Creating a system where each staff member works at the top of his or her license can improve the care a practice provides its patients.
Physician practice owners carry much more responsibility than they did in previous years. In fact, an avalanche of administrative requirements required to succeed, even survive, in healthcare is placing an even greater toll on morale. According to a Medical Economics web poll in December 2013, 41.9% of physicians say that administrative hassles threaten their relationships with patients. And while the challenges have been well documented, the solutions require a new approach to delegation and teamwork, experts say.
“The notion of what it means to lead has shifted. We are moving to a team-based model of care-and it’s not just doctors,” says Andrew Morris-Singer, MD, president and founder of Primary Care Progress, a nonprofit organization that develops leadership practices amongst an interprofessional group of medical professionals. “There are different levels of credentials, expertise and diversity in the doctor’s practice right now. And we never taught physicians how to be on a team and lead a team that’s not all physicians.”
Morris-Singer adds that physicians no longer can have the mentality that they have all of the answers-and this is a good thing. Because of the increased complexity of patient care, especially surrounding chronic disease, it will be important for physicians to build a staff that can manage all areas of a patient’s needs.
The need for appropriate delegation can save a team time. According to a Health Affairs study primary care physicians could save 30 minutes per day by delegating routine functions to staff members. While it’s not a lot of time, it is a start.
“We aren’t able to know the exact answers anymore in terms of care delivery,” he says, adding that different staff members can assist physicians with getting patients to adhere to prescriptions and other guidelines.
“We have to work in a team with a unique, complementary set of skills. This is not substituting the doctor. There’s no one on the team who knows complex diagnoses and can build a therapeutic alliance better than the physician. But that’s not the only thing a patient needs.”
Next: Giving up responsibilities
Physicians who own their own practices must also grapple with billing, coding, staff management and making sure EHRs are accurate. Physicians spend nearly 22% of their time on non-clinical paperwork, according to a 2012 study by Physicians Foundation.
Even when they have staff who handle finances and other aspects of the business, many physician-owners still have a hard time staying out of all areas of the practice.
“It is a trust issue,” says Nancy Brown, CPA, partner and chief financial officer of Think Big Health Care Solutions in Wellington, Florida. “Not delegating makes them inefficient. Appropriate training, delegation and oversight increase their productivity, which helps regulate patient flow and increase revenue.”
There are simply some tasks in the office that physicians should no longer be doing, including managing incoming and outgoing documents, refilling prescriptions, and contacting patients about negative test results. Physicians should also leave financial aspects of the business to practice management professionals, says Laura Palmer, FACMPE, senior industry analyst for the Medical Group Management Association (MGMA).
“Financial discussions with patients are best handled by competent, trained business office staff rather than physicians,” Palmer says. “This allows physicians to focus their attention on the clinical relationship with the patient and maximize their time with them.”
Making sure that all staff members know the importance of everyone else’s positions is paramount. Allowing staff to cross train can help the staff feel more like a team.
“The front desk staff must understand the patient workflow and what the medical assistants do in order to manage the patient flow effectively,” Brown says. “Medical assistants should be able to schedule, check in and check out patients. Front desk staff should be able to handle calls, help with medical supply inventories, handle minor patient portal requests, and route lab results to the appropriate person. The best scenario is to have at least one person in the front who is also a medical assistant.”
Brown also says giving staff tasks based on both their skills and personalities can help discover their untapped abilities.
“Be aware of your employees’ personality traits and give them opportunities to explore tasks that they will naturally have the tendency to succeed in,” Brown says. “If they are very social, patient satisfaction is a great place for them. If they are detail-oriented and like to work on complex problems revenue cycle or workflow analysis would utilize their strengths.”
Not every team building or delegation plan implemented in your practice will work. In fact, figuring out what doesn’t work will lead to a better staff and better patient care.
“This is a very local process, there is no one roadmap,” says Morris-Singer. “Think of it as multiple mini experiments happening at the same time. Have the ability to have a collaborative conversation about the needs of the patient population, evaluate the changing skill set of your team, and give it a shot. Regularly revisit your strategies, build upon what’s working and scrap what’s not working.”
Even when employees who are given new or more complicated tasks make mistakes, it is important to evaluate not just the employee, but the process.
“There can be physical limitations such as typing speed, the number of calls a person can answer or the complexity of the task. Sometimes it’s a matter of time before the person develops enough competency to accomplish the tasks easily and without assistance,” Palmer says. “Not jumping to conclusions and understanding what an employee needs to be successful can be really helpful in creating great relationships with colleagues and achieving practice goals. Investigating the situation will help the administrator determine if the workload is too heavy, the task too difficult, or if the time allotted to complete the task was insufficient.”
Next: The big picture
Once physicians start to trust their existing teams with new tasks, they can begin to focus on long-term strategies that will more thoroughly engage patients. Strategic hiring of new employees, adding ancillary services and marketing the practice to more patients are decisions practice owners can consider when they have more perspective.
Morris-Singer says adding new staff members such as health coaches or community health workers increases patient adherence and continues to help staff work as a team.
“[A health coach] is where the rubber meets the road. It’s a relatively inexpensive new job in healthcare that helps patients understand their conditions, what they can do, and how to access services for care management that may be outside of clinical boundaries,” Morris-Singer says.
He also suggests that practice owners integrate pharmacists into their primary care teams because they offer, “untapped expertise. Pharmacists know about medications, side effects and complications, diet and exercise, and they can help patients access medications at lower costs,” Morris-Singer says.