How to Make Your Office More Efficient and Effective: Three Areas for Workflow Improvement

Primary care physicians often feel frustrated when they have to sacrifice face-to-face patient care time to perform burdensome administrative tasks as part of inefficient workflows. Our patients sense our frustration and experience similar reactions. While there is much in today's health care system that needs reform and is out of our direct control, this is an area physicians can affect. If we analyze our personal workflows, we can create more efficient ones and reclaim some of our time, especially outside the exam room.

This article pairs literature on practice efficiency with practical suggestions based on my experience, beginning as a farmhouse-based solo country doctor followed by decades working in several large institutions as a clinician, physician manager, residency director, and informatics director.

The mindset physicians need to adopt is that wasted time adds up. I call it the “30-second rule” — spending 30 extra seconds per patient leads to 15 extra minutes of work per day (assuming a volume of 30 patients per day). Conversely, spending 30 fewer seconds per patient by adopting more efficient workflows leads to 15 minutes saved per day. Multiply that across all your workflows, and the potential time savings is substantial. It may take six months or a year to get there, but that's insignificant in the context of a decades-long career.

In the organizations where I have practiced, workflows ripe for this kind of time savings were: managing patient messages, EHR note creation, and patient scheduling. This article offers tips for each of these areas.

Consider the impact of your messaging workflows. I once studied a 75-clinician practice and found that some teams received more than 100 patient messages per day, while other teams received as few as 30 messages per day. The teams had similar patient panels but different levels of efficiency. We established a goal for each team to receive only as many messages as their average visits per day; for example, 30 visits per day should result in no more than 30 messages per day. To reach this goal, physicians (and their team members) had to ask the following question before each visit: “What can I do during this encounter to eliminate at least one future incoming message?” Here are some recommendations that address common reasons for messages: test results, prescription refills, and other patient requests.

Adopt pre-visit labs. This is one of the most efficient and effective workflow changes to institute. Ordering labs drawn prior to patient visits ensures that results are available in time for the visit, which is better for patient care. For example, having a recent A1C available fosters meaningful real-time diabetes management discussion and care plan adjustments during the visit, when you have patients' full attention. This eliminates less effective post-visit patient messaging. In my experience, the patient may not read or understand these messages and they can consume up to five minutes of physician time per patient. Plus, when clinics introduce the pre-visit lab workflow, patients overwhelmingly prefer it.^1,2 Always schedule follow-up appointments and provide future pre-visit lab orders before patients leave the office.