How to determine whether you need to replace all the staff you have lost during the pandemic and the ‘Great Resignation.’
If your practice is struggling with right-sizing your staffing levels, you are not alone. Patient volume in clinics and ASCs throughout the country is “consistently inconsistent” due to COVID-related cancellations and no-shows. Finding and hiring staff is still difficult, with no definitive return to normal times in sight. And practice administrators are engulfed in the trials of balancing staff levels and patient volumes in a way that allows their practice to make a profit.
Add the expectation of increased patient volumes in 2022 as the post-COVID tide rolls back in, and your practice may find itself in one of two groups: those trying to replace every person and position lost since March 2020, or those remaining flexible as patient volumes fluctuate. Even pre-COVID, we’ve increasingly heard more about resilience at times of disruption during the last few years. But now is an especially good time to re-evaluate your practice’s response to being unexpectedly interrupted with little notice.
As tides shift and many of your employees are new (without old habits to hold on to), there is a great opportunity to set new performance expectations, streamline processes, experiment with new ways for patient appointment scheduling, testing and retinal injection procedures, and staff your practice to cover these services. This applies whether your practice is struggling to see enough patients right now or if your practice is growing exponentially. (In the latter case, you may not need to hire as many employees as you might have needed in the past for a given patient volume, once you have streamlined policies and protocols.)
To make changes like these, you need leadership to inspire staff and doctors to reach for success. It starts with the practice owner(s), administrator and management team. Clearly and specifically communicating the benefits for the employees will motivate them to get back on board as you navigate a post-COVID world. For example, protocol changes that streamline patient flow (and require fewer staff payroll hours) could result in more flexible work schedules or more varied responsibilities for the employees.
Here are seven ways to reframe the way you approach the staffing challenges and adopt data-driven decision-making, which helps improve and support your financial and customer service goals.
1. Collect data
Some EHR reporting abilities are better than others, but all systems should be capable of helping you track basic volumetric data (total and new patients, revenue, expenses, surgeries/procedures/testing counts, staff payroll hours by department, clinic days worked by doctor.)
2. Prepare a monthly report
Using this collected data, look for trends — upward or downward. Compare the data to industry benchmarks (see sample calculations below or a more extensive version in John Pinto’s Little Green Book of Ophthalmology, 6th edition) to see if your practice experience is falling within peer practice norms.
If your practice has metrics that show you are operating outside of some norms, determine why this adverse trendline is happening. It may be that falling outside of norms is acceptable for how you choose to operate your practice, or it could reveal issues that are critical to resolve.
3. Benchmark for knowledge and improvement
Tracking and knowing your practice’s metrics is key to making improvements in your practice or confirms that your overall performance is within norms or better. Even if you are less interested in comparing your practice to other practices, reviewing your performance internally — month-over-month and year-over-year — informs you of any slight changes that may be under the radar.
4. Calculate staffing ratios
Once you have collected the base or primary data, perform derivative calculations to see if your staffing is right-sized, over- or under-staffed compared to your patient volumes. The Table (below) shows some basic calculations and benchmarks.
| STAFFING RATIO | DEFINITION | TYPICAL VALUES |
| Overall lay staffing efficiency | The number of staff-hours per patient visit — average monthly core lay staff payroll hours (omit optical and contact lens staff) divided by average monthly patient visits, inclusive of postops | Wide-ranging from 1.5 to 3.0; typically +/-2.5 in an efficient general practice and +/-2.8 in a retinal practice |
| Tech efficiency ratio | Technician total payroll hours divided by patient visits – include technicians, scribes and testing staff. | About 1.0 in a general practice (can be higher in a practice that delegates more care to lay staff, a practice with trainees or a hub-spoke practice with lots of travel); 1.1 in a pure refractive surgery practice; 1.3 in a retinal practice; often at or under 0.8 in plastics and pediatrics |
| Reception staff efficiency ratio | Reception staff total payroll hours divided by patient visits — include check-in/out staff, call center staff, operators and medical records staff (omit time spent posting charges if this is a front desk task) | About 0.5 — this is highly influenced by the patient mix of the practice and its customer service standards. |
| Patient accounts staff efficiency ratio | Billing department payroll hours (all staff doing posting, charging, collections, etc.) divided by the additive product of the total patient visits and total surgical cases | About 0.3 hours — it takes about 18 minutes of billing staff time per patient visit to handle revenue cycle chores in the typical practice. |
5. Implement change
Determining what you want or need to improve is only the first step. The next steps involve the managers and staff who will be impacted by change. Include them in the process, and respect their feedback. (Even if they don’t agree with the needed changes, having been involved in the process usually overrides any resistance because they understand the motivation and need for change.)
6. Communicating change takes work
The goals must be clear. Share the new goals and processes with all those remotely involved. Hold meetings to review new processes (eg, the new protocol will be X, and this is why we are making changes).
Follow meetings with written communication for further clarity.
7. Follow-up
When you implement change and follow-up on how it is being performed and working out, you are sending the message to your staff that you care about the change and its impact. If follow-up is light or non-existent, that sends a message, too. For successful implementation, you must follow-up consistently and often.
Conclusion
Challenge your practice to embrace the current disruption. Use this time as an opportunity to re-evaluate the way you do things and the staffing you need to perform to the highest level of customer service and patient care. OM
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