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Patients complain that administrative and coordination tasks eat up too much of the time they spend with their dermatologist. Staff members are besieged by paperwork and processes that delay visit start times and upend patient flow. Meanwhile, dermatologists shoulder a greater number of care coordination tasks that impede their ability to practice medicine. The result?
Dissatisfied and disheartened patients, staff, and dermatologists.
We don't have the power to eliminate all of the bureaucracy, so how can we ease these strains? More dermatology practices are anticipating the tasks necessary to support the patient's visit and doing them before or after the visit. With thoughtful pre- and post-visit planning, you can shift many tasks out of a patient's appointment time.
That was certainly the direction North Atlanta Dermatology of Duluth, Ga., took as it grew from a solo office to a three-physician practice with a PA. "As the practice got bigger, we made changes and implemented procedures so that it would go faster," says practice manager Elaine DiMaggio. "I'm willing to change it all the time."
Streamlining onsite care is critical to maintaining the sanctity of the patient-physician interaction. Set a practice-wide goal that while a patient is within your dermatology practice, you and your staff will do only the activities that must be done while that patient is onsite. Your front-office staff will have verified the patient's personal information, pulled the patient's charts, and performed other related tasks before the appointment.
North Atlanta Dermatology has patients verify their information ten minutes before their appointment time — the paperwork is already waiting for them. "The day before we do the schedule for the next day, and then we have staff actually pull the charts for each doctor," explains DiMaggio.
Such a well-planned approach to pre-visit activity gives staff more time to schedule necessary follow-up appointments and perform other tasks that should be done while the patient is onsite. Segregating clinical duties before, during, and after the patient visit allows each member of the patient care team to focus on the patient, not paperwork, during the patient visit, thus providing a higher level of care.
Not surprisingly, dermatologists, staff, and patients are delighted when administrative and clinical follow-up chores can be completed away from the hubbub of the office and do not impede visit time. The stumbling blocks experienced by dermatology practices tend to be a result of poor planning rather than faulty execution. Here are four actions to ensure a smooth implementation:
Identify operational constraints. Lack of capacity, rapid growth, high demand, facility inadequacies, and glitches in laboratory results, electronic medical records, or other support systems can severely constrain the performance of dermatologists and staff. These issues, which always seem to rear up at less-than-ideal times, prevent staff from performing the right tasks at the right time.
Operational constraints can cause "task-creep." For example, if no one has time to check prescription renewals before the visit, staff may try to do so while patients are waiting at the checkout counter, which delays other tasks. Similar task shifts can occur with other clinical tasks, such as processing test results.
Develop standardized processes and associated protocols and tools. Often, dermatologists and administrators perceive that staff are performing inconsistently. There may be some truth to it — there are as many ways of doing things in a dermatology practice as there are staff and dermatologists. Minimizing variation in performance of tasks is an essential step to ensure that staff consistently meet patient needs.
Prepare a standardized task list for each employee type. This list goes beyond the job description. It describes every task required of each employee position. The task list will create clearer and mutual understandings of duties by function. It also will help staff cover for each other during absences, as well as help speed the training of new employees.
Provide staff orientation and competency testing. While standardized processes and assignments go a long way toward creating consistent patient-visit support, success depends upon staff performance.
Pre-planning the patient visit has substantial benefits. Take a look around your dermatology practice and consider how a thoughtful approach to doing tasks at the most appropriate times can result in streamlined patient care and happier patients.
If your dermatology practice wants to provide the best care possible for its patients, stop trying to do everything during the visit. Identify tasks for which the patient does not have to be present by figuring out what things can be done prior to, during, and after the visit.
For example when a dermatologist sees a patient at North Atlanta Dermatology of Duluth, Ga., everything needed for the patient visit is already in the exam room. "The medical assistant pulls the chart and looks in it. If the patient comes back, let's say, for a wart, and [the MA] knows the physician is going to have to pare it down — or have meds or liquid nitrogen — the medical assistant will have that ready on the table before the physician comes in," says practice manager Elaine Di Maggio.
All of which results in less time running around and more time interacting with the patient during an appointment.
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Disclaimer: The material above has been prepared by Physicians Practice. It has not been reviewed by the DermQuest Editorial Board for its accuracy or reliability. Reference to any products, service, or other information does not constitute or imply endorsement, sponsorship, or recommendation by members of the Editorial Board.