Optimizing your greatest asset: Your time

April 23, 2010

Patients want it, you can bill for it, but you can't store it. It's your time.

Key Points

Patients want it, you can bill for it, but you can't store it. It's your time-your most important asset. Not only is time important for your personal well-being, but wasted time can mean wasted money. Fortunately, you have more control over your time than you realize, but if you don't protect your time, nobody else will.

If you never seem to have enough time, try these tips to use it more efficiently:

Review your schedule. Open each day with a review of the schedule, involving your staff to elicit their feedback and carry out any needed changes right away. Look for anomalies in the schedule-the overbooked patient who is always late to his appointments; the guardian who called to discuss behavior or school problems and needs a bit more time; the child with special needs who requires a larger room to accommodate a wheelchair.

Start the day on time. Make sure your staff has the exam rooms ready the day before. Initiate a checklist for the start of the day to ensure that your workspace is ready. If office hours start at 8 a.m., schedule your first patient at 7:45 a.m. Otherwise, the 15 minutes that it takes for the patient to proceed through greeting, registration, and clinical intake mean you're behind from the moment you start the day. The first appointment of the afternoon is an equally important opportunity. If you're concerned about patients' perceptions about actually being seen at 7:45-they know it's often 8:00 a.m. or 8:15 a.m.-give appointment times for "Dr. Jones' care team" or "your arrival time" to manage expectations.

Set the agenda. To avoid being trapped by a patient's, "Oh, by the way, Doctor...." at the conclusion of the appointment, set an agenda for the visit at the beginning. Have your nurse find out the patient's priorities for the appointment as part of the rooming process. After introducing yourself, listen to the patient. Repeat their words back to them. Make a statement such as, "That's what we're going to focus on during today's visit. Is there anything else you wanted to discuss?" That way, you'll get the patient's needs on the table.

If the patient brings up another issue for discussion at the end of the visit and you don't have time to address it, acknowledge and deflect the issue for the future by saying, "Ms. Smith, I would like to have enough time to discuss the important issue that you are raising. I'd like to schedule you to come in next week, but I'm glad we had a chance to talk about X, Y, and Z today."

Don't batch work. Intuitively, it seems like a better use of your time to ignore your messages until the end of the day and just focus on patient care. The challenge with this strategy is that patients often call back if they haven't received a return call within three or four hours. Your staff will have to handle these increasingly frustrated callers. Plus, when a nurse walks into a stack of 30 e-mails or charts to do in the mornings, rooming your first patient will certainly be delayed-and that's an easy way to burn out a good nurse.

Build extra time into your schedule for returning calls. Don't let an hour go by without checking messages. Alternately, see three patients and then use every fourth encounter as time to handle messages. If your staff needs you sooner, have them put the message on a red form or clipboard to alert you of the urgency of the matter. Having a written communication system means that staff won't have to stand there waiting for you and can continue to get their work done.