Practice Management

5 Changes to Streamline How Your Office Operates

By Lilien Vogl, OD

Dec. 19, 2018

Your office’s work processes should create a smooth patient experience, and minimize doctor and staff aggravation.

To create a practice that both my staff and patients would love, I made changes based on the Lean Management Value Stream Mapping method, a system used most famously by Toyota, which guides a business on tracing each step of the customer’s experience, and then finding ways of making each step more efficient and pleasant.

Lean Management Philosophy is about focusing on your customers, or patients, and what they most value. How can I give them more of those things that matter most to them, and get rid of the parts that don’t give them value? I believe uninterrupted time with the doctor is what creates the most value in an optometric practice. The rest is essentially waste. Eliminating and minimizing waste enhances the patient experience.

The first step is drawing out the patient journey “present state” with your team. Immediately, unnecessary steps become obvious. Resist the urge to talk about solutions now. The harder part is imagining and drawing out the “future state” you’d like your patient to take, eliminating wasteful steps. The real work comes from taking the present state to your ideal future state. You and your team will need to work through the whys and hows of improving. Changes need to be tried, evaluated and reassessed until it is agreed upon as a standard for your practice. Fortunately, most of these changes are simple and low- or no-cost.

I sold my independent practice four years ago and now consult with other independent optometric practices, helping other owners discover ways to make the experience of both patients and staff more positive and profitable.

Wasted staff time and inefficient processes cost a practice money. The following five steps in Lean Management can result in saving as much as 1-3 hours per day in your schedule, enabling one-to-two additional patient exams per day, and the generation of as much as $500 more per day. What’s more, you end up with a staff that is more satisfied, and less frustrated, in their jobs. Staff with that high level of satisfaction are likely to stay with you longer, and be better primed to provide great care to patients.

Standardizing how contact lenses are stored and re-ordered can make it easier for doctors to efficiently serve contact lens patients in the office, and minimizes doctor frustration when looking for the trials they have just prescribed.

Standardize Contact Lens Choices & Trials in Exam Rooms
We standardized contact lens choices by the doctors, and placed trial lenses in each of the exam rooms.

My associate and I decided on our preferred lenses for spherical, toric and multifocal contact lenses. Using craft boxes and trays from vendors, we were able to stock each exam room with the trial lenses we most frequently needed. When the lenses were used, the peeled-back tops of the trials were placed in a container and scanned at end of the day for re-order.

Cost: The scanner was supplied by our contact lens distributor. There was a cost for the plastic contact lens trays of $30 per 100, and the  craft boxes cost $7-8 each.

Improvement: No longer did the doctor have to leave the exam room to get trials, saving as much as 2-3 minutes per contact lens patient. This allowed us to use that found time to answer patient questions, or provide helpful information, such as what to expect in the wearing experience with their new contacts.

Have Doctor Sign Rx & Provide Educational Material In Exam Room
For years in my practice, the doctors followed patients out to the front desk to sign their prescriptions and provide the patient with printed-out educational material. Each time the doctor did this, other patients in the reception area would stop the doctor to chat and ask questions. Sometimes, in the hectic environment at the front desk, the patient would forget, or not feel comfortable, about asking questions, or the doctor would forget to give the patient all of the educational material. This created a rushed and chaotic end to appointments.

To make it unnecessary for doctors to sign the prescription at the front desk, and hand the patient the printed-out educational material at the front desk, we invested in a printer in each exam room, so doctors could sign prescriptions, print educational items and hand to patients without ever leaving the exam room.

Cost: $100 per printer.

Improvement: A conservative estimate would be that a few minutes of the doctor’s time was saved per patient, and in some cases, more than five minutes per patient was saved, if you take into consideration all the times the doctor would follow a patient to the front desk, and get stopped by other patients on the way and back.

In addition, having the ability to sign the prescription, and print out educational materials, in the exam room means a more peaceful, calm end to appointments in which the doctor can be assured the patient is leaving with all needed items in hand, and the patient can have enough quiet and breathing space to ask last-minute questions that come to mind.

Low-cost supplies like these can be an economical, no-waste way to organize your office, ensuring doctors and support staff quickly find everything they need to serve patients.

Designate Spots in Exam Room Drawers for Doctor’s Supplies
My associate and I were frustrated that the supplies we most frequently needed, like dilating drops and fluorescein strips, were often missing. So, we created designated spots in each of the exam rooms where these items would always be put back, and where they could always be found.

We took a Kaizen foam board, and cut the foam to fit our exam-room drawers, and then outlined and cut a space for each item. We created a checklist that the tech followed each night, so we knew there would always be enough supplies for the next day. Techs and doctors would put each item back because there was a designated location for each item.

Cost: Kaizen foam board 2’ x 4’: $15 and foam knife: $2.75.; blue masking tape, $10 per roll.

Improvement: Doctors sometimes saved a couple minutes per patient that would have been spent looking for missing supplies, and leaving the exam room to go into another part of the office to find what was needed. Along with saving time that used to be spent looking for missing supplies, doctors were no longer frustrated, and there was no longer confusion from staff about which supplies were needed in each exam room. When everything you need is easily found, patient appointments go faster and friction and unpleasantness is eliminated from the patient experience.

Designate Spots for Support-Staff Supplies
Like the medical supplies needed in each exam room, which doctors too often couldn’t find, support staff often experienced frustration and wasted time not being able to find commonly used items like scissors and staplers.

So, we found designated spots for each of these frequently needed items, and ensured each supply was always returned to the same spot. We created labeled outlines in tape on the front desk for each supply, including scissors, pen, paper, stapler and phone. Staff were instructed to always return each supply to its exact designated spot.

Cost: Large roll of masking tape: $25 or less.

Improvement: Staff were no longer frustrated trying to find needed supplies, and the patient experience improved because they wouldn’t have to wait while the staff member looked for a needed item, like a pen or stapler. The office also improved its image, ensuring that patients would no longer leave with an impression of a disorganized operation. As much as a couple minutes per patient could be saved with time no longer needed for support staff to look for supplies.

Contact Patients As Each Piece of Eyewear Is Ready
Our staff handled this task typically. The boxes of newly arrived eyewear, or contact lenses, were emptied. All of these materials needed to be placed in trays, and then checked for accuracy. Then, our staff needed to contact the patients to pick the eyewear and contacts up. Our staff for years would wait until we had a batch of ready-to-pick-up eyewear and contact lenses to contact patients. This process would result in staff coming back to work, after interruptions, and not remembering where they left off. By the time the patient was contacted, it was often the end of the day.

To make this work process better, we adopted One-Piece Flow from Lean Management. That meant one completed pair of eyewear, or contact lenses, was pulled at a time, the tray for that material only was pulled, it was checked for accuracy, and the patient was called for pickup. We were able to contact patients throughout the day, so that they wouldn’t all arrive at the same time, and if our staff was interrupted in their work of receiving the new eyewear, and contacting patients, they could more easily pick up where they left off.

Cost: None

Improvement: Patients were contacted immediately when their completed eyewear, or contact lenses, was ready for pick-up, improving the patient experience, and staff avoided the annoyance of being interrupted during a long task, and then having trouble reorienting themselves.


Lilien Vogl, OD
, is the owner of Creative OD Solutions. She previously owned Vision Wellness, an independent practice in Phoenix, Arizona. To contact her:


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