By Larry K. Wan, OD
Eliminating unnecessary wait time improves office flow. It also puts post-exam patients into your dispensary with time and energy to spare.
Doctors traditionally view wait times in their office experience as anecessary evil–something patients donot like, but which they cando little about. Two years ago, we decided we could do better. Implementing the principles of OD Lean, a program by Johnson & Johnson Vision Care Institute in Jacksonville, Fla., we made changes that have resulted in a streamlined office visit for patients–and increased our profitability. Most individuals mentally budget one hour for doctor’s visits. OD Lean research shows that if you can get the patient out to the optical in under 45 minutes, the patient experience will be better because the patient mentally still has time to “shop” without feeling they have to rush out. In 2011, our optical sales outpaced our overall growth by over 4 percent.
We had OD Lean instructors come to our office to deliver their full program. This is the best way to achieve transformational change, but I have also experienced the program at the Institute as a pilot participant with my optical manager for OD Lean’s 1.5-day program. Here is the process we used to find gaps in office flow efficiency.
Sketch Out Operations with Step-by-Step Time Analysis
To begin, my staff and I story-boarded our process utilizing Post-It notes for each step patients go through in our office. The check-in process was on its own storyboard with Post-Its for each critical step , pre-testing on another, exam room on another storyboard , and so forth. The idea is that it’s much easier to rearrange the order of a process with Post-It notes versus re-typing a process with every little change. We were careful to break each step into sub-parts. For example, each task the patient was put through at check-in was looked at. That means we looked at everything from the amount of time patients stood in line at the check-in desk to the paperwork we asked them to fill out. For the pre-testing step, we looked at how long patient history or other conversation with pre-testing technicians took and then how long the pre-testing itself took. For the experience in our optical, we looked at how long it took an optician to help the patient, and how long it took for the patient’s eyeglasses order to be processed.
Use Advance Planning: Check-In Time Cut in Half
In our office, check-in used to take 20 minutes per patient. We had forms they were only presented after reaching the office. Patients would reach a check-in desk with staff that had not pulled up to their screens the patient’s chart and history until the patient was standing before them. Patients now are able to fill out paperwork ahead of time online and our staff has a system whereby they already have the material in front of them by the time the patient comes in. They also have insurance information looked up or taken down when the patient calls for an appointment, so the patient only has to confirm their insurance and present their card for photocopying when checking in. These changes have reduced check-in time from 20 minutes to 10 minutes.
Enforce Consistency of Process: Pretesting from 18 Minutes Down TO9 Minutes
In our old pre-testing sequence or process, our technicians would greet patients, update their medical case history, check acuity and eye pressure, perform visual field testing, review contact lens care when applicable and check the prescription of the patient’s current pair(s) of eyeglasses. The efficiency gap was that each of our six pre-testing technicians was doing these steps in a different order. To change that, we experimented by tracking time on different orders of performing the pre-tests, and then when we found the order of pre-tests that was most efficient, we insisted that each pre-tester use that same order of testing for each patient. Experimenting to discover the most efficient order in which to conduct the pre-tests and then asking each pre-tester to stick to the same order of tests reduced our average per-patient pre-testing time from 18 minutes to 9 minutes. On top of the time saving to patients, the consistency of process makes it unnecessary for doctors to recheck the work of pre-testers, as we frequently had to do when each pre-tester did the pre-testing in her own way.
Make Best Use of Space
Some offices have abundant space, but are not using it wisely. For example, some ODs have all their pre-testing equipment bunched together in one room. If you are able to spread it out into two areas or two rooms, you will be able to move two patients through at the same time–even if you do not have duplicates of all of your instrumentation. If the instrumentation is spread out, there is room for one patient to begin the process while another patient is nearing the end of the process. By contrast, it is hard to have two patients going through pre-testing at the same time in a cramped area. In addition to discomfort, doing so may compromise patients’ HIPAA privacy protection.
Stagger Patient Appointments
Rather than double-booking patients for the same time slots, even those with multiple doctors, should think about staggering appointment slots. Offices with more than one doctor often make the mistake of thinking that just because there is more than one doctor and exam rooms to match the number of doctors, there won’t be bottlenecks. But logjams can still occur in shared areas like check-in, pre-testing and the optical shop.
Organize Appointments According to Reason for Visit
As we all know, some appointments take longer than others. For instance, patients who wear contact lenses, and especially those who require diagnosis for contact lens discomfort, frequently take longer than patients who just wear eyeglasses who are there for their annual examination. Rather than haphazardly booking patients regardless of reason for their visit, book patients strategically, considering how much time each appointment will most likely take. Experiment by clocking and recording times to figure out whether it makes more sense to group a certain kind of visit, such as contact lens wearers or those patients just visiting for follow-up care, in the same blocks of time, or whether it makes sense to see patients there for time-consuming appointments interspersed with less time-consuming appointments. Whatever you do, don’t disregard the reason for the office visit when booking appointments. Organization and strategy make all the difference in the effort to streamline your patient experience.
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Larry K. Wan, OD, is the owner of Family EyeCare Center in Campbell, Calif. To contact him: Wanski@aol.com.
