American College of Physicians: Internal Medicine — Doctors for Adults ®

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Is your practice operating efficiently?

From the May 1997 ACP Observer, copyright © 1997 by the American College of Physicians.

By Deborah Gesensway

Since time is money, several hundred internists investigated how to get a little more of both through a full day pre-Session course devoted to improving their practices' efficiency.

During the course, a team from the Boston-based Institute for Healthcare Improvement laid out a series of strategies physicians can use to reduce delays in getting appointments and the time patients spend waiting on the telephone or in the exam room.

The problem of inefficiency is not just one of physician frustration and lost income, explained Charles M. Kilo, ACP Member, an internist and infectious diseases expert at the Institute. It's also one of patient satisfaction and health improvement.

For example, he said, it is unacceptable to tell patients who request a same-day appointment that the first opening is 10 days off or that the first slot available for a routine appointment requires a two to three week wait.

Instead, practices can make changes by understanding how "bottlenecks" slow their systems and putting in place strategies that have worked for other group practices and hospitals. The Institute last year worked with more than 20 groups and hospitals on a special project to reduce delays and waiting times.

For instance, explained statistician Thomas W. Nolan, PhD, understanding how queues affect waiting time explains why tiny changes can have huge effects when you're operating at close to capacity. A common example has to do with telephone calls; how long patients wait on hold depends on individual factors like the number of calls a receptionist can handle in an hour.

"The positive side is that you can make small changes and have an impact," Dr. Nolan said. If you can shave 10 seconds off each phone call or make it necessary for one less person to call the office, the amount of time patients spend on hold will drop dramatically.

One strategy for improving efficiency is matching capacity to demand. Physicians need to know where a process bogs down and identify the bottleneck. "The capacity of a system is determined by the constraint in the system," Dr. Nolan said. If the doctor is the constraint-because the office cannot do more than that doctor can do in the set amount of time-the answer is taking away tasks from the physician that can be done by somebody else. "Don't have him doing anything that somebody else can do," he said.

"The Reducing Delays and Waiting Times Guide," published by the Institute for Healthcare Improvement is available for $49.95. Information: 617-754-4800.

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