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  • NP and PA
  • Skin Cancer
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  • Drug Watch
  • Pigmentary Disorders
  • Acne
  • Pediatric Dermatology
  • Practice Management

Practice efficiency: Streamline patient flow with effective office strategies


Efficient patient flow makes wise business sense - there's no CPT code for the time you spend waiting to talk to the nurse, or idling while a patient is being roomed. Eliminate this non-productive, non-reimbursable time by streamlining your workflow.

Key Points

Previsit process

"Pre" everything. In other words, pre-register patients, pre-verify insurance coverage, pre-authorize applicable procedures and pre-collect for service. Perform as many tasks as possible prior to the patient's arrival. A comprehensive pre-visit process improves your chances of getting paid, and it reduces the time patients wait after they arrive.

Make a checklist of items you expect staff to have ready before clinic starts. Make one list for the front office and another for the clinical area.

Don't leave anything to chance. For procedures, draw up checklists of what you expect - equipment, staff, placement of supplies and instruments, and so forth. Take a photograph of your desired setup so there are no misunderstandings or oversights.

Rooming process

List everything you want in the order you want it done, from obtaining vital signs and requesting and documenting patient histories to reviewing medications, chief complaints and any standing orders.

Think it all through like a process improvement consultant visiting a Toyota factory. For example, why should you have to wait for the patient needing a full-body skin exam to undress and climb onto the exam table? List it in your rooming process so the patient is gowned and ready when you arrive.

Telephone contacts

Ask patients for permission to leave their test results at a designated phone number. Ask them to provide several phone numbers - home, cell and work, plus a spouse, guardian or another contact they trust to receive their test results.

Of course, when there are positive results, ask patients to call you back.

Hallway meetings

Before each clinic begins, spend a few minutes with your staff to go over the schedule. You can spot potential issues and stumbling blocks, such as the patient with missing test results.

Keep these quick meetings under five minutes. If there's time, address at least one challenge from the previous day that could have been handled better, so you and your staff can manage it more effectively the next time.


Use basic appointment types such as "short," "long" and "extended." Your scheduler can note any special details about the patient in your scheduling system's "appointment reason" field.

If you force her to search through dozens of appointment types to try to find the perfect match, you'll end up with more, not fewer, unfilled slots. The scheduler will never consistently find the perfect match for every opening in an overly complex template.

Also, give your schedule a reality check. Base scheduling on your work style and your pace, not some ideal that you may not be able to achieve or - just as bad - that holds you back.

It's not uncommon for dermatologists to run a half hour behind - the problem often starts with the first appointment of the day. Reception processes consume considerable time, so instead of trying to align your appointment schedule with your front desk, make sure the schedule optimizes your time.

Decide when you want your morning and afternoon clinics to commence; then schedule patients' "arrival times" 10 to 30 minutes earlier.

Quality of the wait

On average, patients wait 21 minutes to see a dermatologist, according to Press Ganey in the Physician's Office Pulse Report 2008: Patient Perspectives on American Health Care. While dermatology practices have the least amount of waiting time reported in the survey, those 21 minutes can still seem like an eternity to a patient.

While working on reducing your wait time is always encouraged, be sure to also manage the quality of the wait. It's the little things that count. Don't, for example, resort to telling patients, "The doctor will be right with you." Instead, give them realistic wait times. Proactively addressing the waiting issue demonstrates to patients that you respect their time.

Keep patients occupied with current magazines, puzzles (crossword, jigsaw and Sudoku are all favorites), an area for laptop and/or cell phone use and interesting artwork on the walls.

Tick tock

Don't rely on your wristwatch to keep track of time - patients who see you glancing at it will be irritated that you appear to be in a hurry. Hanging a wall clock behind the head of the exam table allows physicians and staff to focus on patients while still maintaining a sense of the time.


Knowledgeable, experienced staff are critical, but add "personality alignment" to your list of hiring criteria.

In sum, hire for "fit." Find individuals who share your work ethic, sense of teamwork, customer service orientation and dedication to always striving for improvement.

The secret to good work flow is to work with good people, deploy good strategies and execute well. You may be amazed at how smoothly things start to run in your dermatology practice.

Elizabeth Woodcock is the principal of Woodcock & Associates and a speaker and writer specializing in practice management. Visit her Web site at http://www.elizabethwoodcock.com/.

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