Practice Flow Concepts Every Doctor Should Know

August 1, 2012

Larry Brooks of Practice Flow Solutions reminds us that doctors’ training and education through medical school and residency is for the most part focused on the medical aspects of the career they have chosen.  But medicine is not only a noble profession but a business too.  It is a business of selling time and knowledge.  Often times the training and schooling the doctor receives does not prepare them for that portion of their business, and this lack of education on the operational aspects of their career results many times in an extraordinary amount of their time while in clinic or surgery being consumed by things other than patient care.

Doctors, how many times do you:

  • Stand around waiting on a patient to be ready to see
  • Have to go looking for staff
  • Walk information or instructions to support staff
  • Escort a patient out of your clinic

These type events eat away at your time, insert frustration into your day, and are costing you, your practice and patients.  Better practice flow concepts would eliminate these events and allow you to be more productive, patients get care sooner, and you enjoy medicine more.  Practice flow is defined as the movement of patients, staff, doctors and information through your practice.  It is all about time management.

A lesson in time management

Time management for a medical practice is about allowing the doctor to perform those functions requiring the skill and judgment of a doctor, eliminating lost time and delegating those tasks that do not require their education, knowledge and skill.  It is NOT about spending less quality time with patients.  When done correctly the doctor spends as much time as they need with each patient, runs on time, finishes on time, and sees more patients.

But how do you know if you could see more patients?  If you answered yes to any of the issues mentioned above or you know of times you are not effectively caring for patients, then you could see more patients with better practice flow.  The issue is not typically with the doctor, it is normally with the flow concepts out of sync with the doctor’s capacity.

Doctors, do you know for sure how long on average you spend with patients, actually performing those functions that only you can do for the patient?  Without this information how did you determine the flow aspects such as how many patients to schedule, staff to hire, or parking spaces to have?  This information identifying the capacity of the doctor is invaluable to setting up practice flow concepts upstream from you to allow your time to be used to its fullest.  Knowing the doctor’s capacity sets the basis for all other operational decisions.

Doctors, when assessing how your time is being consumed, have one thing in mind:

“The doctor’s main task is to care for patients.  Tasks that do not require a medical education should not be consuming the doctor’s time.”

Now you may not ever reach that degree of time management, but the closer you get to it the more patients you will see, the more revenue you will generate, the better your practice will be positioned to handle whatever the healthcare system throws at you, and generally you will enjoy practicing medicine more.

Practice flow concepts that will allow you to spend more of your time caring for patients are:

Doctor capacity determines appointment schedule

The length of every visit is going to be different.  And the volume of patients a doctor can handle is not based on national standards but on that doctor and how they want to manage their patient encounter.  For this reason the task of scheduling so that patients are readied at a rate that allows the doctor to always have a patient ready to see, but not so fast that patients wait for long periods is not easy.  Understanding the average length of time the doctor spends effectively with each patient visit type and the number of each visit type the doctor sees on average each session will allow the practice to have the basic information that should guide the patient appointment template.

You should create a “dashboard” to continually track this volume information. Once this information is gathered, there are all types of appointment scheduling techniques, such as wave, modified wave, open access, equal length slots, etc. that can be used to schedule.

A much more detailed study can be performed to determine how effective the time is being used.  This requires tracking how the time of the doctor is consumed while seeing patients.  The time is then allocated into three categories, Practicing medicine, Staff and Lost.  The idea being that only tasks consuming Practicing medicine time should be performed by the doctor and others should be engineered away from the doctor to allow the doctor to spend more time practicing medicine.

Grouped exam rooms to reduce distractions

The number of exam rooms a doctor requires will vary per doctor and should be based on the patient volume that doctor sees.  This number of rooms should be constant every time the doctor is in seeing patients, unless the doctor has certain type days where the volume will be different, such as a post op only session, or procedures only session.  These exam rooms should be grouped in pods and be arranged if at all possible across from one another versus in line on the same side of the hall.  Exams across the hall require less walking, therefore less time.  The general rule should be that the doctor should walk no more than about 10-15 feet between patients.

