Tips For Staying On Schedule


March 03, 2022

There are two over-arching reasons for you to stay on time: patient satisfaction and to de-stress you.  I'll be the first to admit that staying on time can be a challenge. Here are some strategies that can help keep you on schedule. 

  • Get to clinic before your first scheduled patient. Preferably you get to clinic early. If you show up at 8 am, your first patient is at 8am and then you first need put out whatever this morning’s fire is, you start the day off behind and you will be all day long.  The other advantage to getting in early is to huddle with  your MA so that you have a game plan for potential bottlenecks. 
  • Create a block schedule. Train your scheduler the rules of the block schedule. 
  • Communicate scheduling issues with your scheduler. If you have a patient that always takes more time, schedule them in a longer slot. 
  • Don't routinely double book. If it takes you 15 min to see a follow-up and you put 2 patients in every 15 min slot you will invariably run behind. 
  • There will be times that you have to double-book. Have a code so you don't double book one of those patients that always takes longer. 
  • When you enter the room, set an agenda by greeting the patient, and asking them what they are here for today. The better you define and manage the expectations of the visit, the greater the patient satisfaction.
  • Set the timer on your phone. The vibrating phone is a gentle reminder that  time is up. 
  • Have a plan with your MA-instant message, a knock on the door, a "call."
  • Do your absolute best to not answer calls in the middle of clinic. Use HIPAA compliant email and text messaging for quick questions. If you must talk on the phone, set up a time—before patients, after patients or as a scheduled appointment. 
  • Have information about diseases and procedures ready to print during the visit. Discussing the patient handout(s) and then handing it to the patient at discharge with improve patient comprehension, decrease phone calls to your office and improve patient satisfaction and outcomes. 
  • Most EMRs have instant messaging. If yours doesn’t, install a HIPAA compliant instant messaging application. We all know how questions, unplanned tests and procedures can disrupt your otherwise perfectly flowing day. With instant messaging you can be in an EMR chart and have a separate window open for instant messages to communicate with your staff without leaving the room. 
  • Create a list of supplies that every exam room should be stocked with. Standardize your rooms by labeling the drawers and putting supplies in the same place in every room so you don’t have to search for things. Train your staff to check supplies and re-stock daily. Have a tray/cart stocked with supplies for  your most commonly performed procedures. 
  • Understand that most  “practice management emergencies” that occur during the day are not true emergencies.  
    • Have a process for everything. 
    • Establish a chain of command for urgent questions. 
    • Huddle with staff before clinic and then check in after patients to identify  practice management issues.  

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00:00:00 Hi, it's Dr. Weitz. Thanks so much for joining me for this episode of the private medical practice academy. There are two overarching reasons for you to stay on time. The first is patient satisfaction and the second is to distress you. Now I'll be the first to admit that staying on time can be a challenge, no matter how hard you try.

00:00:21 There always seems to be stuff that happens in an attempt to derail you. That said one of the advantages to being in private practice is being in control today. I'm going to share some strategies with you that can help you stay on schedule first. And this should be obvious to you get to clinic before your first scheduled patient. Preferably you actually get there early.

00:00:46 Look, if you own your own practice, you know that there always seems to be some issue that needs to be dealt with first thing in the morning. If you show up at 8:00 AM and your first patient is at 8:00 AM, and then you first need to put out whatever this morning Spire is, you've already started the day off behind. Then you're playing catch up all day long.

00:01:09 The other advantage to getting there early is to huddle with your team, go over today's schedule with your ma so that you have a game plan. In my practice, we would look over the schedule to identify any potential bottlenecks. We had a plan for how to keep clinic moving. Now that's not to say that everything went smoothly every day, but the more you can make things predictable,

00:01:34 the easier it is to deal with the unpredictable. If you start the day late, you will be late all day long. And the later you are, the more time you must spend apologizing to the patient for being late, which in turn only makes you that much later and stresses you out because the visit is going to take that much longer. It's the quintessential snowball effect.

