Clinical Review

The 10 principles of practice efficiency

Author and Disclosure Information

Time-saving routines to manage the “psychology of waiting” and set a game plan for each day


As reimbursement plummets and expenses rise, the options to improve your practice’s profits may seem more limited than ever—either you see more patients or spend less time with the ones you have. There is another option, which is often overlooked: Reduce the constraints on your time by improving your efficiency.

This article outlines 10 practical steps you can take to streamline your practice.

1. Manage the psychology of waiting

The link between patient wait times and practice efficiency may not be immediately apparent, but it does exist. When a patient feels you have kept her waiting unnecessarily, she may conclude that you have no respect for her or her time.

This perception can lead to situations in which you must spend time fielding complaints and making apologies and explanations in the exam room. Although such “service recovery” may consume only a minute of your time, it takes precious minutes away from your efficiency.

Keep patients informed about extended waits

Instruct your staff to inform patients of longer-than-usual waiting times when they first arrive at the office for their appointment. Maister and colleagues found that patients perceive waiting to be longer than it actually is when they are uninformed, uncomfortable, and unoccupied.

Update patients about delays every 15 minutes. Consider asking a member of your clinical team to address the issue if the wait exceeds 30 minutes. Explain lengthy delays, and give patients the choice of waiting or rescheduling. This attention to communication makes patients feel you value their time, too.

Waiting room comforts, personal touches, entertainment

Pay attention to comfort issues such as chairs, room temperature, and back-ground music. Review pre- and post-exam dressing protocols, and make sure to stock extra-large gowns for patients who may need them.

Make your waiting room a delight

Some creative but tasteful ideas to brighten the reception area include hanging artwork from your personal collection or from local artists, many of whom are happy to display their work in exchange for the exposure (place their business cards discreetly next to the work). Other ideas:

  • Baby pictures of you and your staff
  • Pictures of you at your hobby or with your family
  • Interesting memorabilia
  • Jigsaw or crossword puzzles, word searches, and other lap games (you can create your own using Web sites such as
  • Personal computers with Internet access
  • Free long-distance on available phones (restricted to domestic calls only)
  • A diverse magazine collection for patients and their partners
  • Pagers to allow patients to walk to nearby shops if delays are lengthy
  • Notepads and envelopes for patients to write a letter or 2 (consider offering to stamp and mail completed letters)
  • Brochures about services you offer

In short, comfort and entertain your patients, and you can turn the potentially negative situation of waiting into a delight.

2. Review charts in advance

A failure to review charts prior to seeing patients can limit your efficiency, add to your frustration, and give patients the impression that your practice is disorganized.

Tell your staff that chart preparation is a high priority. Require that all charts be previewed 1 or 2 days before patients are seen. Let staff know you expect them to include in the chart the results of tests you ordered at the last exam, communications from physicians to whom you referred the patient, and relevant operative reports.

Don’t overlook billing issues

In addition to the clinical review, an administrative review of a chart in advance of the visit can ensure that your efficiency and good care will be remunerated.

Assign a biller to review your charts for insurance verification and benefits eligibility. He or she also can note any accounts with outstanding balances, and evaluate and resolve any outstanding referral or authorization problems.

Check samples and supplies

As a corollary to chart preparation, assign a staff member to ensure that the pharmaceutical sample closet has adequate supplies for the following day, and review equipment and supplies to see what needs to be ordered.

Red-sticker the low inventory items. To make it easier for staff to spot low inventory, provide small red adhesive flags for them to stick on shelves (or remaining stock) when supplies run low. Appoint a staff member to make the rounds of exam rooms and closets to identify the flags, restock, and order any necessary supplies. Items should not be allowed to run out.

3. Ready the room

A well-prepared exam room means you can care for patients without unnecessary delays. Rooms should be cleaned between—not in front of—patients, and staff should ensure that supplies and equipment are readily available.


Next Article: