Physician Practices: Giving Your Physicians Enough Time

I have been in healthcare almost twenty years and we still struggle to give physicians enough time and it is because we are unable to think outside the box.  When I go to the hair salon, I don’t wait more than 5 minutes past my appointment time as a standard.  They recognize that I am paying for their time and my time matters.  However, the difference is that they give themselves enough time for the person in front of them.  Here are some tips for accomplishing this:

  1. Some patients just take longer – Use your fancy EMR and put scheduling notes on the patient – this may be a patient flag. Then make sure your physician uses time based E/M billing to get paid for that longer appointment.  Or make sure they are adding billable events like preventive counseling codes to the visit.
  2. Salons bring in a stylist in training to help their busy stylist – in that case the low-level stylist gets things ready like mixing color, washing hair, etc….  Technology is really helping us to have this same opportunity there are med students who provide scribing via the web for physicians directly into your EMR to reduce the time providers are spending documenting.  We also have the ability to hire a mid-level that is willing to take care of the other things like med refills and patient phone calls to allow the provider to just see the patients in front of them.
  3. Have different schedules, some physicians are just more chatty than others and instead of beating them up – give them more time, and make sure they are billing appropriately. You don’t want a doctor billing a level 1 that spent an hour with the patient.
  4. As you are building this schedule, think through your visits and eliminating some demand. For example, maybe some visits (like UTI and Strep) – could be nurse visits.  The practice still gets some revenue, but it frees up capacity for your providers to have longer appointments.  Web Visits are another great option for things that don’t require you actually putting your hands on the patient.  It allows you to have a shorter visit that you can fit in between a longer visit.
  5. Don’t forget to set expectations with patients, for example that your provider only has time to discuss these 3 things today but we will get you scheduled to discuss the other 5 things next week.
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Leap Day Tips for Leaping Up or Leaping Out of Your Job Rut

Recently, I have had several conversations with friends and peers about being unhappy in their job and wanting more or something different.  And many times we just don’t know how to go after the something more or different.  So here are my tips for getting out of your work rut or taking advantage of where you are right now.

  1. Do you have all the skills the job you want requires? I am not asking if you can do the job. I am asking can you check off all the applicant requirements as well as the desired qualifications of the job description?
    1. There is a job that gets posted periodically with a really great company that I would like to be a part of, but it has a desired list of certifications that I only have one of. So, I have started tackling them. I am currently working on the most expensive one and it is what I asked Mr. Style to pay for as my Valentine and Birthday gift instead of flowers and new shoes.  Even if this job doesn’t come available, again, I am positioning myself for a similar job with a similar company.  Your current job may even reimburse you for this certification.
    2. Maybe the experience is more project management and this is a great opportunity to ask your current supervisor to give you a project. Tell them, you are ready to tackle a new responsibility.  This is a chance for you to either demonstrate your ability to move up in your current organization or it is a great resume builder.
  2. Did you apply? You would think I wouldn’t have to ask this, but I have had several people tell me that they didn’t understand how someone else got a job that they didn’t even apply for.  A similar scenario is someone being promoted when your boss doesn’t know that is what you want.
    1. If you want to move up in your company, you have to tell your supervisor and make sure if you work with other departments that the leadership there knows you want to do more. If your supervisor doesn’t do this as part of your review, set up a meeting and talk about your career path.  You might be surprised to find that they really want to help you.  Be prepared for constructive feedback, they might give you suggestions of areas to work on as well as suggest training that might benefit you.  If that doesn’t work, set up a meeting with HR and let them know of your desire to move up.
  3. Are you networking? As an introvert, this is where I fall short.  And the internet with sites like LinkedIn, lulls us into this false security with “social networking”, but it isn’t enough. Nothing compares to face-to-face networking.  If you really want to change companies or move up in your company, you need to make time to get to know others.  Toastmasters is a great place to build up your communication skills and meet new people in other industries.
    1. Pay It Forward: A friend of mine recently stepped into a new role and was looking for advice from someone with a similar role. I connected her with a peer via e-mail, and now they do coffee regularly.  Both people have returned the favor.  I also host dinners once a quarter for like-minded women.  The group started out as 4 and now we have about 20 people.  5 of whom, have changed companies as a result of our networking dinners.
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Bringing Southern Hospitality to Your Physician Practice: Building the Right Schedule

I love the holidays, because we get to see distant family that we don’t see that often.  But it never fails, being in healthcare I get to hear all the good and the bad from family about their doctor.

