Saturday, August 16, 2008

When the junior Administrator has more power than you

I had an interesting conversation while car-pooling with another surgeon and our junior front desk person. The surgeon speculated that we should be adding more blocks of time for one type of surgery. The junior front desk person said “we’ve been adding two ½ hour blocks after lunch for over a month now”. He asked, “Who told you to do that?” and she responded “my supervisor, Joanne”. How does it come to pass that our most junior front desk person is a month ahead of the surgeon with the schedule planning?

Power is that ability to make people do what you want, so she who controls the schedule, controls the power. Handing over the reigns of schedule control is a tough pill to swallow for many providers. While they may say the front desk controls it, critiques, both overt and implied, are frequent and one-sided.

While our clinic is not immune to provider critiques we try to use surgical wait times as the yardstick for blocks of time rather than a static template. By setting wait time expectations with our administrative supervisor, she can frequently monitor (weekly) and fine tune blocks of time. It is only the most drastic changes that the providers hear about and I suspect that is to ward off any surprises rather than to seek approval. Our administrators have a far better feel for how long people are waiting than we do.

I’d suggest the following method.
Where there is more than one person controlling the schedule, assign one to be the gate keeper of block booking (administrative coordinator)
Set expectations – our office uses wait times, some use revenue others use appointment types*
Have an initial meeting to create a template
Discuss how much the template can be changed without provider input
Review the results (based on expectations) every 3 months

Other than balancing the number of doctor days between clinics most changes to our block booking templates are made by the administrative coordinator. Handing the reigns over to the people that are on the front lines makes the schedule more nimble, improves office performance and the experience for everyone involved.

* Booking by appointment type is used by clinics that have static funding and either very high or low wait times. The schedule is built to please the provider when schedule will have no effect on patient satisfaction.

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