The only traffic in that pod should be that doctor’s patients and direct clinical support team.  No through traffic should go through a doctor’s pod.  The less the traffic the less the distractions and the more on time and productive the doctor can be.

Electronic communication reduces walking

How many times do you leave an exam room and have to search for staff to give instructions or information to, or have to search for the next exam room in order. How often is your clinical support staff not available to assist because they are “up front” looking to see if there is a patient checked in?  This is due to walking being the primary conduit for information exchange.

An easy way to determine if walking is your practice’s main source of transmitting information or an order is to stand in the hall for a while and observe your staff and doctors.  Does it seem that they are constantly scurrying around?  If so, there is too much walking and that is costing your practice in lost opportunity.

To gain this time back the communication systems need to be streamlined to allow effective communication without having to walk.  Some examples of systems you may find helpful are:

  • A light signaling system, Electronic Health Record(EHR) or a combination of both can direct the doctor without having to search, the staff having to run around to flip flags or wait outside the exam to tell the doctor where next, or move that magnet you’ve had for years.
  • To keep your clinical staff in the doctor’s pod more and the receptionists at the front desk more use an electronic system such as an EHR system, printers, email, pagers to notify of a patients arrival.
  • To eliminate the doctor hunting for staff to give verbal orders use a scribe in the exam room, a light signaling system, EHR, or walkie talkie to transmit the information.

Use protocols, dictated instructions as part of the previous note and team meetings to reduce trips in and out of the exam room

How many times do you go into an exam room only to turn around in a matter of seconds to order a test, ask for additional information, or look for assistance?  Protocols, Dictated instructions, and team huddles will help to reduce the multiple trips into the exam for the same visit and allow you to see more patients.

Protocols that are constant and understood by all in the practice the staff will be better able to anticipate what the doctor will need for certain visit types, patient ailments, etc.

Dictating in the progress note what is to be done at the next visit allows your staff a better chance of having that patient completely prepared for you the first time you go into the exam room.

A quick stand up clinical team meeting in your pod at the beginning of the session will allow you to give instructions regarding specific patients to allow the team to have things prepared prior to you seeing the patient.

Control patient’s travel distance, turns and exit path to reduce confusion

Patients that get confused, lost, or turned around in your facility cost you in time because either you or your staff has to show them the way out.  This happens when the travel path of the patient becomes long, has too many turns, and there are no identifying landmarks to keep them oriented in the facility.

To reduce the travel distance, only have rooms and functions along the path the patient will take that have direct patient contact.  People naturally tend to try and exit a facility the same way they entered.  Because of this the patients exit path should be back along the same path they entered.  Allow the patient to exit the same way they entered and have spaces designed and decorated so the patient recognizes them and stay oriented.

Have staff’s job descriptions not be counterproductive to the doctor being efficient

In your practice there are a host of duties that your staff perform, some for patients in the office for a visit and some for those that are not.  Having the same staff handling tasks for both patients in the office and not can cause the staff to get caught up doing duties that keep them from having a patient ready for the doctor to see.

When setting up your staffing model and job descriptions allocate tasks so those for patients not in the office do not conflict with those for patients in the office.  This may mean additional staff, or the same number of staff just reallocated to more specific tasks.  With the understood goal of everyone being “the doctor always having a patient ready to see”.


The doctor’s time is the most valuable asset the practice has and it should be thought of that way and used appropriately.  To accomplish this you need to have an understanding of your personal patient volume capacity, the time that volume requires of your staff, and the space that volume requires.   With practice flow concepts organized to allow you to have a practice environment that is efficient and productive.  This will lead to a much happier practice life, staff that has a higher job satisfaction, patients that have a higher satisfaction with your practice, and much more profitable business.

Larry Brooks
Practice Flow Solutions
7742 Spalding Dr. + S. 368 + Norcross, Ga. + 30092   
C: 678-983-0229 + P: 678-935-7911 + F: 678-935-0186

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