2015 holidays were no different. Mr. Style’s aunt pulled me aside and tells me she has concluded she has a great doctor because:

  1. she can’t get in to see him for 2 months
  2. when she does get an appointment, she waits at least an hour.

You would think that he was Ralph Lauren making her a dress for the Emmy’s.  And I run across the same sentiment frequently.  The idea that my doctor is better because he is “in demand” is so foreign to me, as a healthcare professional. Physician practices are tasked with treating sick patients and the waits and scheduling challenges are not an achievement to be proud of – rather it is a problem in our very broken healthcare system.

Fixing this isn’t rocket science.  It is simply a matter as administrators and practice managers of changing the way we view our physicians’ schedule and panel.

  1. Is your PCP Panel Size appropriate? If you can’t get in a new patient in the next month and your provider isn’t taking a vacation in the next month, you probably need to cap his/her panel. (If your provider has recently cut down on the amount of time they are seeing patients – look for patients that might be willing to switch to a new provider. For example, maybe they came in for a sick visit and really liked the provider they saw – ask if they would consider switching).
  2. Make sure your team is helping providers see patients and not doing things someone else could. For example, diabetic foot exams can be given to a CMA with training.  Your CMAs can review prescription requests to ensure they are set up correctly for the provider.  Having your provider take a few minutes to review the schedule with the CMA before the day starts is a great way to keep them on schedule and to be prepared for the patient.
  3. Build your template. Without doing a full consult, I can’t tell you the perfect template for you. What I can tell you: patients are people who don’t want to wait in your waiting room or exam rooms for long periods of time.  To fix this, simply:
    1. Do a time study with each provider. A simple spreadsheet – where you put the type of appointment, time scheduled, time arrived, time brought back, time MA/LPN left room, time provider entered, time provider exited, and time patient left)
    2. Use this to say Dr. X needs 30 minutes instead of 20 or if it is just certain patients that always need more time (document that in your scheduling system or just make a list of them). Give the providers the time they need– there is nothing wrong with having  different times for different providers.
  4. Bill for the time they spend. There are wonderful resources out there about billing evaluation and management codes based on time and how to document that.  Instead of seeing one more patient, instead bill for what you are doing.  For example, tobacco counseling is its own reimbursable code that you can add to a non-wellness visit.  Discussing weight loss when an obese patient is there for joint pain – bill it, it should have its own reimbursable code.

New year’s resolution: Let’s change the idea that good doctors make you wait.  Imagine what an impact your practice will have if doctors actually see your patients when they need you.

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The Working Mom’s Guide to Childless Coworkers During the Holidays

It is that time of year, when working moms are panicking about how to prepare a Thanksgiving feast, ensure your home is a tribute to all that is holiday, manage a multitude of school programs, shop for the perfect presents, get your Christmas cards out, and somewhere amidst all of this we are supposed to work full-time (many of us as the breadwinner), too.

In this season of inclusiveness, however, what we may easily forget is the coworker that is covering work-related as we got stuck in traffic at the mall on our lunch break or dashing out for the school program. These are the people who are gracious enough to work during the holidays at times we need to be with our family.  Here are some tips for making this season better for them.

Time Off  Make sure you are giving them equal time off.  For example, I used to take administrative call duty the week of Christmas, and in turn I was given the week of New Years off.  And they gave me a bonus for working Christmas.  Another suggestion is in September to have people rank the days off around Thanksgiving, Christmas, and New Years by their priority to ensure you have adequate coverage and that we try to give everyone at least some access to the days that are their priority. I find by using a joint spreadsheet that people are more considerate of each other and this allows managers to be as fair as possible during an already stressful holiday season.

Thank You A good friend of mine works for an IT startup holds an appreciation day for.  Here’s how it works: You nominate someone who helped cover for you during the holidays and they get a day at a hotel with golf and a spa.  One year, my kids drew pictures for the young manager who covered for me.  I tucked a gift card in with the pictures so she could splurge on herself. The theme here: sincerity and a heartfelt note. Even in modern times, Emily Post has a good point.

Be Mindful This is still your job.  Be mindful of the time you are putting in or not putting in.  I usually go in at least one weekend to catch up this time of year to make up for all the other distractions that exist.  I also take work home, and which is a sacrifice of sleep and zaps the creativity that drives our Elf on the Shelf scenarios, but it is the right way to help carry the load.

