How to Make Routine Work for You in Practice

Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

In last week's Practice Perfect, I compared the concepts of routine and variety in medical practice. I find this topic so exciting, I just had to write a bit more about it. This time, I’d like to take a moment and – for those of you convinced routine can be an advantage – suggest a method to successfully bring routine into your daily practice. By doing so, you’ll improve practice efficiency, profitability, and make your life that much easier.

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Observe and Choose

Take a step back and watch your practice from an observer’s viewpoint. Survey the day to day occurrences of your office or clinic. Look specifically at those procedures that are performed repeatedly several times throughout the day. You’ll find that many, if not most, of the processes to run a clinic are repetitive. Examples include answering phones and making appointments, checking patients in and out, rooming patients, in office surgical procedure set ups, the procedures themselves, surgical scheduling, and taking radiographs, among others. These repetitive processes done poorly are often where an office will lose its productivity.

Additionally, look honestly at those areas where your office seems to have problems. Do your patients sit in the waiting room too long, in spite of having the available rooms? Do you have to repeatedly leave your room to look for supplies or office staff? How many times do you need to de-glove and re-glove when seeing a patient? Have your postoperative patients’ dressings been removed and radiographs taken before you see them? These areas, among many others, represent potentially lost time and productivity.

Once you’ve taken a jaundiced eye to your practice methods, choose one single process with which to start. Avoid a shotgun approach that has you changing everything in your practice at one time. You’ll overload both yourself and your office staff. Go through this with one procedure and use what you learn to create a template to make further changes down the road. Remember, office staff handle gradual changes better than rapid ones — it’s human nature.

Create the routine

The next step is to create the actual routine. How do you actually want the particular procedure to occur? Let’s take rooming a patient as an example. In my hypothetical office, my assistant simply sits the patient down in the room, tells the patient the doctor will be right with them and then closes the door. I’ve become frustrated, because I have to gather the patient’s past medical history and wait for them to take off their shoes. I want these things completed before I walk into the room. My improved hypothetical routine might be the following:

Bring patient to room.
Obtain vital signs (BP, height, weight temperature). Document on intake form.
Ask patient to sit in chair and remove both shoes and socks. Assist them if needed.
Obtain the following information from the patient: chief complaint, medical history, allergies, medications, surgical history. Document on intake form.
Tell patient the doctor will be right in.

This humble list of only 5 steps will decrease your room time (you no longer have to wait for the patient to doff his shoes), and you’ll start with more information. You’ll now spend less time in the room, increasing efficiency, and provide better patient care, since you can take that saved time and invest it in your patient. As your staff becomes increasingly experienced you may trust them with more steps and autonomy.

Institute the Routine

This is perhaps the most difficult part. The key to successful implementation of any new policy or procedure is communication with the staff. The first step is to add your new procedure in the appropriate section of your office staff manual. If you don’t have one of these, you should. Next, review the new procedure with all of your staff at the appropriate time. Take adequate time, either before or after patient hours (not in the middle of a busy day) to review the procedure. Demonstrate exactly how you want it done. Ask the staff to demonstrate the procedure so you can evaluate their proficiency. Ask for their input and suggestions and listen to those suggestions. Make this a positive experience, reinforcing the team, rather than making it seem mandated from above. Once your staff is proficient, have them start using the new protocol during patient encounters.

Follow-up and Analyze

The final step in any new procedure is follow-up. If you don’t do this part, your staff is likely to fall back to the old methods. Observe how your staff performs the new protocol. When not performed correctly, make respectful suggestions and corrections. Remember, do this individually with your staff. Never correct them in front of your patients. Respect is key. Over time the new procedure will become routine, and you’ll have to make minimal corrections. Finally, whenever possible, track the performance of your new protocol. Are you actually spending less time in the patient room? Are your patients’ waiting room times truly shorter? Is your procedure tray set up and ready to go at all times? Analysis requires thought and effort, but will assist you greatly in the long run.

Some procedures, especially those that are more complex or requiring many steps, may need to be modified based on their performance. Don’t be disheartened if a new routine doesn’t work as well as you hoped. Consider it carefully, figure out where the problems are, and make the necessary changes. As you institute increasing numbers of protocols, you’ll find your practice runs like a well-oiled machine. You’ll be more productive and profitable. You may also find routineization works well in the operating room or on hospital rounds. The opportunities to increase efficiency through routine are never ending!

Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum. Best wishes.

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Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]