Original Publish Date: January 14, 2020
Peyton Manning made the 'OMAHA!' trigger word famous to let his lineman and team know that something was changing. Wouldn’t it be great if before every patient exam the doctor could calI a set of signals to get everyone lined up right? If every morning were exactly the same and patients came to the office in a neat and orderly fashion running a medical practice would be easy and you would not need to choreograph the patient flow dance. Unfortunately, patients do not present with the same symptoms, problem list, medications or fit neatly into the schedule slots. The reality is patients come in all sizes, shapes, variety, and sometimes they present with emergencies. The practice has many exam rooms, ancillary services, employees of various skill sets. Some days staff are on vacation, sick or tied up with other duties. Practices have many variables working in them hourly. How do you organize a busy, complex practice for maximum efficiency? Sometimes we need to look to other organizations for ideas on how daily duties are organized.
Hospital nursing staffs meet for morning or shift report to share information and to plan assignments. Police departments meet prior to hitting the beat to discuss assignments and special issues. If you turn on your television on any Saturday or Sunday afternoon from September thru January you see a management organizational tool in the form of a huddle. Then you watch an organized line up known as a formation with every player knowing their assignment.
In football the purpose of a huddle, offensive or defensive, is for a coach to relay a play to the 11 individual players that must combine their individual movements into one that accomplishes the desired result. A coach, after assessing the down, field position, score, wind, the unknown variables that the other team will employ sends in the directions (a play).
Other business’ use Monday morning executive meetings for short check ins of important objectives for the week. One way to make the team accountable is to ask each team member for the 3 priorities they have for the day or the week and then adjust accordingly.
A busy practice will review patient laboratory data, test results, or issues before the patient’s scheduled visit. The team is prepared for the expected lab and test results that the physician may need based on the anticipated patient visit.
Many practices have added a different tool, start every day with a morning huddle or on a particularly bad day-call a ‘time out’. The time out is a powerful tool that can help staff get re-organized, take a chaotic day and turn it into a winning day. The time out is not used as much as it can be because physicians and the team get so swept up by the ‘wave’ that they lose sight of how to get back on track.
Every morning schedule a staff meeting of 10 minutes or less that includes the physician, front desk staff, physician’s nurse, nurse practitioner or medical assistant. If possible, include the office manager, medical records, lab or radiology staff. The agenda should consist of a review of the patient schedule for the day, any unique directions should be given to the appropriate staff, clinically challenging patient charts should be reviewed by the physician and medical assistant/nurse. Orders for diagnostic tests should be prepared and front desk and appropriate personnel should be notified to direct the patient to the necessary department’s exam rooms, etc as soon as the patient arrives. Review the staffing needs for the day taking into account patient volume, staff vacations and illness. Finally, the schedule templates for the day should be adjusted based on the anticipated needs of any difficult patients.
This is not a meeting to discuss strategy or practice issues, only to discuss that day’s schedule, staff and clinical issues specific to that day’s patients.
The initial morning huddles will take longer than 10 to 15 minutes. It is critical that the coach (physician) put a play clock on the morning huddle to require staff organization and crisp communications. Expect that it will take up to 4 weeks for staff to understand the information needed to complete the ‘huddle’ in 10 minutes. Require staff (this includes the physician) to be on time and ready to go at the scheduled report start time. It is critical that the early meetings are mandatory and are not cancelled for any reason. Staff and physicians must understand that this is not a feel-good exercise but a part of the practice operations. Issues, reports, changes must be crisp and detailed. Assignments made clear.
How does a busy physician find 10 minutes (one patient slot) in an already busy day to be able to huddle up? A practice that is well organized will find that the 10 minute investment will actually open up more patient slots and become more efficient, less stressful and more profitable. Staff and physicians survive planned emergencies much easier than unprepared emergencies. Over time staff will learn how the physician and their teammates respond to certain situations and will be able to adjust with much less stress.
It is vital that leaders remember that success is about great execution. Execution requires good fundamental blocking and tackling, if you do the little things right staff and patients will notice.
37, 88 OMAHA!, Hut, Hut….Go!….Go! Clap!
In 1999 Tom had the opportunity to start Medic Management Group LLC. formerly known as (SS&G Healthcare Services LLC.). Medic Management Group is a Consulting and Management Services Organization specializing in physician practices and healthcare issues. Medic Management Group LLC. is the leading provider of management, billing and consulting services to physicians. Medic Management Group LLC works with clients in 26 states and manages over 3,000 physicians. Medic Management Group LLC consists of 150 of the best physician practice specialists. Visit the Medic Management Group LLC web site at www.medicmgmt.com