By Jennifer L. Stewart, OD
Nov. 10, 2021
Efficiency improvements create a better patient experience and enhance your profitability, enabling you to see more patients per day. Here are a few changes that allow us to better serve patients and grow our practice.
The use of scribes in our exam rooms has improved our ability to concentrate on patients during exams, and has made the time with patients more efficient. We first started using scribes five years ago, slowly adding these employees to our practice. We now have four scribes on staff.
We decided to add scribes after we transitioned to electronic health records, and realized that we didn’t want the doctors to have to enter information into patient charts themselves.
Our scribes’ primary role is pretesting patients and scribing in the exam room. They gather patient history, medical and ocular history, chief complaint, medications and all of our pretesting data. They do all entrance tests, set the phoropter, pull up images on my computer and pull any diagnostic lenses I may need. They input the entire exam and I check it over once they are done.
They are also cross-trained to answer the phone, check patients in, make appointments and help at the front desk. In addition, they maintain the supplies in the exam rooms. Our scribes get to know the patients and can anticipate the things I need. For example, they know when I like to have patients back for follow-ups and the common medications I prescribe.
Each scribe earns $18-$20 per hour and works full-time.
I initially conducted the training of new scribes myself, along with my opticians, who were the ones handling pretesting before our scribes took over that task. Now my lead scribe trains newly hired scribes. The new scribe shadows the other scribes for the first 1-2 weeks until they are comfortable. We try to get them pretesting on their own first and then have them learn the EHR system. I also train them throughout the year on ocular conditions and anything else I think they should know about the needs of our patients.
The patient experience has improved substantially since adding scribes to our practice. I spend my entire exam focused on the patient and not entering data.
Many patients have mentioned how nice it is to have undivided attention from me in the exam room. They have been to doctors who have their back to them, pecking at a keyboard the whole time. For me, the face-to-face time, and not having to take notes, is essential to providing quality care. Patients get to know the scribes, especially if they see us often, and enjoy having the same person take care of them.
We have two doctors seeing 2-3 patients each per hour, with four scribes, using 3-4 exam rooms. The scribes are essential to keeping patients moving and to cleaning and disinfecting the rooms after. We would not be able to keep that pace (and leave on time with all charts done!) without scribes. I never do charts from home as they are all done way before the end of the day. This a great boost for my work-life balance.
I meet with my scribes in the morning to look through the information on the patients coming in that day. This meeting takes place at the front desk 15 minutes before our first patient arrives. We are able to carefully select the patients new scribes should work with. I am able to find “easy” patients for the new employee to pretest.
I remember something about almost each patient, so it’s a good way to introduce the patients to the scribes before they walk through the door. We see what needs to be done for each, any special “quirks” of patients, and things each has told us they like and don’t like. This process takes no more than five minutes per day.
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The morning huddle also enables me to let our front desk know if there are any patients who need to be called ahead of time – patients not confirmed, insurance changes or patients who may have outstanding balances, for example.
Daily morning huddles enable scribes/techs to know exactly which patients they are working with, and what needs to be done for each patient. Knowing these things ahead of time means there is no need to stop and find the doctor in the middle of the work day to ask which tests need to be done for each patient.
Empowering Staff to Make Decisions & Delegating
Giving employees the training and assurance they need to make many decisions on their own allows the doctor to become more efficient and creates a smoother patient experience. They don’t have to wait as the employee runs to find a doctor to get permission to do what the patient needs.
For example, my staff does not have to consult me about time slots to schedule patient to, especially emergencies, and can almost always find ways to turnaround the experiences of unhappy patients on their own. They also are nearly always able to answer patient questions themselves over the phone instead of creating a list of questions for me to answer at the end of each day.
I tell my staff that the patient in front of us and the patient on the phone are our priorities, and helping them as quickly and efficiently as possible is what we do. If they had to find me for everything, the process of smoothly serving patients would slow down, leading to a less positive experience in our office.
Empowering employees to make decisions on their own keeps the office flowing, leaving me to make only a few decisions myself (usually only the most important) and spend less time “in the weeds.”
In addition to thoroughly training employees, I don’t micromanage and I have an open-door policy that allows them to ask me any questions that will help them better serve patients. They know I have confidence in them to make smart decisions, and do what each patient needs to have done to leave our office happy.
Jennifer Stewart, OD, is a partner in Norwalk Eye Care in Norwalk, Conn. She also is founder and chief vision officer of Performance 20/20, a sports vision training center in Stamford, Conn. To contact her: firstname.lastname@example.org