"4-S Production Chain"
Style
A physician’s style is determined by the physician’s personality, the way he or she was trained, and how he or
she wants to practice medicine. Too many practices try to change their style rather than identify it. At Practice
Setup we help identify each physician’s style and then organize the other links in the production chain to help
the physician maximize his/her “Natural Style.” To understand the production characteristics of a physician’s style,
Practice Setup, by working with each physician, learns to understand how the physician’s time is consumed while
seeing patients and whether this time is:
- Doctor Time – Time consumed by functions only the physician can perform.
- Down Time – Time consumed for no productive benefit, such as not having a patient ready to see.
- Delegate Time – Time consumed by functions that could be delegated to a staff member.
The physician’s “Natural Rate” is the rate in which he/she would see patients if down time were eliminated and
the physician effectively delegated all the delegable tasks he/she currently does. This would mean all the time
left in the physician’s day was effectively practicing medicine. Knowing this rate, it’s possible to design the
rest of the “4-S Production Chain.”
Staffing
Staffing is typically a touchy subject in a medical practice. So many articles have been written about the
correct number of staff, how overhead must be managed, and how staff salary is the highest line item making up
the overhead. But at the same time, if physicians do not have staff available to whom they can delegate tasks,
they will have to perform those tasks, causing their patient volume/revenue to suffer. When trying to determine
whether or not an additional staff member is needed, look not only at what that staff member does to the overhead
line on the financial statement, but also look at what that staff member could do to the revenue line in terms of
time they free up for the physician to be more productive and see more patients. Remember, the only line of that
financial statement that truly matters is the net line. The second part of the staffing model is the job functions
assigned to the staff. A general rule must be followed: “The staff’s number one priority is to always have the next
patient ready to see.” For the staff to be successful at this, the practice needs to give them the proper duties
and systems. For instance, if the same tech is responsible for loading the physician’s exam rooms and scheduling
procedures, that staff member’s job functions are setting him/her up to fail. He/she will get tied up scheduling
and not be able to keep the rooms full. Or if the receptionist has to check patients in as well as answer the
phone and make phone appointments, he/she is set up to fail at one of the tasks because no one can successfully
do both at the exact same time.
Systems
There are many “systems” in a medical office, but the two that seem to most impact the physician’s ability to
be effective and productive are the patient flow system and the communication system. Patient flow seems simple:
just allow patients to stay oriented in the facility, ensuring the ability to self-exit so the staff and physicians
do not have to escort them out. This is much simpler said than done, but when good patient flow is achieved, it can
be a huge benefit both in terms of time savings and increased production of the physician and staff.
The key to achieving this is to use a person’s natural instinct of wanting to exit a facility the same way they
entered. This means organizing and decorating the path the patient is escorted along from the waiting room so it is
memorable. Having this path pass the checkout counter means the patient will naturally get to where the practice
wants them to get after the exam without consuming the physician’s or staff’s time escorting them. The communication
systems of an office are the other major wasteful time consumer. Instead of using the patient’s encounter form,
printers, light signaling systems, and computer network to communicate, many practices are still using the
“sneaker network.” This outdated mode of communication requires a physician or staffer to find the intended
recipient of information to convey that information or give instructions. The staffer achieves no beneficial
productive task while walking. Review any communication that currently requires you or your staff to walk and/or
verbally transmit information or instructions to see if there is a non-verbal way to accomplish the same task.
This will allow the physicians and staff to be more productive and reduce the commotion of the office.
Space
Last but not least, the spatial requirements of the physician must be determined. This is often the first thing
practices look at. But without first determining the physician’s style and how he/she likes to practice, how many
staff will be required, and the systems that bind the practice together, it is impossible to determine the correct
amount and layout of space. Again, the patient per hour rate of the physician determines the spatial need.
For instance, the physician that delegates what he/she can to staff, uses scribes in the exam process to note
the chart, and sees probably in the range of eight to 10 patients each hour will need more space than the physician
that does not delegate well, manages the chart him/herself, and only sees in the range of four to five patients
each hour. The style of the physician determines the way the spaces get allocated and arranged. For instance,
do you like to mix your procedure patients and regular exam patients during the same clinical session and therefore
need exam and procedure rooms in the same exam module? Or do you schedule procedure-only sessions and therefore
need a minor procedure area separate from clinical exam modules your partners may be using?
—Kevin Smith, Section Editor, Business Advisor