Your team player who does not have children may be someone who is struggling with infertility or simply chose a different path from the moms in the office.   Either way, the rules that guide the way you interact at the office every day should stay in effect during the holiday season:  keep your conversations during this blessed season professional, merry and bright, but remember that not everyone wants to hear what your kids did last night.

Please send all questions, comments, concerns or issues to southernservicestyle@gmail.com

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Creating a Culture of Service Through Southern Manners Part 1

“I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” – Maya Angelou

There is a lot of debate over Southern manners and the “realness” of them.  However, for this site and my personal definition … Southern manners are the Golden Rule at it’s best.  Do unto others as you would have them do unto you.  By doing this, people will remember you and/or your organization with a true spirit of Southern hospitality.  This is Step 1 in my Southern manners series.

How do you instill this in your team? By starting with how your team treats each other.  Each company I work with, I gather a group of employees across the organization and we create Good Team Member rules.  When they are finished we send them out to every employee to be signed and dated for their personnel file.  These rules become part of the Performance Improvement Process.  By creating a culture of respect for each other and ownership of opportunities, we transform our organization into a culture of service.

Examples of Good Team Member Rules:

  • Demonstrate integrity, professionalism, and courtesy in their interactions
  • Respect each other’s time, space, and opinion
  • Encourage new and existing team members
  • Erase departmental/positional boundaries
  • Have a “willing to help” attitude.
  • Take ownership of identified opportunities
  • Share information and ideas
  • Give and receive constructive feedback
  • Leave their personal problems at home
  • Are positive and avoid the negative
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How to Manage Physicians: Set Them Up for Success

I had a friend ask me the other day, when I was going to tackle managing physicians.  And she held up her fists and told me to “Go Get ‘Em”.  I am afraid she is going to be disappointed

Though I have “managed” physicians that act like petulant children and even had the occasional Dictaphone thrown in the vicinity of my head, I think a discussion of managing physicians is better addressed by talking about how your team as a whole sets up physicians for success.

Let’s get some basic foundations established to understand the pieces of the puzzle and how they fit together:

  1. Healthcare is the business of Treating Patients.
  2. Physicians are Revenue Generators.
  3. Managers are Expenses.

Our job as managers is to clear the path so that our Revenue Generators can do just that.  My job at its heart is simple:

Make seeing patients as efficient as possible for my provider

This means having the clinical staff (CMAs, LPNs, RNs) take real ownership of each patient and getting the providers everything they need before they enter the room – not taking vitals and letting the patient just wait in the room with no other assistance. This means:

In addition to taking vitals, the team can administer questionnaires, draw standing order labs, and look to see if any preventative care is needed at this visit (like a flu shot or mammogram order). They can also update medications.

I encourage practices to train their clinical staff in motivational interviewing to help focus the patient on the 2-3 items they want discussed in that visit.  The staff should be partners in the patient’s care, so the handoff to the physician during the visit is seamless.

GOALS: Save time, save money, increase volume and maintain quality of care.

Schedule visits for the right amount of time, and actively manage the schedule

If you have a handful of patients who always need your longer appointment slot, then keep a list for your schedulers and make sure they are scheduled appropriately.

This also means making sure patients are confirmed for their appointments.  I have found e-mail or text messages work best.  Very few people take the time to call to cancel or confirm, but they can easily reply to an e-mail or text.  Note: Most practices I work with have less than 10% of their patients that require a phone call, but keeping a tight schedule on schedule is worth the effort.

In our practice I have found that new patients and physicals take about 10 minutes to prepare for the provider.  I book these patients in the first slots after breaks and I double book with a 10 minute phone or web visit. The staff don’t have to prep a phone or web visit and the provider just saw 2 patients in the same slot (this will help overcome the challenges below).

Ensure patient satisfaction so I maintain return customers.

At the end of the day, healthcare on the front lines is like any other business – and patients are like any other service industry client. Treat them with respect and you will keep their business and gain referrals.

Value your customers time! Patients waiting 30+ minutes to be seen (including time in your back office) is unacceptable. Period. Goal: patients don’t wait more than 5 minutes. If your physician needs 30 minutes for return visits, give them 30 minutes.  They can bill to cover the time they are spending and you will have a much better quality review from patients and are more likely to get the word of mouth referrals that are priceless.

Get feedback and give it to EVERYONE (including your docs).

