You don’t have to accept one built for someone else.

“Seventeen ... seventeen” echoed over the high wooden fence. Curious to see why the group of children were chanting, I found a small hole in the fence to look in ... only to have a finger poke me in the eye. While writhing in pain from this corneal abrasion, the chant shifted to “Eighteen … eighteen!”

This “dad joke” breaks my golden rule about humor at the expense of eye injuries. However, I couldn’t resist since it set up so nicely for the discussion on applying design principles when establishing your clinic.

MY SCHEDULE: IT JUST HAPPENED

On my very first day of work, I had no clue about my schedule. The office just set it up the same way it did for the senior doctor in the practice. Eventually, my schedule became full, and the focus became how to increase the number of patients seen each day. I never questioned this, wanting to fit in with the other doctors in the practice by accepting their schedule. After all, if the other doctors used this schedule, it must have stood the test of time.

I was quietly chanting “Twenty-seven patients ... twenty-seven patients” as volume increased each day. While this resulted in success in terms of numbers, eventually the formula inversely correlated with my satisfaction at work. My lunch time eroded, patients waiting long periods were grumpy when I entered the room and staff had to work late to finish up. My instinct was to point the finger and complain, but I realized it was time to look in the mirror instead, because my schedule impacts my reputation and ability to enjoy practice. Once I had accepted ownership and the need for change, it was time for me to design and build a clinic that reflected my values and style.

PRINCIPLE NO. 1: VALUE FOR THE USER AND PRODUCER

This brings us back to the first principle of design: Optimize function that brings value to both the user and producer. In this case, it meant making a schedule that doesn’t create long wait times before doctor and patient are face to face.

Humans are complex. Some pathology takes more time, and some personalities take even more time. Then there are the emergency patients, additional testing, patients who take a half an hour to fill out check-in forms and other random interruptions. We can never eliminate these issues, but a conscious effort helps. We did studies to see how long it took to see certain types of patients and used the information to create different time allocations for post-ops, pressure checks, new consults and emergencies.

We adjusted with feedback from the entire team. The constant messaging at staff meetings was that none of us wanted patients to wait long, and we did want staff to have time for lunch and end the day at a planned time.

Our drive to optimize scheduling never ends. For example, we recently added emergency Friday spots after noticing we were consistently finishing later than intended heading into the weekend.

PRINCIPLE NO. 2: QUALITY AND EXPERIENCE

Have you ever tried to see what it is like to be a patient in your practice? It is very interesting to sit in your own waiting room for 30 minutes and watch patients check in and wait. Pro tip: Do it on a day patients are seeing other doctors and not you!

This brings us to our second design principle: The created process should focus on quality and total experience. In our practice, we noticed that the low-hanging fruit was to get rid of the stack of new patient forms to fill out at check-in. We started mailing the forms before the first appointment, asking patients to bring the completed forms with them.

Another initiative was to have the provider see the patient only once each visit and avoid a “two-pass” exam. Add-on testing was the culprit. Thus, providers now schedule all testing when they schedule the patient for the follow-up appointment; for new patients, the technicians consult with the provider if they have any concerns for potential additional testing. This allows the doctor to see the patient once and have all necessary information for decision-making. The more consistent flow reduced stress for staff and patients.

PRINCIPLE NO. 3: A FOCUS ON PATIENT OUTCOMES

Sometimes getting busier can force you to re-invent the clinic. Recently, our practice was seeing a significant increase in cataract evaluations — a great problem to have, but we noticed it was also increasing stress within the clinic. Brief IOP checks were experiencing long wait times if a cataract consult had a lot of questions, and the provider was stressed because the staff was not consistent in testing for a cataract evaluation, thanks to the multitasking they were required to do for the wide variety of patients in the clinic — which stressed staff as well.

Applying the third design principle saved the day. That is, make certain the process works for the patient and focus all outcomes for the end user. This principle led us to create a pilot separate cataract consult clinic that began as 2 hours once a week. We micromanaged each piece of the patient experience: communication at each step, testing protocols and how to stay on time. It took several weeks to smooth out rough spots, but patients’ expectations for the visit were met in the end. The clinic ran on time, and the doctor could enter the room knowing that all necessary testing for decision-making was already complete. This led to an increase in happy cataract patients and an even greater increase in cataract surgery volume.

The more you work on improving your clinic, the more you want to work on your clinic. It is amazing how much time many providers spend planning a vacation — researching highly rated hotels, restaurants, day-trip excursions — but do not spend the same amount of time planning how they work. Many people go on vacation but also complain that they are so busy they don’t have time for lunch or don’t understand why staff turnover is high. Take the same energy you spend planning a trip and plan your clinic.

PRINCIPLE NO. 4: BUILD ON MOMENTUM

The fourth principle is to use your own positive experiences to create meaningful change. As you experiment with change and see the impact on your patients, staff and your own job satisfaction, continue to build on this success and let it snowball.

Fear of missing out is why the guy in that bad joke I started the column with looked through the hole ... and of course led to a poke to his cornea. It is instinctive to focus on adapting day to day but zooming out for a big-picture overhaul will rebalance priorities and positively impact staff, patients and the practice. Using design principles for a clinic reboot serves as the guide to creating practice growth and job satisfaction within the practice. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.
Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.