00:01:58 Second, create a block schedule. This will make it much easier for your scheduler to know how to schedule your patients. While there should be a self-explanatory new patients go into a new patient slot. You need to spell this out for the scheduler or your front desk. There is no benefit to scheduling a 30 minute new patient in a 15 minute followup slot.

00:02:20 It just frustrates everyone, the patient, your staff, because the patients are complaining and ultimately you bear the brunt of it. And while I'm at it, you need to be honest with yourself. When putting together this block schedule, if it takes you 45 minutes on average, to see a new patient, then don't create a new patient block. That's 30 minutes.

00:02:41 If you do, you're just setting yourself up to fail while I'm on the subject of schedules, be sure to communicate scheduling issues with whoever's doing your scheduling. Some patients are more complicated or take more time than others. When you send that patient to schedule their followup, make sure you have communicated with who's ever going to be scheduling the follow-up. For example,

00:03:05 we had a code to indicate that a patient shouldn't be scheduled on the same day with multiple other patients with the same code to be perfectly blunt. It wasn't necessarily about the number of patients I saw in the day, but the who as a pain management physician, I could see 30 plus straight-forward folks. And think I had a great day, or I could see half of that where all of them were difficult and be brain dead by the end of the day,

00:03:33 try and figure out if there is an issue with certain patients and figure out a coding system so that your scheduler knows how to deal with that. The same thought process goes for double booking. I personally am not an advocate of routinely, double booking. Think about it. If it takes you 15 minutes to see a follow up and you put two patients in every 15 minutes slot,

00:03:56 you will invariably run behind. That said there are likely to be occasions where you will be double booked. Again, we had a code that was assigned to patients who could not, should not ever be double booked third. When you enter the room, set an agenda by greeting the patient and asking them, what are they here for today? If it's clear that the list of what needs to be covered is going to exceed the allotted time,

00:04:26 address this upfront also by understanding what the patient wants to address at the beginning of the visit, it's easier to avoid those last second end of the visit surprise questions. The better you can define and manage the expectations of the visit, the greater the patient satisfaction and the higher, the likelihood that you're actually going to finish the visit in Neo bonded time. As an aside,

00:04:52 there will always be those patients who have that. Oh, but doctor, I have one more question. I dealt with that by gently suggesting that they come to the next visit, where they listed their questions so that we can make sure that we get to them all before the end of our time together. And that I would address the items on their list.

00:05:12 And then I would indicate to the scheduler that this patient was a longer follow-up fourth set the timer on your phone. I would start the timer on my phone. When I walked in the room, then my vibrating phone would be a gentle reminder that my time was up. If I didn't already finish the visit, despite my best efforts, I could still get stuck in a room,

00:05:38 but Miami Katie and I always had a plan. She would message me through my instant messaging as part of my EMR. If I wasn't out after my phone vibrated and Katie had messaged me, she would then knock on the door and tell me that Dr. Bell, you know, as an Alexander Graham bell, the guy who invented the phone was on the phone as my cue to wrap things up while I'm on the topic of calls,

00:06:06 do your absolute best not to answer calls in the middle of clinic. This is a sure fire way to run behind HIPAA compliant, email and text messaging makes it much easier to communicate. In my practice. We routinely had to do peer-to-peer reviews. The doctor would call you and then put you on hold. It could easily set me back 15 minutes.

00:06:30 If you have to talk to somebody on the phone, whether it's a peer-to-peer or it's another physician who wants to talk to you about a referral, try and set up the time before patients, after patients or as a scheduled appointment. Now, if it's somebody who's calling you about a patient that you share, if you're giving them your cell number, they can easily send you a text and you can respond either by text,

00:06:55 or you can simply say, Hey, can I call you at X time or text you at X time? If it's a peer-to-peer, then your best chance of actually getting that doctor on the phone in a timely fashion is to actually schedule an appointment. Fifth, have information about diseases and procedures, ready to print during the visit, discussing the patient handouts,

00:07:20 and then handing it to the patient to discharge is going to tremendously improve patient comprehension. It decreases phone calls to your office and it improves patient satisfaction and outcomes. In my experience, it will also decrease that I have another question because between discussing the handout and giving it to them, you are likely to have already addressed that one. Last question. Sixth,

