brand logo

Fam Pract Manag. 2017;24(6):35

Break the rules for better patient care

Medical practices have many rules governing patient care, ranging from treatment protocols and HIPAA requirements to rooming procedures.

These rules are typically designed to make your practice operate smoothly and protect patients, but some rules may exist solely because no one has ever challenged them, and they may be holding your practice back.

To identify rules you may need to challenge, start by asking physicians, staff, or even patients what one rule they would like to change or eliminate to improve the care experience and why. You can ask these questions through email, during patient visits or team meetings, or through an anonymous online survey.

Once you've collected the suggestions, sort them into three categories:

1. Rules that need clarity. Rules in this category usually just need clarification regarding what is really required, what is organizational myth, and what is the original purpose that may have gotten lost.

2. Rules that need a redesign. These rules might be unpopular administrative directives that need to be updated or changed, typically by the organization's leaders.

3. Rules that need advocacy. Rules in this category are often federal or state regulations that are beyond the organization's direct control and require an appeal to the controlling entity.

Once you have identified problematic rules, work with your colleagues, staff, and patients to identify the specific actions you will take.

Avoid portal overload

Many practices have begun using online portals to give patients greater access to their physicians and their health data. But integrating portals into the practice's daily operation, particularly managing higher volumes of patient messages and data, can be challenging and could overwhelm physicians who already face information overload.

A key consideration is to ensure that little of that increased communication from the portal falls on the physician. Incoming messages and scheduling requests should be triaged by appropriate staff using protocols similar to those for telephone calls. If a patient message requires more than one interchange with the practice, the subject probably warrants a scheduled appointment.

Ideally, the physician will receive from the portal only the information on which he or she needs to act. This ensures that the patient benefits by getting answers quickly, and the physician benefits by focusing on duties that match his or her license.

Don't fear conflict within your team

Collaboration would seem to require working together with-out conflict. But a team that has no tension or disagreement is likely not coming up with the best ideas, implementing flawed plans, and not building trust among its members, only acquiescence.

Team leaders should embrace productive conflict, recognizing the value that different points of view can generate. This will require a change in the culture of most teams, so here are some ideas to introduce healthy conflict to your work:

  • Review each team member's role and each role's different agenda. Recognizing these different agendas may ease tensions by showing that disagreements are not personal, which may encourage more discussions to push for better solutions.

  • Use personality or style assessment tools to identify each team member's perspective. Those with perspectives different from the rest of the group should be encouraged to speak up more often to address weaknesses in the team's plans.

  • Define what behaviors contribute to “good” conflict versus dissension, which ultimately saps the team's effectiveness. For example, appoint a “devil's advocate” to force the team to analyze and defend the evidence being used to make a decision.

Conflict is often uncomfortable, so you will need to do more than just allow team members to challenge each other. You will need to make it a regular feature of your work.


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

Continue Reading

More in FPM

Copyright © 2017 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.  See permissions for copyright questions and/or permission requests.