“Organizations are perfectly designed for the results they achieve. Want new results, get a new design.”

—Paul Gustavson

Have you ever wondered why some customers report a great patient experience while others state that their encounter wasn't that good? Are you sure that the patients you treat today will experience the same level of service as the patients you saw yesterday or will see tomorrow? Do you worry how the practice will function if a certain staff person is on vacation or absent? Are you confused about how to build in consistency to get the same high-level results you desire over and over?

The goal of most medical practices is to consistently provide the highest possible level of care in a personal, welcoming, responsive, and positive manner. Many factors impact patient care and the overall patient experience. Achieving consistency throughout the entire patient continuum requires having effectively designed processes and policies in place that are clearly documented and adhered to by all team members. It is only through effective documentation that a practice can be confident it is consistently providing the results it wants to achieve.

This article examines how clear documentation of a practice's systems—including all of the processes that comprise these systems and the policies that govern them—is the key to consistently providing positive patient experiences.

Why Document?

Clear documentation of practice systems and all relative components provides the foundation for delivering excellent patient experiences all of the time. It also helps in identifying processes that may need updating or are no longer useful.

Likely you already have established systems in place; but, if they are not all clearly documented in a way that clearly communicates them to staff, you will never be able to guarantee your patients the kind of consistent results and experience they are counting on. The following lists indicate a.) the risks of not having all systems documented and b.) the benefits of proper documentation.

Practices without proper documentation:

  • Have a lack of direction and purpose, and rarely meet their goals.
  • Are person-dependent (versus system-dependent). Essentially, patient outcomes and experience are reliant on a specific employee.
  • Experience downtime because staff must repeatedly ask questions and managers must repeatedly provide direction and handle situations.
  • Have frustrated employees due to a lack of understanding how to perform their jobs and accomplish what they need to do.
  • Experience downtime when trying to get new employees trained at the level needed to perform the job.

Practices with proper documentation:

  • Have organizational focus and effectiveness. Essentially, they have a strong sense of mission and direction.
  • Are system-oriented (versus person-dependent). Essentially, systems are in place and can be carried out by any team member. Patient outcomes and experience can be duplicated, regardless of the presence of a specific employee.
  • Provide clear roles to staff, allowing for less confusion and questions. This empowers employees to handle situations and perform their jobs so that managers have more time to lead the practice in accomplishing its goals, as opposed to managing the tasks of staff members.
  • Have more success at effectively onboarding new employees as policies and processes are clearly outlined and presented during training.

These lists show why documenting your systems and their components (processes and policies) makes sense.

Create Operating Documents

The end product of effectively identifying, analyzing, and documenting your practice systems and all related components is the creation of documents that outline and define what you do and how you do it. Some practices may choose to compile this information into a formal document, such as an operations manual (see below). Others may choose a less formal method of compilation. What is most important is that you produce a complete and fluid final collection of these documents that can be updated as the practice grows and evolves. You should expect to review, revise, and/or develop each element regularly and with ease.

As a result of creating operating documents, you will have an integrated collection of systems, processes, and policies to guide the day-to-day activities of your practice. This allows for more control over your outcomes and patient experiences (i.e., the quality of your products and services), which in turn provides you with leverage in setting yourself apart from the competition. Additionally, these documents provide organizational clarity and a means for quality assurance. They will clearly state: this is what we do and how we do it.

While there are multiple formats for documenting systems into policies and processes, effective operations documentation shares the following key features. They:

  • Contain up-to-date, written documentation.
  • Are easy to understand, even for a new employee.
  • Are clear and concise (the manual does not include every minute detail or complicate the process).
  • Accurately outline what is to be done and where processes fit in day-to-day operations.
  • Define all key roles, assignments, and responsibilities, including decision-making responsibility.
  • Indicate the expected result or outcome (e.g., desired performance).
  • Contain policies and processes for all practice systems.

Practice processes that should be documented:

  • Answering an incoming phone call
  • Handling a patient complaint
  • Paying an invoice
  • Billing a patient for services
  • Conducting a consultation with a new patient
  • Checking out a patient
  • Scheduling an appointment
  • Making appointment reminder calls
  • Rooming a patient and preparing patient chart for provider
  • Responding to a Web inquiry to the practice
  • Protocol for treatment/delivery of each type of service rendered
  • Checking in inventory items when received by the practice
  • Removing an item from inventory when it is used or sold

Practice policies that should be documented include:

  • Managing patients who are late (i.e., how late may a patient be before he/she must reschedule)
  • Handling a no-show
  • Carrying a balance for customers
  • Altering the assigned schedule times for each provider
  • Managing refunds (or returns for retail)
  • Returning phone calls from patients (time frame and who can return the call)
  • Purchasing/receiving products and services

Creating an Operations Manual

Once you understand the basic elements of system documentation and begin the process, you may choose to effectively compile the information into an operations manual.As you follow the five steps in the chart, you likely will identify and want to create new systems. Additionally, you will have the opportunity to determine if your systems are compatible. For example, are your front-office processes (check-in, answering the phone, etc.) and back-office processes (accounting, finance, HR, technology, administration, etc.) in alignment to effectively support the operations of the practice. To stay on target, remember to design your practice for the results you want to achieve. In essence, keep the end goal in sight.

Do not wait for the right time to start (i.e., when things are slower or you have the practice fully staffed). The right time is now. Your operations documentation does not have to be perfect from the start. Your processes and the documentation of them can and will improve over time.

Extraordinary Results

Systemizing your business takes time, but it is worth it. With your effective systems documented in an operations manual, it is possible to achieve consistently extraordinary results. Set periodic reviews of the documentation processes, practices, and policies; Always be on the lookout for ways to improve and optimize. By regularly checking and improving your processes, your practice will get better and your patients will receive superior service, outcomes, and value. And that's a major a win for everyone.

Barbara Sifford is a management consultant with the Allergan Practice Consulting Group, of Allergan, Inc. a specialty pharmaceutical company based in Irvine, CA. Mrs. Sifford consults with dermatology and plastic surgery practices in areas of financial analysis, practice valuations, human resource issues, internal and external marketing, team building, and aesthetic practice development.