Reducing patient wait times and decreasing cost

Decreasing the amount of time a patient spends in the waiting room relies on identifying the bottlenecks in a practice. A bottleneck can be anything from technicians to physicians. The four tools for success given by Brett Gerlach include leveling workloads, pooling resources, eliminating handoffs, and reducing variability. A practice can also control patient flow by figuring out the best way to schedule appointments, by eliminating excessive reservations, and by reducing the types of appointments.

Key Points

San Diego-"I hate the waiting room because it's called the waiting room so there's no chance of not waiting," said Jerry Seinfeld once in a comedy routine, and most patients agree.

Although there is no guarantee that a patient's visit won't be long, there are methods to reduce it. Brett Gerlach, founder and president of Brevium Inc. of South Jordan, UT, illustrated this with his presentation "Understanding and Reducing Patient Wait Times," at the annual meeting of the American Society of Ophthalmic Administrators.

"Paying a consultant to come in and do time studies can cost upward of $30,000 if you have consultants do all of the timing work and all of the analysis," Gerlach continued. "I wanted to offer some shortcuts today that you can use-without formal methods and without expensive time studies-that will allow you to begin to bring your wait times down."

The bottleneck theory

Every practice has a clog in the process that slows things down. Just as a clog in the sink stops the water from going down faster, a clog in the practice prevents patients from seeing the physician faster. This clog or roadblock is called the bottleneck. Finding the bottleneck requires observing the patients to find out what is making them wait. It can be anything from the technicians to equipment, or even the physicians themselves.

"There is one complicating factor and that is that bottlenecks move around because you have variability. Things don't always take an hour or a half an hour," Gerlach said. In that case, Gerlach says to focus on where the bottleneck is most of the time. Technicians or choreographers are a good source go to for the best sense of information.

Four tools for success

Gerlach suggested four tools for eliminating the bottleneck. The first involves leveling workloads, which is a process of evening out the amount of work done at each step. One way to do this is to add a resource, such as hiring another technician or physician.

Leveling can also be accomplished by removing duplicate work.

"If you find, for instance, that your doctors are repeating refractions done by your techs because they aren't done properly, you can fix that by training and some quality control on those refractions, and making sure your techs just always nail it before it goes to the doctor," Gerlach said.

Moving work is another way to even out tasks, such as having a technician do refraction.

"Without timings, moving work is not safe," Gerlach said. "The reason for this is because once you've moved it, it may be that you have just created a worse bottleneck than you've relieved. If you've got a 10-minute task and your doctors take 15 minutes to do a work-up and your techs take 20, if you take that 10-minute task off your tech's plate and put it on your doctor's plate, then suddenly your doctor's taking 25 minutes and your tech's taking 10, and that's a worse situation."

Pooling is the next tool used in this method of time reduction. Gerlach said this can be a very powerful way to see results. Usually there are sets of people who can do the same task, such as technicians.

"If you dedicate a technician to an individual doctor, say you work up only this doctor's patients, you set up a situation like having to stand in one particular line without the ability to move out of that line. But if you have a set of techs that are able to work up the first patient that comes in, as they become available, for any of the doctors, then you've pooled the task, and you're going to reduce the wait times for your technicians," Gerlach said. "However if your bottleneck is not the techs, this is not going to help you."