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Fam Pract Manag. 2008;15(8):45

Be creative in finding time for retreats, meetings

We find time for retreats that last a day and a half and involve all of our practice's staff (five physicians and 30 staff) by closing the practice on a Friday. We then pay overtime as needed for the half day on Saturday. Doing this on a workday ensures that everyone is available.

Also, we make time for staff meetings at lunchtime. We close the practice during lunch and then schedule appointments for a half hour later than normal in the afternoon.

Both the biannual retreats and the monthly staff meetings allow us to move forward on quality improvements with the support and engagement of our staff.

Streamline nursing home care procedures

When I cared for a large number of patients in nursing homes, I received phone calls from multiple nursing homes throughout each day. Interrupting patient visits or other duties to attend to the phone calls was costly. To fix this, I created a system that reduced the number of calls by 75 percent. I asked each charge nurse to fax me his or her list of questions, concerns and recommendations each day by 11 a.m., and I called back by 1 p.m. each day to follow up.

This system had many advantages, including decreased calls and interruptions. It also forced the charge nurse to carefully consider the issue and what he or she thought should be done. In most cases, the nurse's suggestion was what I would have done, but going down the list of questions and saying “yes” to the recommended treatments saved me from having to explain each one. If I didn't agree with the nurse's recommendation, I would give my own orders.

Also, because the nurses knew I would address their questions, routine issues were dealt with routinely. For example, if a nurse needed to inform me of a status change, she could put it on the list, which was less time-consuming for me than talking about it by phone.

Add insight to hiring process

Our practice implemented a “trial day” during which a potential employee shadows an employee for a day. This allows our practice to see the candidate interact with employees, providers and patients, and it gives us the opportunity to confirm the skills or education needed for the position. This is also beneficial to candidates, as it allows them to “trial” the position and gauge its fit for them.

This process has been very successful for our practice. Even if a candidate doesn't return after lunch (which happens occasionally), the trial is still deemed a success because our time wasn't wasted in continuing the hiring process with that candidate. On the flip side, candidates we've been unsure about during the interview process have “sealed the deal” during their trial day.

All trial day candidates must sign a HIPAA confidentiality policy. This ensures patient and clinic privacy and also informs the candidate that the trial day is unpaid and does not guarantee future employment.

Candidates often do their best to shine during interviews, but this process allows us to see beyond the initial sparkle.

Reward staff for meeting productivity goals

I set a goal with my staff for the number of office visits we should provide each month. If we reach the goal, all staff members get a bonus (money, gift certificates, etc.). Several work a varied number of hours during the week, so to make the bonus fair, it is based on half-days worked (e.g., I give them $5 per half-day worked during a regular week). Last year the staff received bonuses five times.

Staff members no longer hope for a “slow day.” On days that are not booked with appointments, both front-office staff and nurses call patients to come in for well checks or other needed services.

This has been a great morale booster (the staff does a “happy dance” if we meet our goal), and it is great for my bottom line.


Practice Pearls presents readers' advice on practice operations and patient care, along with tips drawn from the literature. Submit a pearl (250 words or less) to FPM at

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