model scheduling as explained above.

Optical handoff

Many optometrists treat the optical handoff as a burden, but failing to do this is a recipe for a walk-out.

The transition from exam room to optical is the critical junction between diagnosis and treatment and sets the tone for eyewear purchases, which are a major source of practice revenue.

Our consultants have established the following ideal scenario:

1. The practice identifies a signal (e.g., a light system or a wall chart) to inform the optical staff that a patient is ready in the exam area.

2. When the optical staff gets the signal, they arrive at the exam room to take the patient from the doctor. At this time, the optometrist clearly articulates expectations for the patient so everyone can hear. For example: “Angie, Mrs. Smith has a new contact lens prescription today. We’re going to order an annual supply of her lenses, and we also talked about getting her fit with some new sunglasses that protect her eyes from UV.”

3. The optical staff escorts the patient to the optical to carry out the doctor’s orders, and the doctor can transition to the next patient.

Of course, the handoff won’t always happen smoothly. Optical may be busy and the doctor may have to lead the patient to the optical to browse frames while waiting. However, our consultants recommend setting the expectation of a handoff process that allows opticians to be proactive most of the time while making seamless transitions from patient to patient.

Think creatively

By considering efficiency from the patient’s perspective and making some of the adjustments described in this article, practices can realize significant growth without additional capital expenditures. OM

Mr. Teixeira is senior manager, Customer Experience, Johnson & Johnson Vision Care, Inc., North America. E-mail him at, or send comments to