Remember, your doctors are scientists at heart, and they need data to support the feedback you give them. Patient data can be gathered a number of ways., by using a free survey site and e-mail just a few days every few months or in-person post card-sized surveys at checkout are usable raw data to help you offer constructive suggestions.

How do you fix the hard stuff? Real world training.

Example: If you have a bedside manner problem, let them know.  Then find them training.

  • Toastmasters is a great way help improve their communication skills
  • Motivational Interviewing helps them find a new way to engage the patient

Remember – Nobody wakes up and says “I want to do a crummy job at work today”, including doctors, and this is a team sport. It takes ALL of us to make patient care pleasant for patients, doctors and clinical staff.

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Management Monday: Celebrating Mom the Empathetic Leader

With Mother’s Day around the corner I thought I would tell you about the less recognized leader in my house growing up, my mom.  My dad is the embodiment of a Hands On Manager, but my mom is the Empathetic Leader.  She can read a room just by walking into it, and she is the best judge of character I have ever met.

What is an Empathetic Leader?

Someone willing to really listen.

They have a great capacity for listening, and have a welcoming personality that makes people want to tell them their story.

  • Example – The manager you want to talk to when you find out you are going to have to take time off to help a sick parent.

Someone who is truly intuitive.

I realize this is a catch-all term and can manifest itself in different ways.  The main theme here is that these leaders have a sixth sense to better understand their surroundings, others, and/or situations.  This includes an inner voices, “gut feelings”,  and being more aware of their surroundings to notice if something is “off”.

  • Example – When you are interviewing for a position, this is the person you always want in the room for their “gut feelings”.

Someone who is empathetic.

Just as the name says, they have the capacity to put themselves in the other person’s shoes.

  • Example – This is the manager that can help the employee who is on the wrong seat on the bus or maybe even on the wrong bus feel okay with the conversation, because they start it off understanding how unhappy they are being in a role that doesn’t fit.

Someone who builds strong relationships.

This is the crowning jewel of my mother and empathetic leaders.  It is what makes them exceptional.  Their willingness to listen and ability to empathize with others develops strong relationships with their team and others across an organization, which develops the type of loyalty that is necessary in a change-driven organization.

How Does an Empathetic Manager take it to the Next Level? By letting things go. (Yes, like that now famous Disney song)  Empathetic managers feel deeply; therefore, take team opportunities more personally than others.   They also tend to take constructive feedback and internalize and overanalyze it.  Many empathetic managers are not managers, yet … they need to be developed into realizing their potential.  They see their empathy as a weakness when it is a strength.

Don’t forget to thank your mom this Sunday!  As always, please send your questions, comments, concerns, or opportunities to southernservicestyle@gmail.com.

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Management Monday: Opportunities vs. Problems

I believe that the way you approach a problem is the key to finding a successful solution and for managing change.  I don’t have problems … I only have “opportunities”.  And trust me, I have lots of opportunities.

So here are my tips for successfully turning problems into opportunities at work:

  1. The Problem Employee that Used to be Great

Ex: The employee who is _______ (Rude, Inappropriate, Late, Out, etc…) – This is an employee who used to be great not one that has always been a problem. (Problems need to leave in their first 90 days)

Problem: I promise that I will spend more time on HR another day – but if you think of this as a “problem” – I find people put it off to avoid the confrontation or they just keep counseling the person until they have fulfilled the red tape to fire them.

Opportunity:  This attitude change, is “Hey  ____, I think you bring value to our team and I would like to the work through this opportunity.”  In my experience, I end up with a better employee as opposed to one with one foot out the door.

 

  1. The Problem Vendor that Used to be Great

Ex: The vendor who used to be great, but who is now providing poor service in some way.  Problems should be terminated quickly.

Problem: If you think of this as a problem, you may go through quite a few vendors without getting what you want.

Opportunity: I treat vendors who used to be great, the same way I would want my customers to do – let me know there is a problem, so I can learn from it.  So that is how I approach great vendors that have an opportunity.  I give them a chance to fix it.  It actually builds a better relationship, and I usually end up with a WIN through a credit or freebie or something.

 

  1. Your Crisis Does NOT have to be My Crisis, But it Can Be Our WIN.

Ex: The parent who forgot that they needed their child’s physical form filled out for today’s soccer registration.

Problem: If you brush the parent off stating we require 2 business days, most likely they are going to find a new pediatrician.