00:07:47 most EMR is have an instant messaging system incorporated into their software. If yours doesn't install a HIPAA compliant, instant messaging application, we all know how questions unplanned tests and procedures can disrupt your otherwise perfectly flowing day. Before we had instant messaging, if a patient had an MRI done and we still didn't have the results, it was just incredibly frustrating. You had to get up,

00:08:16 leave the room, find the medical assistance. So they could then call the imaging center to get the report, or let's say I wanted to do an unplanned in office procedure. It was the same story I had to get up, leave the room, go find the medical assistant. And then they had to pull whatever it was that I needed to do this procedure.

00:08:35 With instant messaging, you can be in an EMR chart and have a separate window open for instant messages. You can communicate with your Emay without ever leaving the room. You can also communicate with the scheduler. As I had told you, you needed to do earlier. The key is to make sure that your at the scheduler, anybody that you're going to want to communicate with also has their instant messaging window open.

00:09:01 Now that should seem pretty obvious to you, but believe me, you can be instant messaging from now until the cows come home. But if the other person is not actually on instant messenger, you're not getting anywhere this behind the scenes, dance can help you stay on schedule and it makes you and your team look totally on the ball because you know what stuffed miraculously appears without you ever having to leave the room.

00:09:29 Look at the end of the day, leaving the room to go get something or to find the medical assistant does nothing to improve your patient satisfaction. Next, create a list of supplies that every exam room should be stocked with. Standardize your rooms by labeling the drawers and putting supplies in the same place in every room. So you don't have to search for things,

00:09:51 train your staff to check supplies and restock every morning before clinic starts. The last thing you want to discover when you're about to do an exam is that the box of gloves is empty. It also really helps to have a tray or a cart that stocked with everything you need to perform your most commonly done procedures so that you can instant message that medical assistant and that cart can miraculously just arrive.

00:10:17 And there's no delay. And then I want to address the practice management issues that can completely derail your day. Running your own private practice has numerous perks, but it comes with management responsibilities and headaches. Let me start with the fact that most of the practice management emergencies that occur during the day are not true emergencies. Most of them can be dealt with either before or after seeing patients.

00:10:46 How do you deal with the chaos that occurs during clinic have a process for everything? For example, what policy do you have for patients who show up late stopping to answer, whether you'll see a late patient takes time worse yet, if you were the one who has to intervene between the front desk and the patient, you're going to be even that much further behind.

00:11:07 If you have a policy, then the front desk knows exactly what they need to tell the patient and you don't need to get involved, establish a chain of command for urgent questions. One thing that will help is a list of what must be addressed by you now, versus what can you deal with after patients? Don't worry. If you don't have that list today,

00:11:28 this is something that comes from experience and running this practice. And it's a list that you're going to revise multiple times. The one thing about handling practice management issues before and after patients is that you have to carve out time for this. In addition to the five minute huddle you want to have with your Emay before clinic, I would strongly recommend doing the same huddle with your other staff.

00:11:52 If you have practice manager huddled with them before clinic, and then check in with them after patients to identify any urgent issues. Now, this does not take the place of the weekly meeting that you should be having with them to go over practice issues. The purpose of this huddle is really to address the urgent issues that you didn't want to deal with during the day the practice managers should huddle before and after patients with the front desk and the clinic staff to address urgent practice management issues as well.

00:12:23 And they should be the point of contact during the day. That way the practice manager can bring you a list of the issues and you address it during your huddle with the practice manager. Now, if you don't have the practice manager, then you'll want to be the one to do that practice management huddle before and after clinic with your front desk and clinical staff,

00:12:46 before you feel overwhelmed, that huddling is going to just make your day that much longer. Let me reassure you that by preemptively, putting out fires and not giving in to the during clinic practice management chaos that can occur, you will ultimately have less stress and you will stay on schedule for me. This was probably the best 10 to 15 minutes spent in any given day.

00:13:12 Thanks for joining me. Please be sure to sign up for my newsletter below, I'll be sending you tips on how to start a practice, grow a practice, and then add multiple services so that you can maximize your revenue.


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