Retina Consultants of Carolina [RCC] is a seven physician, five location Retina-Ophthalmology practice located in the North-Western quadrant of South Carolina. Over the past decade, RCC has experienced significant growth and optimal quality outcomes through the steady dyad leadership of a managing partner physician and practice administrator. However, with continuous growth comes inherent challenges, and when the practice administrator announced their retirement the physicians felt it was time to address some of these ‘growing pains’. RCC subsequently engaged Knowledge Capital Group [KCG] to conduct a full-operational assessment to provide both observations and recommendations to address areas that impacted practice performance. The resulting report included narrative specific to financial performance, human resources, infrastructure, organizational scalability and lastly patient access and clinic throughput. This case study is part one of a series, specifically addressing patient access and clinic throughput.
The Challenge – Access and Clinic Throughput
RCC’s primary location was comprised of waiting rooms (3) and 14 single use clinical spaces – screening rooms (6), exam rooms (6), imaging rooms (2) and treatment rooms (1), all of which were utilized by two physicians and over ten optical technicians daily. Imaging equipment that limited, with a capacity of only one patient every 10 minutes. Physician scheduling templates were uniform and rigid, failing to consider appointment type, physician practice style or resources required. Additionally the template included a hard stop from Noon – 1pm daily for lunch.
This combination of single-use clinic spaces, multiple waiting rooms, limited imaging capacity and homogenized scheduling template resulted in varied throughput amongst physicians, frequent clinical flow bottlenecks and less than satisfactory physician and patient satisfaction. A patient’s typical wait time was in excess of an hour and a half before completion of the multi-phased exam, often leaving and returning to different waiting rooms throughout the process. Staff were often faced with down-time, while waiting for available resources and due to the aforementioned rigid scheduling template, any developed momentum was lost over the lunch hour. Compounding all of these challenges, was an average physician caseload of up to 50 patients per day.
Approach – Clinic Layout, Scheduling & Staffing
To mitigate these operational challenges, KCG partnered with RCC to implement best practices and lean business strategies, better positioning the practice to optimize patient and physician experience. KCG consultants began by conducting an extensive on-site evaluation of staff and physician workflows, roles and responsibilities, and supportive technology to determine the root cause of RCC’s operational challenges. Leveraging the findings of this assessment, KCG translated the practice’s needs into detailed recommendations for change and a comprehensive plan to mitigate workflow constraints. This plan focused on three key areas:
Although many of RCC’s patients suffered from impaired vision and mobility, the clinic’s physical layout required that patients cycle through multiple screening, exam, imaging and treatment rooms during a standard clinic visit. In addition, with clinic staff organized by modality, rather than patient, a single appointment might require touch points with multiple technicians, creating inefficient handoffs throughout the visit cycle. Further, during the assessment it was discovered that roughly 80% of patients utilize a particular piece of imaging equipment (OCT), of which the practice only had one onsite.
To drive throughput and eliminate unnecessary movement of patients, KCG worked with practice leadership to reconfigure the existing clinic layout – converting underutilized clinical and administrative work spaces into multi-purpose rooms that were equipped to screen, exam and treat patients. Not only did this enable the practice to increase clinic capacity and revenue potential, but also to realize greater operational efficiencies: leveraging space and staff strategically to streamline clinical delivery processes that had historically occurred in choppy, interrupted, segmented steps.
These proposed changes, outfitting the clinical spaces to be multipurpose and purchasing additional imaging equipment, required an estimate spend of $250,000. Practice leadership was hesitant to move forward, but after calculating a conservative ROI and discussing the relatively short pay off term of 11 months, all parties agreed that it was a smart investment to make with relatively low risk and began to implement recommendations.
Physician Scheduling Templates
Even with enhancements in clinical space utilization, inefficient scheduling practices prevented RCC from operating with maximum effectiveness. Scheduling templates were not customized for the practice, failing to consider nuances in physician practice style, patient characteristics, acuity, encounter type or procedure-based workflows that could inform a typical appointment time and required resources.
To address this, KCG redesigned and implemented customized, personalized, physician-driven scheduling templates that supported a continuous operating model. The redesign was built on a foundation of 15-minute patient blocks, with a rotating lunch hour, eliminating mid-day down time. Six different encounter types were designed to balance required resources and duration. Additionally, each physician’s surgical block time and administrative time was accommodated. An iterative approach was taken throughout the design process, to ensure each physician was provided an opportunity to provide input and feedback. The result was a scheduling template that created a more appropriate and consistent length of appointment, driven by encounter type and required resources.
Clinical Delivery Staffing
To realize the full potential of the redesigned clinic space and scheduling templates, KCG implemented a new, strategic staffing approach that re-organized ophthalmic technicians by clinical work space ‘pod’ and physician, rather than modality. Only in cases of specific skill sets were technicians assigned to a particular modality. This approach was overlaid onto the Physician Scheduling Templates to ensure complete clinical coverage at all times. Finally, KCG developed and implemented a skills assessment framework and ongoing training program to ensure staff competencies across all required clinical modalities. Understanding that a decrease in unnecessary patient touch-points with clinic staff increases clinic throughput, these changes allowed for continuous clinic operations and optimized throughput.
KCG’s engagement enabled Retina Consultants of Carolina to:
- Increase clinical space by 40% and capacity by 50%
- Balance required staffing and equipment resources, eliminating constraints that formerly resulted from an abundance of new patients or concurrent demand for a single modality
- Improve patient satisfaction by: streamlining patient and staff processes, reducing extraneous touchpoints by an estimated 35%; addressing reduced patient mobility issues by minimizing multiple patient-moves throughout appointment; reducing wait times and creating a more consistent length of appointment
- Reduce clinic bottlenecks, which created a more efficient and predictable flow of patients
- Define clinical roles amongst staff, resulting in more efficient staffing and greater staff satisfaction
- Provide a more predictable flow of patients, improving the practice’s ability to make informed decisions