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    Blocked clinic flow can be analogous to a beaver dam

    Analyzing root cause of poor clinic flow sheds light on poor front desk, technician relations


    Front desk, technician animosity

    The other day, one of my doctors came in and asked why there was such animosity between the front desk associates and technicians--in essence: “Why don’t they like each other?”

    I have spent a good part of my career trying to explain this to vice presidents, administrators, and doctors--people who are neither technician nor front desk members. It never works and usually only muddies the waters more. I have learned to shrug my shoulders and live another 15 minutes by saving my breath, but it is still a valid question.

    It goes back to being about beaver dams.

    Meaningful use and government mandates have added blocks all throughout the system that continue to add more and more time to each patient visit--and ends up damming up the clinic from ever getting their hands on the patient to do the exam.

    In most offices, the patient spends an exorbitant amount of time discussing insurance information, vision plan insurance proof, HIPAA information, billing information, and woe be it if he or she needs an interpreter or needs to have a future test scheduled.

    A patient can check in for an 8:30 a.m. appointment and the technician is still waiting to receive his or her paperwork and get them going at 9 a.m.


    A 'dam' scenario

    Here is how it potentially goes: A patient arrives to the clinic and has forgotten his or her new insurance or vision plan card. This now creates an issue in regard to the clinic getting reimbursed. Add that the interpreter is late--on top of the 15 minutes the patient is late--and we begin to see a ripple effect downstream.

    Meanwhile, the technicians are waiting in the back to get their hands on the patient.

    Let’s say that patient is a visual field patient. If the patient is 15 minutes late, the process holds him or her another 15 to 20 minutes, and by the time the technician gets the patient, the next visual field patient is already 10 minutes delayed and starting to get irritated.

    The last issue to deal with as a result of the system delay is the technician “standing around” and the doctor becoming angry because he or she will ultimately have six patients ready at the same time.

    The whole process (the dam) causes a backup in the clinic (flooding of a pond), which, eventually, when loosened up (patient is now moving in the system), causes the farmer’s field down the stream to flood and ruin the new corn crop (patient satisfaction).

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