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VBCR - December 2012, Volume 1, No 6 - Practice Management

By Phoebe Starr

Washington, DC—Creating an efficient rheumatology practice depends on acknowledging that your practice has inefficiencies, identifying the problems and challenges that lead to inefficiencies, and, finally, addressing them, according to business consultant Owen J. Dahl, MBA, Director, Owen Dahl Consulting, The Woodlands, TX, who spoke at the 2012 meeting of the American College of Rheumatology.

“You can’t become efficient unless you have a culture that says you want to be efficient,” Mr Dahl said.

Rheumatologists must lead the way for change in everyday practice, he told the audience. “Go back to your office and identify what you are going to work on to change the culture. Talk to your key stakeholders, your fellow physicians, and staff. Tackle a simple issue first and then go on to the more challenging issues,” Mr Dahl advised.

Identifying team members, putting a charter together (more on that below), and evaluating the tools to use are key considerations. Change comes about by identifying the problem, developing a solution, implementing the solution, and following up on the progress of the implementation, he continued.

A project charter is a written document that guides improvements in the business area of office practice. The charter identifies the task at hand and the team responsible for implementing change; it establishes the duties of each team member and sets a due date for implementation.

Mr Dahl advocated “lean management,” a principle derived from the automotive industry. This principle rests on the idea that time may be wasted and that lags and delays in managing patient flow need to be addressed. Mr Dahl said that patient visits can be viewed as a process from the time a patient comes to clinic, moves through triage, and has to wait until he or she sees the provider; the process also includes postprovider time for prescription refills and scheduling new office visits, and it ends with check out.

Identifying inefficiencies in this process will help to streamline the practice. It may be that patient wait time is a problem, or that check in or check out are causing delays. “Develop ways to make these steps more efficient, and eliminate unnecessary delays between these steps,” he advised.

The goal of streamlining a rheumatology practice is to create more value for the patient at each encounter and to accomplish this with less work. “We want to eliminate waste, eliminate variation, and eliminate the lag time between every step in the patient visit, because that creates lost value,” Mr Dahl stated.

When identifying inefficiencies in one’s practice, question certain practices that appear to cause a lag or delay, and ask why the work is being done that way. “Never settle for the usual answer: ‘Because we have always done it that way,’” he advised.

Lean management relies on expediting the work flow and eliminating any nonvalue steps in the process, reducing variations in the flow of patient visits, and involving the staff in implementing changes.

Mr Dahl suggested using a series of questions, beginning with the word “why.” “Why have you always done something a certain way? Why must it be done that way? Why can’t it be done another way?”

A patient satisfaction survey can be a helpful tool, he continued. This survey should have one key question that asks how likely the patient is to refer the practice to a friend or family member. He suggested using a scale from 1 to 10 for the answer, with 10 indicating “unlikely.” Then ask a second question about what experience led the patient to choose this ranking.

Streamlining inefficiencies will achieve better patient satisfaction, eliminate duplications, make better use of available resources, and increase the quality of care, he said.

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