By Rosemarie Nelson
AUGUST 2015 – When you have the right number of staff doing the correct jobs, your practice can run like a well-oiled machine. When you don’t, breakdowns are inevitable. This notion of rightsizing staff may seem elementary, but many practices have nurses doing jobs medical assistants could do, or they use the same number of staff for five physicians as they did when the practice had only three.
Too few staff can negatively impact productivity, recruitment, patient safety, and patient satisfaction and quality measures. Too many staff can cause higher staffing costs and turnover. Both scenarios cause staff morale to suffer. But when staff are in proper roles, they are happier and work more efficiently. There are some things that we don’t need to tax a nurse with that would really enhance the position of a medical assistant. Being in the right role can mean job enrichment for a lot of people.
Before you change your staffing model, analyze the current roles of your staff. Think about how these roles fit with your current practice and your future plans. Compare this data to benchmarks from organizations such as the Medical Group Management Association.
Determine whether the data suggest areas of opportunity for your practice as well. If you are significantly above average in certain areas, for example, use this information either as a marketing piece or as a way to cut overhead by reducing the number of employees working in those areas.
If your analysis reveals you need to change the size of your staff, set up a group for the task that includes the practice manager, a high-level human resources employee, and the nurse manager or clinic manager. In general, the people supervising or managing the staff should all sit down as a team to review the process. You may also want to include someone responsible for billing and collections.
Ask staff for their feedback. They can help identify what they’re doing and the work flow in their own world. Find out how they spend the day. Their responses may surprise you.
For example, you may not know that three people answer the telephones. Although this process keeps patients happy because they always talk to a live person, it may essentially hinder your productivity and decrease patient satisfaction because you keep patients waiting in the office.
Once you form a team and garner staff input, try these steps:
- Analyze your productivity and practice model. Measure work volume (e.g., the number of patients checked in, the number of telephone calls managed per day per employee). The key question to address is, ‘How productive are the employees at the present time and with the current processes?’ In this step, try to determine how many staff would be the “right” number to take on the amount of work you have at your practice. Then compare these ideal numbers to your actual numbers. Remember that for some areas or processes, you may already have what you deem the correct number of people working.
- Evaluate processes. Map out your critical processes (especially those that are performed many times each day) and look for steps you can combine or eliminate. The fewer the steps a process takes, the more likely you’ll get through without a hitch. This will also help streamline your work.
- Take action. Develop an action plan with a responsible party and deadline so that the process is conducted in a systematic and timely fashion. Don’t just say that you think each doctor needs another nurse. Figure out how you can actually shuffle or add new staff to make this happen, and the date by which you’d like to accomplish this.
Even when staff understand why you must change their roles, they may still hesitate to accept changes. Be sensitive during the transition and allow staff to adjust. Make it clear that this [process] is something that the practice will be doing on a continuous basis to ensure that it has the proper infrastructure and offers the proper support. If staff believe you considered their opinions and input, they may more willingly follow through with what you ask.
Watch the staff in their new roles. Give the changes time to sink in but keep an eye on them to spot what’s working and what’s not. If, down the line, you realize that your old staff model worked better than the new one, don’t be afraid to admit your mistake or misjudgment and make changes again.
Knowing you have the wrong number of staff and not doing anything about it is worse than not realizing that your practice isn’t running at maximum productivity.