As your office count grows, one of the costs that most frequently grows out of control is employee costs. This happens for 2 reasons. The first is that poor information and scheduling strategy leads to a disorganized schedule, confused staff and patients and spiraling costs.
The second is that adding staff seems like an easy, quick way to solve a particular problem, especially a problem that relates to your patient and office volume increase. The thought process goes along these lines: “With one office, I didn’t need a person to handle [function x], but with 10, I’ll need someone full time to do that.” So, for doing the financial accounting, you add an extra person. For handling the marketing, add a person. Tech support? Need a body. And so on. We’ll deal with this issue in our next post.
Here is how you keep your schedule and staff organized to keep that cost under control.
Group your staff
Try to think of staff in terms of teams that will work the same 2-3 offices. This is usually pretty easy because certain staff will live in closer proximity to certain offices than others. Having regular staff creates a consistent experience for the patients and enables you to deal with the day-to-day issues more effectively. For example, let’s say that a deposit goes missing. You don’t need to go to a report or flip through a schedule to find the right people with whom to speak. You know who works that office and who should be responsible.
Some practices have designated an “A team” that moves among all offices. That team only works in the offices on new patient days. They tend to be experienced, sales oriented and familiar with your way of doing business. The logic here is clear: new patients are absolutely vital to the life of your business. With an “A team” you always have your best people working those days which enhances your rate of success. This adds a bit of complexity to the scheduling process and may be disconcerting to patients, especially if they see certain staff members on one day and never see them again, but this has proven to be quite effective in improving batting averages and patient satisfaction.
Organize your schedule into blocks
In a normal, one practice environment, someone was generally always at that office. If a patient wanted to be seen on a given day, it was generally no problem. Staff was available. You were available. Even if you weren’t planning to have a full patient day, if a few people wanted to be seen on a particular day, it was no problem. Now, it is a problem because no one may be in that office on that day – and will possibly be in an office far away-- so you can no longer have days with 5 patients seen. You have to have the schedule well organized so that you have a minimum number of patients on a given day. AND you do want to make sure you schedule the new office for no more days than are necessary to see the existing patient base. You simply no longer have the idle time available to have a sloppy schedule or have things run slow.
On the surface, this may appear to create inconvenience for the patients in 2 ways. First, the number of days available to be seen becomes much more limited. If you are open 6 days in a month, that patient only has those 6 days from which to choose. Second, limited days means limited availability of those coveted afternoon and early evening appointments. For the first problem, if your system is very organized and electronic, you may be able to offer the patient the opportunity to be seen in another office if that patient is willing to go a little farther away (while transfers may cause controversy, one off patient moves like this generally do not). That actually adds convenience for them by opening up a greater range of days and times than in a one-office model. Absent that, if you have an office open 6 days in a month, varying which days of the week the office runs should create a time convenient to the patient.
For the second problem, our policy has always been that a patient has to schedule at least 1/3 of his or her appointments in the morning. That simply makes everything fair for everyone. Obviously, some people will have extenuating circumstances that prevent this, but the majority can usually work within that framework.
Schedule from new patient days out
When you draft your schedule, start with new patient days. As we’ve discussed earlier, choose Tuesdays through Thursdays and try not to pick days just before or just after major holidays. You want to pick days when people are into their normal routines and not trying to play catch up. Then, fill in with the regular production days while accounting for potential travel from staff.
If you have a remote location requiring you or staff people to travel and employ overnight lodging, try to group the days together to minimize travel time. Then consider trying to add a new office nearby to enable you to build a non-traveling staff/doctor combination there.
Staff according to your volume
One mistake I see a lot – and it’s one that we made in the past – is that practices staff offices in anticipation of future growth or put a full staff in place with no starting patient base. The argument is that this allows the staff to gel and develop skills with a smaller patient base so that they are skilled when the patient base grows. Fair point, but one that adds cost far and above the benefit you might receive from this early staffing.
Yes, there might be some hiccups if you add staff on the fly as volume grows, but those are usually temporary. Start small, save the money and hire only when necessary. How do you when is the right time to hire? Check out the next section.
Monitor results
Am I going to shut up about this? No. Important decisions like staffing hinge on good information telling you when to hire and when to change your schedule. You don’t add staff only when people complain that they are working too hard. That tends to be an emotional response. You want to make that decision based on good information. If I can see x patients per day with 3 staff, how many can I see with 4? Do I have enough patients to add that fourth clinican or can I just open up another day and work with the people I have? Quality data helps you to find the answer.
On top of that, quality, timely info doesn’t just allow to keep track of who is doing what and where, but also to give you information to make future decisions. You hear a lot these days about “Big Data.” Well this gives you the data you need to do the type of analysis that sets you apart from your competitors. You can answer questions like “Which team has the best show up rate” to “which day of the week produces the best batting average.” Yes, a lot of this might seem like minutiae, but these are the types of details that historically separate OK practices from ones that are wildly successful.
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