Steps in developing, introducing and implementing new processes

Practices must continually update and improve policies to stay successful.

Issue: June 10, 2008

ByJohn B. Pinto

“The process which led from the amoeba to man appeared to the philosophers to be obviously a progress — though whether the amoeba would agree with this opinion is not known.”

— Bertrand Russell

John B. Pinto

Whether you have been in practice for months or decades, consider this: All of the important and durable progress that you have made in your ophthalmic practice has been created to the extent that you have created a process for each aspect of the business.

When systems break down in your company, it is usually due to just one of three causes:

An agreed process has not yet been developed, so everyone pretty much does their own thing, which often turns out to be flat wrong.
A process has been developed, and is even followed by staff, but it is flawed in some way, often because it was introduced by top-down fiat rather than organic consensus.
Or the process is a very good one but is not understood by staff due to gaps in original training, ongoing reinforcement or regular inspection. There is “process drift.”

Let us go back to the basics. What is a “process?” How should a process be developed? Who should do this important work in your practice? And once you have developed a great process, how should it be introduced and kept alive?

According to the Oxford English Dictionary, a “process” is, “A series of actions or steps towards achieving a particular end.” You obviously undertake thousands of processes in your practice weekly, although you are probably less formal in thinking about these than they deserve. And you are changing them all the time — not always consciously nor for the better.

All new processes are born from either problems or opportunities. These can come to light at any level of your practice. Your most junior front desk clerk may tire of duplicated effort and see a chance to streamline things. Or your most senior partner may blow her top about a yet-again ill-equipped exam lane.

What happens next?

If all is going as it should, the problem or opportunity is reported to a process “owner.” This may be a team leader or department manager for small issues, on up to the practice’s administrator or managing partner for larger items. In the best of circumstances, practice workers do not just pitch raw problems into the lap of their superior — they simultaneously propose a new way of doing things. “Our no-show rate has climbed ever since we started booking appointments out to a full year. Rather than only providing a phone call a day in advance, let’s add a step of sending out a reminder card 3 weeks before their appointment.”

Next, the process owner should be gathering information and asking lots of questions. Is there really a problem? Is the cost of the proposed process revision going to cost more than the payback? Would the new process even work? Would it cause new problems? How could we test the new process cheaply and easily to see how it might work, or do we need to make major commitments? How do other practices handle this same matter? Who in our practice needs to be in on a decision about this? What timeline is reasonable? And the list goes on.

The owner then communicates the problem or opportunity and pertinent facts to the other people who need to be involved. This could be just one other person or dozens. It may be limited to internal audiences or involve referral sources, payers, vendors or even regulatory bodies. This communication could take many forms — from an informal staff meeting announcement to a formal white paper.

In the wake of this communication, a discussion — and eventually a decision — should finally ensue. This may require gathering additional information, getting outside counsel, “sleeping on it” or referring the matter to a task force.

Writing it out

Because all processes in your practice should be spelled out in writing, the owner writes the decision up as a formal new policy or protocol, which in larger, necessarily bureaucratic settings should be marked prominently as a draft. It helps to assign such reviews a fixed comment period as they make the rounds, as well as a fixed implementation date so that things do not drag on.

What you do next depends on how firm and certain you are about the proposal. If the proposed process change has been all-but-finally set down in stone by the board, then you may circulate a memo with language along the lines of, “unless we hear compelling counter arguments in the next 72 hours about this proposed policy, this new approach will be in place at the start of business next Monday.”

If you are less certain — or, even frankly, uncertain — about how to proceed with a draft process, the accompanying language might be more like, “we are circulating this early idea to solicit your input and will not move any further with this matter until everyone has had a chance to get comfortable with the new approach.”

If additional information or concerns arise or a better approach comes forward, the protocol or policy is revised. If not, then a final draft is published and distributed. The resulting document should make clear the oversight authority and the consequences for noncompliance. For example, if you have had difficulties with tardy doctors making the clinic run late, you might have a progressive fine system in place that charges physicians $100 for their first “tardy” of the month and rises in $100 steps from there for every subsequent late arrival that month.

Enforcement

Finally, for processes to stick in place, an individual with oversight authority must assure that compliance is achieved, assure that the policy or procedure is working as desired and must be in a position to see that consequences are applied fairly to all nonconformers. Remember: An arrangement for progressive discipline is just as important for providers as it is for lay staff, particularly as a practice grows from a small group to a larger enterprise.

Does this all sound overly technocratic? Too tight? Not to a recent client, whose loose and largely verbal processes for collecting a simple refraction fee, along with uneven enforcement, has resulted in hundreds of thousands of dollars lost in the past 12 months alone.

Examine your own practice setting. How much are outdated or entirely absent written processes costing your shareholders every year? By making constant improvements in the processes you follow, writing them down and running your practice by the book, you’ll more than offset the economic challenges that lie ahead.

For more information:

John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees and The Women of Ophthalmology. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; Web site: www.pintoinc.com.