Fam Pract Manag. 2006 Oct;13(9):67.

Offer evening hours

My practice is located in a small town economically dependent on textile plants. Two years ago, when the plants experienced financial strains, the workers faced rigid restrictions on hours, break times and time off, even for medical appointments. Patients quit returning to our office for routine appointments and began using the local urgent care center, even though it required higher co-pays.

To meet our patients’ needs, we began offering evening hours. Each physician (assisted by one nurse and one front-office worker) was assigned an evening, Monday through Thursday. On the day the physician was assigned to work an evening shift, he or she would start at our usual 8:30 a.m. but would stay until 8 p.m. instead of 5 p.m. To compensate for the increased hours, each physician went from having an afternoon off to a full day off each week, with the exception of any hospital rounds the physician might have, and each nurse and office worker who completed an evening shift received an afternoon off.

For the physicians, this change was remarkably liberating. With our previous schedule of an afternoon off each week, we often used the time just catching up on paperwork. A full day off meant real freedom.

The response from patients has been gratifying. We have 11 patient slots open each evening. With rare exceptions, they are almost always full.

Take your staff to lunch

In our hectic office setting, I find it hard to get to know each employee beyond a cursory salutation as we pass in the hall or meet at the water cooler. On a good day, I may find out what someone did last weekend or is going to do next weekend, but I often feel out of touch. To try to fix this, I’ve started taking a different employee out to lunch each week to try to get to know him or her better. I’ve found that this gesture enriches my relationship with the staff.

Seek performance feedback

Giving and receiving constructive, tailored feedback is key in developing an office where staff morale is high and patients are happy. Try these approaches to solicit feedback from your colleagues:

  • Find a time that is good for both of you to talk.

  • Ask “what if” questions, such as “What would you do if one of your patients became irate because you were running behind schedule?”

  • Concentrate on a specific incident that lends itself to feedback, such as a team project in which you were the team leader.

  • Ask longtime co-workers whether they see any patterns in your work style, including areas where you have excelled and areas where they have seen you struggle.

  • End the discussion when it stops being productive.

Source: Bottles K. Tossing hand grenades: how to deliver feedback in medicine today. The Physician Executive. September/October 2006:32–37.


Conduct fire drills

Don’t let your practice’s employees – or physicians – ignore the importance of fire drills. To make fire drills more realistic, seal off a stairwell or exit, have employees aid an elderly or wheelchair-bound patient as they exit the practice, or introduce other obstacles they might encounter during an actual fire. Give your key employees specific tasks, such as checking the building to make sure it is clear, leading evacuation groups, and contacting and coordinating plans with authorities. Conduct fire drills once a year in your practice.

Source: Practices should conduct fire drills. Conomikes Reports. February 2006:3.


Encourage staff to identify problems

Revealing problems in your systems and processes is the first step in making your practice run smoothly and with fewer errors. Instead of fearing the identification of problems, create an environment in which staff members feel comfortable reporting problems and know that their suggestions will be taken seriously.

Source: Institute for Healthcare Improvement. Treat every defect as a treasure. Available at: Accessed Sept. 18, 2006.



Practice Pearls presents the best advice on effective, efficient practice operations and patient care drawn from the medical and business literature, along with tips developed from your experience. Send us your best pearl (250 words or less), and if we publish it, you’ll earn $25. We also welcome questions for our Q&A section. Send your pearls and your questions to us at


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Send us your best pearl (250 words of less), and you'll earn $50 if we publish it. We also welcome questions for our Q&A section. Send pearls, questions, and comments to, or add your comments below.


Copyright © 2006 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


May-Jun 2020

Access the latest issue
of FPM journal

Read the Issue

FPM E-Newsletter

Sign up to receive FPM's free, weekly e-newsletter, "Quick Tips & Insights."

Sign Up Now

COVID-19: A "How-to" Resource

From "how to code for virtual visits" to "how to safely reopen your office," find the practical advice you need in the COVID-19 Topic Collection from FPM journal.