Opportunity: This can be a real win for your office in terms of customer service.  I have the staff explain that our normal request is 2 business days, but that we will be happy to try to accommodate.  We then suggest, while they wait they could start following us on one of our social media sites and they could also leave us a great review.

 

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Management Monday: Are You the Problem?

Are You the Problem?

“It isn’t you, it’s me.”  This is a great answer when you are trying to let someone down gently, but when it is your work and you are really invested –  recognizing this is really difficult.

Let’s ask ourselves some questions to find out if this really is your situation:

  1. Do you feel like you know more than your boss? Or that you are doing your boss’s job in addition to yours?

I was killing myself trying to make up for the things I thought that my boss should be doing.  I assumed that this is what they should do, because I thought being better is was our shared goal.

  1. Do you feel like you are the only one with a clear vision of where your company, department, organization needs to go? Or that you are the only one in leadership working towards the goal that has been set?

I had a great team working toward the vision our owners set as a goal, but we were carrying the rest of the organization to this strategic goal.  Again, I thought being better is what they expected of me.

  1. You may be getting recognized for doing a great job, but do you get the impression that if you weren’t working so hard that it would be okay with the company?

This is the big one – the signal that you might be the problem.

I know what it means to be working really hard, but I finally had to accept that the organization I worked for didn’t really want to be better. The decision-makers and leaders who defined our strategy and goals were content where they were – they weren’t breaking any laws, doing anything unethical but they weren’t striving to improve either.  I was pushing them to be something they didn’t want to be.  Don’t get me wrong, it makes me sad that they could have been so much more; however, that was my vision for the potential I saw, not their vision or the results they were striving for.

That was when I made a choice. Leaving was the best thing that I could do for both myself and the organization I worked for.   I found a place that wanted my passion and drive for being better.  My old company is still doing well, content with where they are in the market and no one went up in flames. Much to my chagrin – I was the problem.  I was making others unhappy by pushing them, and I was unhappy having to push them.

I now realize this is like me going over to my baby who is perfectly content to take my wooden spoon and smack it to a pot, and force her to “play with it the right way.” She was content and now I am pushing her to do something else.  The tough lesson is that sometimes, we just need to let others be content, no matter how much they could be better and in our eyes, should be.

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Have You Recognized Your Team Lately?

When was the last time your recognized individuals on your team?  For many of you that answer might be Christmas.  And some of you are still sore from the expense of the party or gift that you provided to your team.

However, recognition does not have to cost you or your company a dime.  And actually can be accomplished in a mere 10-15 minutes a week.  (WAIT.  Did she say FREE and 10-15 minutes a week?) Yes, yes I did.  I am going to give you one of the biggest keys to my success in building teams.  (Oh – WAIT.  Now you are going to want me to buy something from you.) NOPE.  I am going to offer this great wisdom for FREE.

Thank You Notes.  (You mean those things I had to write after I got married?)  Yes those.  For those of you raised by mamas who believe Emily Post is the be all end all, you probably grew up writing these for everything.  For those of you who didn’t … I promise it isn’t that hard.  It does not need to be long.  Here is one I wrote today.

Dear X,

Thank you so much for taking on the project of reviewing the patients who have been in recently and making sure they have the (x) setup on their demographic page.  This ensures we have an accurate account of our patients for all of the shared reports we run with (x).  Great catch on the two different places to document this!

Thank you,

S

Please note,  it is only 3 sentences.  I start with the what they have done.  Then why it is important in the big picture (validating the usefulness of what in this case is a mundane task) . Finally, a pat on the back.

Each week I send out 2-3 of these.  I spend no more than 5 minutes.  But I don’t just send them to my direct or indirect reports.  I send at least 1 to someone who assists us in what we do.  The ones to my own employees, I prefer to write on stationary and mail to their home (Okay – I do spend the cost of a stamp and stationary.  However, e-mail works, too).  This allows them to share their worth with their loved ones.  I have had single moms, who put it on the fridge with their kids work from school – showing their children they have value.  The ones to someone who does not have a reporting relationship to me, I e-mail and cc their supervisor.  I want them to have it come performance review time. I had a maintenance gentleman, who had played football in college – so he was a real man’s man, almost cry when he told me how much it meant to him that we noticed what he does.  He told me that no one ever told him thank you.  How sad is that?  But the indirect benefit from this, any time my department called maintenance for a repair – guess who got bumped to the front of the line?  I don’t do them for this reason, but think of it as an added perk.

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