Changing practices for increased productivity


The four Ss to control production in the practice-style, staffing, systems, and space-if done right, can make a practice run more smoothly. Constraints on a practice can affect its output negatively and should be the focus, rather than resources. Once constraints are identified and eliminated, practices can start increasing their output.

Key Points

San Diego-"Any way you want it, that's the way you need it" may apply to relationships, but letting a physician run his or her practice any way he or she wants it could decrease productivity.

The concept that changing the physician's style increases productivity could be the solution to some practice's problems.

Concepts like this started to develop in the early 1980s at Medical Design International (MDI), Atlanta, where Larry R. Brooks, partner and senior medical planning consultant, puts these theories into practice. At the annual meeting of the American Society of Ophthalmic Administrators, Brooks spoke about "The Four Ss to Control Production in the Practice: Style, Staffing, Systems, and Space," giving physicians a different perspective when designing new practices and changing existing ones.

Taking a different perspective

Various groups measure production differently. For example, Electronic Health Records looks at production based on charge per visit while the Medical Group Management Association looks at income generation.

"Today when you hear the word production, what I am talking about is the MDI definition, which is physician hourly output," Brooks said. "What we have found is if you look at the hourly output of all of the physicians at your practice, at once it's going to tell you a lot about how to design your new facility or how to organize your current one."

The constraints on a practice can affect this output negatively and should be the focus, rather than resources. According to Brooks, the physician should become the constraint that controls production, not other factors.

Practices that realize their productivity is based on the amount of patients seen per hour can start moving forward. Goals such as reaching the net income, which was accomplished by lowering expenses, can now be reached by increasing physician output.


The first step to increasing productivity is figuring out the style of the physician and eliminating what holds him or her back. Brooks gave the example of one physician who always walked patients to the check-out desk because he felt it was a good way to bond with them. However, Brooks found that by not walking every patient to the check-out desk, this physician was able to see two more patients per hour.

Observations like this one can be identified in a time-motion study, which monitors the physician during a 2-hour time block. Watching the physician throughout the day can be used to determine the existing patient volume and help figure out the physician's natural rate of seeing patients. Brooks advises determining an average of 10 2-hour sessions.

The time-motion study findings are divided into three categories: effective time, time that can be delegated, and wasted time. Effective time is time spent doing tasks that only the physician can carry out, such as examining the patient or making calls to other physicians.

"We're not Star Trek so we can't use teleportation, so doctors are going to have to walk from one room to the next, but at the same time you want doctors to be able to come out of the exam room and go straight to the next patient with no downtime," Brooks said. "If you are able to do that then you are maximizing their capacity."

Time that can be delegated to another staff member and wasted time, such as the physician standing in the hallway waiting for a technician, is time that needs to be decreased. Once these data are gathered, figure out methods to increase effective time, according to Brooks.


Next in the process is changing the way the staff works. How well the staff does its job can be just as important when it comes to increasing the natural rate of the physician. The main focus is working with staff members who work directly with the physician, such as check-in clerks and greeters.

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