When speaking on the subject of practice management, I often refer to a truism from the book The Four Disciplines of Execution that says something along the lines of this: more good ideas will exist than the capacity to execute them. It’s likely that many of us have a similar ever-expanding list of practice improvement ideas that we can never seem to find adequate time to explore. Just as no one can escape gravity or the Pareto principle (i.e., the 80/20 rule), consultants are also often the victim of this scenario. As such, though we cannot escape it, we can instead find ways to work around it. The secret—instead of continually stressing over never having time to implement something new, take a moment to pare things down and remember what you already have. Ask yourself, what process, system, technique or strategy currently exists in the practice that would be better off being removed? Putting the focus on what you can eliminate or change, instead of what you can add or expand, can have positive effects.
Open Your Mind
As is the case with nearly any practice improvement idea, start by first considering why you do a certain thing the way you do. Typically, the answer is one of three possibilities.
1. “We’ve always done it that way. The guy I bought the practice from did it that same way, too.”
2. “Everyone else I know of does it this way, so it must be the best way to do it.”
3. “How else would we do it?”
Each task in your office—no matter how small and whether involving patients or not—should be analyzed this way. Given there are approximately 20 million items that could be reviewed, recognize that you could spend several lifetimes attempting to do this and never finish. And, given the rapid rate of change and competition in our industry and the viral spreading of ideas in the digital world, just when you believe you have something solved, it becomes time to revisit it again.
For example, ask yourself why patients have their pretest procedures (like autorefraction, topography and fundus photography) done in Room No. 1. You’d likely agree that all of the three previous answers apply here—and since they do, we should ask why! So, involve your staff. Discuss eliminating or altering something to help avoid the bottleneck in Room No. 1. This does not mean eliminating a procedure like autorefraction—the question was, why are those tests done in Room #1?, not why are they done at all?
With this fix, you are freer to take tests out of Room #1. That might mean something as simple as putting some of the technology in a second available room, if you have the rare luxury of extra space. If not, what about seeing whether some of the technology is available in a portable equivalent that would allow you to move it, instead of the patient?
Or, look into whether an at-home version of the process is available. For example, does your staff ask any history questions in this room as part of the procedure? If so, could they be added to your web site and effectively moved, not only out of Room No. 1, but out of the office entirely? This could mean the difference between seeing 10 patients a day or 12 patients—or more.