It’s been about 3 months since I started focusing on my efficiency in my practice. I’m currently in the middle of collecting data on the length of time each step of a patient’s visit takes in clinic so we can optimize our patient flow (aka value stream mapping). In the meantime, I’ve made some minor changes in my own work habits that have helped me manage the increased patient volume I’m seeing as my practice grows - about a 25% increase over the last year. Despite this increased volume, I actually typically leave the office earlier with my work complete compared to a year ago. Here are the 7 changes I’ve made that have helped the most:
- Go in early
It seems counterintuitive since the initial change is adding more time to the workday upfront, but I’ve found it significantly easier to manage my administrative tasks by having around 30 minutes before clinic to work without interruption. Since I’m typically the only person in the office during this time, there are no distractions. Additionally, I find that I work more efficiently at this time of day and find it easier to focus compared to after a day of 50 patient exams. Lastly, and probably most importantly - I know I will have time to complete these tasks (emails, pre-operative orders, etc) instead of finding myself at 5pm deciding whether to push through and get these tasks done as quickly as possible or leave on time. All in all, my total time spent on these care-adjacent jobs is less when I get them done before clinic starts.
2. Document in the patient room
I previously held the belief that documenting in front of the patient was slower than writing my notes as a batch when I hit a lull in clinic. Then, my volume has increased such that there aren’t that many lulls in clinic (which is how it should be). While I’ve always had a good memory, writing 5-6 notes after seeing a set of patients is a whole lot different than finishing a day and trying to remember all the details of 30+ unsigned encounters.
I’ve also realized that I repeated a lot of work every time I wrote a note after the patient left. When I went to sign the reports on their ancillary testing, I had to review the tests again to remind myself the details to report. When I wrote my plan, I often needed to recheck a part of the exam that I had written and knew while I was in the room. Documenting after the exam may have gotten the patient out of the room faster, but it was increasing my total amount of time working in the chart. The key is to do the work once, finish the note in the room, and document completely and efficiently to not hold up clinic flow. While this is easier said than done, I have improved my ability to do so with practice and repetition.
3. Avoid context switching
As a fellow, I covered multiple attendings’ inbaskets while managing the flow of busy surgical days and seeing urgent patients between cases. My multitasking abilities kept me from having a seemingly unending list of patient phone calls and questions to manage at the end of the day. Carrying this forward into my attending practice, I felt the need to look into any inbasket message that popped up immediately as I saw the notifications. I’ve seen now that allowing this habit to interrupt my workflow leads to delays more than it saves work at the end of the day. While some messages like refill requests were things I could easily complete in a few seconds, others led me to dive through a patient’s chart to read their last note, decide answering the message would take too long, and turn it back to unread to attend to later - therefore costing time and effort without production. When we are constantly switching contexts, we also lose efficiency from the time spent refocusing on the task at hand.
My current practice with the inbasket is to avoid opening it unless I have an obvious block of time without patients to see or clinic notes to complete. If this hasn’t happened by mid-day, I will at the latest attend to it at lunch. I do find it helpful to to avoid leaving it all to the end of the day as some messages may warrant a same-day appointment for the patient which can be arranged if noted earlier in the day. Other messages may be easier to handle if a callback can be delegated to someone else in the office - obviously harder to achieve if you don’t read the message until clinic is over and everyone has left for the day. Attending to these messages when I actually had time instead of fervently multi-tasking through the day has reduced distractions and protected my workflow while still avoiding a pile of tasks at the end of the day.
4. Eat the frog.
Mark Twain once said "If you have to eat a live frog, do it first thing in the morning. And if you have to eat two frogs, eat the biggest one first.” While procrastinating is it’s own entire subject in the realm of efficiency, I found this message most helpful when it comes to difficult patient encounters. Any time I had a patient who was not doing well despite my best efforts, I would find myself logging into a computer outside the room and checking the technician note before I entered. How unhappy did they sound in the HPI? What was their vision - had it improved? There are multiple problems here: First, I was always still going to walk in and ask the patient how they were doing, repeating this step that I’m doing by previewing the chart. Second, I’m going to make assumptions about how unhappy they may be from reading what the technician wrote instead of hearing it from the patient. Finally, it adds to the anxiety of the situation by convincing yourself you need to do extra preparation before seeing the patient. Entering the room and facing the encounter head on avoids the unnecessary time spent considering how the encounter might go, and leads to a more natural interaction when you hear the patient’s concerns directly from the source.
The Roman philosopher Seneca noted that “we suffer more in imagination than in reality.” It’s easy to convince yourself that seeing an unhappy patient will be a traumatic event, when in fact what we tell ourselves may happen is typically far worse than how the encounter actually goes. Tackling what we perceive to be most difficult right away avoids time spent worrying, and leads to downhill momentum when that task is behind us.
5. Utilize focus modes on your phone.
Who among us hasn’t used a lull in clinic to read the news, check social media, or find any number of distractions available on their smartphone? Smartphones are helpful tools that are also designed to be exceptionally good at grabbing and holding your attention. If you find yourself falling into these distractions easily, it’s important to use the available features to keep yourself focused.
Creating a focus mode for work allows you to change what apps you see on your home screen, and even block certain apps for use. With practice and consistency, the default to scroll during moments of downtime will fade as well.
6. Remind yourself of your goals.
When I returned to work after my paternity leave, I set a goal for clinic days - leaving at 4:30pm with my notes complete. While I previously had typically finished my last patient encounter around 4:15, I usually spent an hour finishing notes and attending to other administrative tasks after the patients were gone. Having a clear goal in mind made it easier to handle my administrative tasks before clinic started, write more efficient notes in the room with the patient, and avoid distractions during the day. I will give a disclaimer that it takes a balanced mindset to work toward a productivity goal like this while preventing it from affecting patient care. Some days that goal won’t be achieved, and that’s okay. Some patient visits take longer, and need more time than one would have expected. Accepting that the productivity goal comes second to patient care is vital. As long as that concept remains your foundation, I’ve found that having a goal provides motivation to cut time waste in activities that don’t provide any value.
7. Discuss your productivity goals with your staff.
I think it’s important to involve your staff in any productivity endeavors you undertake. Here the goals should be less personal and more altruistic. Improving efficiency helps reduce patient wait times, improve the patient experience, and helps everyone feel productive. Rather than letting your staff know you want to leave on time, the key here is letting them know you value improvements to the office workflow. When I started my value stream data collection, our technicians were excited to take part. The same frustrations we feel as physicians with inefficiencies and delays are felt by all staff. Empowering all team members with a combined goal of improving our workflow, and therefore our work day, lets them know that we value everyone’s time. Our staff have come up with several improvements to their workflow just by starting this discussion that I would never have thought of myself.
Small changes to your work habits can pay big dividends when it comes to your time. Putting yourself in position to work with minimal distraction, facing your toughest tasks head on, and being vocal about your goals with yourself and your staff will put you in the right track to efficient patient care.