I have found that staff delegation can do wonders for staff morale, patient satisfaction and doctor productivity, all of which can lead to increased practice revenue.
Here, I explain.
In my practice, I have discovered that having staff trained in many tasks increases their happiness and productivity because different roles enable them to continue to learn and grow.
For example, every staff member at my practice is cross-trained on front desk duties. Specifically, everyone is able to check in patients, gather insurance information, schedule appointments and answer most patient questions via phone. An additional benefit of this to staff is that cross-training decreases the stress associated with front desk staff who may be out sick, on vacation or otherwise engaged with a patient. (See “What You May Want to Delegate,” p.49.)
With staff trained to take on many tasks, such as filling in at the front desk, I have found that there is never an issue with patient wait times. This is significant, as research shows long wait times can negatively affect the likelihood of patients to recommend a practice, as well as the overall satisfaction with the experience, the perceptions of provided information, directions and the overall treatment provided.1 Something else to consider: Patient dissatisfaction can lead to “firing” a practice and seeking care elsewhere.
At my practice, we strive to have the patient through pretesting and their exam and into the optical in 20 minutes to 30 minutes, as we’ve found this is satisfactory to patients, while allowing them to have time with their opticians and not feel rushed.
As a brief, yet related, aside, if available, using multiple, identical lanes can increase efficiency and, thus, patient satisfaction, dramatically. My practice has five exam lanes, plus a large pretesting room and a room for special testing. Patients are always moving and rarely waiting.
Let’s face it, tasks outside of patient care (e.g. prior authorizations, referral letters, pharmacy calls, supply ordering, etc.) can result in longer days at the office, frustration and doctor burnout. With regard to frustration, think about how much time you have, for example, to go over exam findings with a patient? By delegating tasks outside of patient care, however, you can free up significant time and schedule more patients, attend to business tasks and take time off when needed.
For example, I have found that using scribes has given me the time I need to explain why patients may need multiple pairs of glasses (and explaining the need for each), instead of simply handing the patient off to an optician. Further, I have seen an increase in our per-patient optical revenue, as well as an increase in our multiple pair sales, since using scribes.
INCREASED PRACTICE REVENUE
Staff delegation allows for the addition of increasing the number of patients seen per day, which can effectively increase practice revenue.
For example, the average MBA practice (Management and Business Academy) had a median gross revenue per exam of $346 in 2018. If a practice was able to see just one additional patient per day at this rate, that could result in an additional $86,500 in gross revenue for the year (assuming five days a week, 50 weeks per year). If this practice were to see two additional patients per day, this number becomes $173,000. Adding one additional patient per hour (assuming an eight-hour day) brings this to a possible increase of $692,000 per year in revenue. While this metric makes a number of assumptions, it is possible to significantly increase practice revenue with small increases in patient encounters.
What You May Want to Delegate
In addition to cross-training on front-desk duties, I have delegated the following, which has also had a positive impact on my practice:
→ CONTACT LENS DUTIES: I have staff pull diagnostic contact lenses for me, while I am finishing the health portion of the exam, perform insertion and removal training for new contact lens wearers, check VA post lens insertion and fill contact lens fitting sets and reorder trials. While this is occurring, I will often go to another exam room to see a different patient.
→ A PORTION OF THE EXAM: This looks different in every practice. In some practices, technicians pretest patients using the latest technology, and that is where their duties end. Examples of the latest technology include: autorefraction, IOP, fundus photography, OCT and screening VF. The doctor takes over in the exam room from start to finish. In other practices, the technician not only pretests the patient, but goes over medical history as well.
Taking it one step further, some practices have technicians perform some of the entrance testing in the exam room (VA, color vision, stereopsis, etc.), while in other practices the technicians refract patients using, for example, digital refraction systems, which can speed up exam time significantly. Technicians and staff can also be cross-trained to administer specialty testing. In my practice for example, no less than four team members are able to perform a VF, and almost every person can use the OCT.
LOOSEN THOSE REINS
Relinquishing control over any part of our practices is not easy, but necessary to both sustain and grow our businesses. Also, doing so does not mean that we are abandoning checks and balances. In fact, it can be argued that delegation actually provides the time needed to make sure one’s business is running the way it should (see above). Why not examine your current workload and determine what can be delegated to staff? As shown above, everyone can win. OM
- Bleustein C, Rothschild DB, Valen A, et al. Wait times, patient satisfaction scores, and the perception of care. Am J Manag Care. 2014;20(5):393-400.