Improving Your "Touch Time"
Ten Surefire Tips for a Faster Patient Cycle

By Elizabeth Woodcock,
MBA, FACMPE, CPC
Elizabeth Woodcock is a writer for Physicians Practice

In today's busy world, having the most efficient practice possible benefits physicians, their staff and patients alike.

There is a growing need for physician offices to improve their operations. Time spent in the waiting room rather than the exam room delays the "Touch time" patients want and need with their care team. And it's time with patients that probably attracted you to medicine in the first place.

"The key to success is to design your patient flow process around the patient – not the physician or the nurse," says consultant Deborah Walker Keegan, PhD. "The patient flow process should be patient-centered and physician-led in order to reduce cycle time and meet or exceed patient expectations."

When applied to a physician office, "cycle time," an engineering term, refers to the time from when the patient enters the office until his or her exit. Although many office visits can be accomplished in 60 minutes or less, beating this cycle time – or any other specific benchmark – should not be considered the goal of a performance improvement initiative. The goal is to make sure that the touch time is the highest it can be.

10 STEPS TO MORE TOUCHING
To maximize touch time, follow these 10 steps:

1. Schedule appropriately. Most often, lengthy patient waits are a result of poor scheduling on the part of the office. Dick Haines, an architect and president of Medical Design International, has seen too many doctors set themselves up for disaster. He urges physicians to identify how many patients they can see in a specific time period. The appointment schedule should be configured to match this rate of production, such as four patients per hour. "Otherwise," he says, "patients can be brought in much earlier than they can possibly be seen... and they will be forced to wait."
2. Don't double-book. Double-booking means extending patient waits. Haines notes, "Doctors don't work faster because someone in the business office puts more patients in a time slot than they can see. When that happens, everything jams up and patients who had an appointment are unnecessarily delayed." Instead, determine which slots may be available by holding some for same-day scheduling, and using a daily staff/physician huddle to determine if slots may be open unexpectedly — for example, an obstetrics patient who delivered the evening prior. (More on huddles in step 5.)
3. Be prepared. Before the patient walks through the door, make sure that you're ready for him or her. This process should begin with a chart preview days before the patient's appointment. Scrutinize the chart to ensure that all of the information the physician needs is in place. This includes results from tests ordered, hospital discharge summaries and any communication from physicians to whom you referred the patient. Physicians should summarize their orders in writing in a specific place in the chart. With a chart preview process, your staff will have at least a day to track down any missing information. Most importantly, this will prevent you from having to hurriedly search for information while the now-stressed patient sits on the exam room table in a paper gown. Also vital is an administrative preview. Encourage patients to complete insurance and other forms before they arrive by mailing them ahead of time or by submitting them on the Web. Patient cycle time is reduced significantly by improving check-in processing time.
4. Get the patient to help. Prompt your patients to consider the details of their complaint before they walk into the exam room. Walker Keegan advocates creating a symptoms checklist for patients to complete and encouraging them to write down the questions they wish to address during the encounter. "If a patient is prepared for his visit, cycle time can greatly be reduced," she explains.
5. Huddle. Get together with your clinical and scheduling staff five minutes before the start of every clinic. Use that day's schedule as your agenda, reviewing every appointment for special needs, probability the patient won't show and any predictable variance of time. A hypothetical example: Betty Smith, a 60-year old, wheelchair bound patient who is always escorted by her three daughters, is scheduled for a full physical at 11 a.m. You might direct your staff to use your procedure room, which offers extra space, and an exam table that can be lowered and tilted. Perhaps they should get a urine sample before Betty is assisted onto the table. If necessary, ask a female staffer to be ready at 11:15 to serve as an escort for you for the pelvic exam. Advise that no patients can be double-booked during that slot as you can predict that Ms. Smith will need the full time allotted. Go patient-by-patient, establishing your expectations for every visit, as well as reviewing special circumstances.
6. Check-in patients on time. Patients walk in and the front office gives them paperwork with few instructions or asks them to wait while a task is completed. Sometimes patients are simply forgotten. When a patient arrives, check him or her in immediately and make sure that the clinical team is promptly alerted.
7. Start work on time. Staff and physicians should be ready for clinic to begin before it does. Too many offices take the attitude that patients won't be roomed until well after the doors open. Clinic start time slips further and further behind. At least one clinical staff member per physician should arrive a half hour before the office opens, and the physician should arrive no later than 15 minutes before clinic. The team should address any work that needs to be performed before clinic, and leave time for the huddle.
8. Have supplies and equipment ready. Clinical assistants should inventory every exam room before clinic starts, looking for any missing equipment or low supplies. Carry small colored flags during clinic to mark low supplies, and look for the flags during your inventory rounds to determine what needs to be restocked. Include a rundown of unusual supplies and equipment needed for clinic during your huddle. Although equipment costs money, Haines advises that having enough is worth the investment. He explains, "Duplicate equipment where it will save steps. For instance, having one blood pressure cuff saves the practice money, but having one in every exam room can speed up the pace of exam ." If you are forced to find needed supplies and equipment in the middle of clinic, wait time will increase.
9. Focus on the patient's needs. Family physician Rich Honaker, president of Family Medicine Associates of Texas, marvels at the comments patients make about his practice style. For example: "Dr. Honaker makes me feel like I'm his only patient of the day." Yet, Honaker, who also trains physicians on improving their productivity, easily sees 20 to 25 patients per half-day clinic. He believes most physicians can double their patient load — and patient satisfaction — by adopting some simple techniques to improve flow. In addition to deploying the strategies already mentioned, Honaker has honed his interactions with patients to ensure that his clinical skills are optimized: "Let's take a patient who is experiencing signs of depression. I can spend 20 minutes convincing her that she has the symptoms of depression and selling her on the fact that she should be treated," or he can administer the Beck Depression Inventory test. He leaves the exam room for her to complete the scale, calculate the results and review related literature. When he returns a few minutes later (after handling another patient in the meantime), she's ready to discuss her depression and options for treatment. Honaker has similar strategies for high blood pressure, osteoporosis and most other chronic illnesses. Techniques like this are more common among specialists, where a diagnosis is often made before or confirmed at the first patient appointment. Open-heart surgery candidates visiting a cardiac surgeon's office for the first time are often shown videos describing the surgery and post-operative recovery. Parents whose children are referred for ear tubes review a booklet about the procedure while waiting to see the otolaryngologist.
10. Bring closure to the visit. A difficult task for many physicians is concluding the conversation with patients. "There are many things to discuss with my patients with whom I've had a 25-year relationship," Honaker notes, "but I've honed my closure skills out of respect for all of my patients' time." Honaker closes his visits by advising the patient that his nurse will be in soon to bring in the contact information for the orthopedist he's referred the patient to, or an educational handout he wants to the patient to have. His nurse can then handle the inevitable patient questions about the number to call for the appointment, and any questions after the patient peruses the educational handouts.

If you find yourself walking around apologizing for the wait all day long, it's time to focus on improving your cycle time. You and your patients will certainly be better for it.

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