Retina clinic scheduling is most assuredly in a world of its own. Retina patients typically spend longer times in the clinic than other kinds of eye care patients, which means retina schedulers juggle more lanes and larger numbers of patients actually in their clinic during any given time slot. Schedulers must also build in waiting periods to accommodate dilations, which happen more often in retina practices. To make things even more complicated, most retina clinics must overbook at least a little to account for no-shows, which happen more often because retina patients are sicker and more complicated than the general population of eye care patients.
“There is no magic scheduling formula in retina,” practice administrator Ashely Villegas COE, OCS told AAO 2017 attendees. The goal is to “create as much predictability as you can” with this 4-step retina clinic scheduling and staffing plan.
1. Understand What’s Really Happening Now
If you’re using only the time estimates that doctors and techs provide to assess your retina clinic scheduling reality, you’re likely working with an overbooked, unrealistic schedule that leaves patients waiting too long and that bleeds into breaks, lunch times, and late afternoons. It’s just human nature to underestimate the time it really takes to do the tasks we do every day.
To understand how time really works in your retina clinic, you need to stand in the hallway for a few days with a clicker and a notebook. Later, add a little bit of time to the average encounter times you observe because “clinicians always move a little faster” when they see you standing there with the clicker, Villegas explains.
Assess physician work flow first. “Everything begins and ends with the doctors,” explains Villegas. “They are the pacesetters.” Using your clicker, measure how many patients they actually see in an hour–not how many they say they can see.
Tip: When it comes to physician workflow, one size doesn’t fit all, Villegas stresses. She has three retina doctors in her clinic, and all need different schedules.
Once you understand the doctors’ work flow, assess task times for the techs who support them. In addition to your own observations with your clicker, billing reports and EHR data on clinic wait times provide a snapshot of what’s really going on at your clinic.
With these data in hand, build scheduling templates for each kind of clinic time—for example, new patient enounters, injection clinics, laser clinics. Note that encounters that are part of clinical research studies will need extra time and staff built into the template.
2. Assess Your Space
Time isn’t the only thing affecting your retina clinic scheduling. You must also think about the time it takes for clinicians to get from one room to another and whether you’re using your clinic’s rooms optimally. The unavailability of rooms could be part of what’s gumming up your schedule.
Bright Idea: Do you have a room where you keep your Christmas tree and other seasonal decorations? (Most practices do.) If it’s in your clinic area, think about storing that stuff out of the way so you can use that room for diagnostic tests or waiting.
3. Understand That More Staff Isn’t Always the Answer
Exhausted all your retina clinic scheduling solutions and still find your practice shorthanded and stressed? Adding a brand new staff member isn’t always the answer, especially if your staffing levels are close to industry benchmarks. If the new staffer you’re thinking about hiring is entry-level, you probably won’t get the full scheduling boost you need because newbies aren’t as effective as good, seasoned techs.
Before you hire, look at the tech time data you’ve gathered. Is there someone who’s so inefficient that you need to coach them or even let them go? Are there training opportunities for slower, less effective staff? Can your most efficient and effective staff serve as team leads or mentors? Ask yourself, “Who can I build a team with in each department?” advises Villegas. Build those people up and give them career incentives to train and coach their peers.
Written protocols can help less experienced staff work more efficiently and effectively, says Jane T. Shuman, COT, COE, OCS, CMSS, president and founder of Eyetechs. Checklists can help techs systemize their workups and quickly remember what they may have forgotten.
Look closely at which technicians are doing new patient workups, suggests These encounters are more difficult and time-intensive, so it’s best to schedule them with your best, most experienced techs. Schedule shorter, simpler established patients with your less experienced techs.
You should also look for cross-training opportunities among your staff, Villegas adds. Cross-training allows staff to step in for one another “on those days when everyone’s out with the flu.” It helps staff be more effective overall because they understand how each task ties together in your practice.
Villegas often uses the summers to train and cross train. She hires students to do the simpler tasks in the practice so that full-time staff have a little leeway to train and cross train.
4. Build Your Bench
If your retina practice is growing and your moving your A-players into higher-level positions, you need to replenish your entry-level ranks to prevent staffing shortages in the future.
Most practice administrators are always on the lookout for cheap, undeveloped talent. Most look for innate traits first. You can’t teach qualities like natural customer-service savvy or the ability to be a team player, but you can train new hires on particular skills once they’re on the job.
How do you recognize the behavorial qualities you’re looking for? Interview entry-level candidates in groups and assign group tasks so that you can observe their behavior and idenify team players, Villegas suggests. She also recommends partnering with internships at local community colleges. You can assess an intern’s potential for longer-term work at your practice without having to commit to a full-time hire.