Is your practice management properly organised?

Written by: Richard Pearce

Does this sound like you?

• You receive texts from 6.30am from nurses telling you they are sick and can’t work today.
• When the suction breaks, you get called, even when you are out collecting the children from school.
• Sales people appear in the appointment book for ‘lunch and learn’ just when you were looking forward to a free lunch break.
• When popping to the loo, you get stopped by a nurse asking if they can take a holiday… next week.
• You don’t really know how well the practice is doing. What’s in the bank account seems to allow you to take out enough to afford a lifestyle that is sort of OK.
• You hate paying invoices! You get handed a stack of them, which gets added to during the month.
• When you pass reception you occasionally wince when you hear a nurse on reception. She’s trying to be helpful but doesn’t know how much a crown is and has no idea how to sign up a patient for the plan. 
• C2 composite has run out again. You know this because while seeing a patient, a nurse from another surgery has come in and is whispering to your nurse and they are rummaging through drawers.
• You chat to an associate as you are heading out the door. They’re unhappy about the number of new patients they are seeing but don’t know how many it actually was last month.
• You get interrupted every other week with a brilliant advertising offer from the local paper. You tell them that you’re not interested at the moment, kidding yourself that it is not in the current marketing plan. Having a marketing plan… That’s a laugh!
• You refuse to look at the practice website because it annoys you every time you check it. It’s old, lots of information is wrong and you’re not even sure anyone looks at it anyway.
• A fuse keeps going in Surgery 2, but someone presses ‘Reset’ and struggles on.

On the drive home you think to yourself, ‘I guess this is what being a practice principal is like!’ You live with a constant, underlying feeling of not being in control and wondering where the next ‘disaster’ will come from.

But, come on! This is no fun. You really enjoy seeing patients, but the rest of it is just a chore. So how can you get organised and free yourself from this tyranny?  

Outsource, automate, delegate 

• Outsource – Employ a third-party company or individual to manage this task/service.
• Automate – Use an online or digital system.
• Delegate – Give this task to a staff member who clearly understands the outcome required, how the task is to be completed and how they report on its progress and results.

Only after you have exhausted all three of these possibilities should you consider doing the task yourself. 

Let’s look at how we DELEGATE first, by starting with the practice manager (PM). When was the last time you reviewed their job description (JD) and confirmed that they do manage all the tasks that are detailed there? Should some of the tasks that you currently do be added to the JD and then you train, monitor and inspect how those tasks are now being completed?

Does the PM ‘own’ the practice operations manual, which details every procedure that happens in the practice? Here is a tiny snapshot of what should be included in it:

• materials ordering 
• signing up patients to the membership plan
• daily cash-up
• list of preferred tradesmen
• with contact numbers (examples are given for who deals with what issue)
• invoice management
• monthly management reporting
• float maintenance
• sales rep booking-in (it’s when you want it, not when they happen to be passing).

You might also consider having a separate reception manual, which details procedures specific to front of house.

The staff handbook should cover everything that is related to staff, such as a procedure for requesting holidays.

The PM can also delegate but they might need to be trained on how to train, monitor and inspect effectively.

Now let’s AUTOMATE what we can.

Staff can clock-in with a card clock-in system or app-based system such as Rotacloud, which can also be linked to a payroll system.

Xero or Quickbooks has invoices scanned to it (Autoentry) and automatically syncs with practice bank accounts. The rules set up mean that assigning income and expenses is a 10-minute per month job, which could be delegated to the PM. So now we have a monthly P & L.

We know our ‘base’ materials requirement every month – we order online, once a month. Some items are cheaper if bulk ordered every three months and we have storage space. 

Staff request holidays (and it is authorised) using an online system (Rotacloud again), but there are others. 

As many suppliers as possible are paid by direct debit. We don’t do cash or cheques. Invoices have to be sent by PDF, this is the 21st century after all (paperless office!).

Finally, OUTSOURCE. A larger practice might consider a bookkeeper coming in one or two times per month to manage this function. They can also prepare forecasts (and provide variance analysis) run payroll and aged debtor reports etc.

Digital marketing, graphic design and web design are outsourced to a specialist agency. You meet with them monthly or quarterly to review the plan and results.

Practices can bury themselves in the weeds and so fail to focus on the big picture. It takes real discipline to take two steps back and analyse what’s actually happening. It then takes energy and maybe some investment to change.  

Tags: Automate, Delegate, Efficiency, management, Outsource, Practice Management