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As costs increase, medical practices need to get creative.

Fam Pract Manag. 2010;17(3):40

Dr. Newbell is a family physician in private practice in Hazel Green, Ala. Author disclosure: nothing to disclose.

Billing more level-four visits, being more aggressive with collections, seeing more patients per day, asking medical supply companies for volume discounts – these are the usual suspects when it comes to improving the bottom line at a medical office. But I recently found thousands of dollars in savings at my own practice in an unexpected place: My staff and I decided to stop having a janitorial crew clean our office and to take care of it ourselves instead, saving over $5,000 a year.

At first, this may not sound like a very good idea. Doesn't this mean asking office staff to do more work, and certainly not the kind of work for which they were hired, for the same pay? It does. Admittedly, this isn't the kind of money-saving tactic that would work at every practice. It is to the credit of my co-workers, whom I consider more family than employees, that such an idea could even be considered.

I started by simply telling my staff about my plan, explaining that it would help to safeguard the financial viability of the office, and asking if they were willing to go along with it. I made it clear that we would all share in the responsibility of keeping the office clean. Did that mean a board-certified physician would take his turn cleaning a toilet? Yes, it did. This wasn't going to be an order from the doctor or office manager that the staff would just have to accept. We would unanimously go forward with the plan, or we would keep our cleaning crew on the payroll. After I pitched the idea, there was not one dissenting vote.

As a busy practice, we could not afford to take any significant time away from patient care or practice management to clean the office. Thankfully, we didn't have to. Some office staff have inevitable lulls in their workday. If the exam rooms are full and there is no need for a blood draw or an ECG, a couple of minutes is plenty of time for a medical assistant to empty a trash can or wipe off a counter. Longer pauses in the work day are less common, but when they do occur, typically late in the day, staff now see this as an opportunity to clean a window or to see if a bathroom requires attention.

Even the time- and labor-intensive tasks of vacuuming the carpet and mopping the floors didn't doom our plan to failure. In fact, my staff and I don't have to do either. For around $500, we purchased two cleaning robots: an automated vacuum cleaner and an automated floor cleaning machine. It's not uncommon for me to be alone in my office after hours doing paperwork or returning phone calls while the two robotic additions to my staff are dutifully grooming the waiting room carpet and scrubbing the floor in the nurses' station and hallway.

Automating something as mundane as vacuuming and choosing to scrub a toilet yourself instead of paying someone else to do it isn't your typical practice management advice. But the rising cost of running a medical practice is not only a burden; it is also an incentive to innovate.


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