By Sanjeev Bhatia, MScPT, MBA
I cover clinic operations, practice management systems and technology, business development, and online presence. bhatiasanj@gmail.com

Structure Dictates Function.

It’s simple. As in biology, structure dictates function. In our case, how you’ve structured your clinic operations (also known as business processes) and how well understood they are by your staff will impact almost every decision you make!

There is not a single clinic initiative or strategy which does not require business processes to be setup, regularly reviewed, and measured. The clinics that have time to focus on new ways to generate revenue (ie No obligation consultations) are the ones that are not spending significant amount of time dealing with issues on how the clinic is run.

I often describe operations as the clinic’s nervous system, providing the pathways to perform functions through the coordination of tasks and flow of information.

So today, I want to share 6 easy tips to help you scale your operations and free up your time.

Keep in mind that a business process is characterized by 3 things:

• People and roles involved
• Steps and Tasks (within each step)
• Resources and tools required to perform a step/task (e.g. practice management software, information technology, documents, forms, reports, etc)

The Reality Of The Situation

Over the past 10 years I have worked with over 100 rehabilitation clinics and hundreds of therapists in the areas of operations, systems and technology, and business development. A simple initiative such as starting a business Facebook page to drive your SEO strategy can be derailed without first setting up the proper business processes:

1. How is content created, reviewed and posted?
2. Where is content stored so it is easily accessible and not sitting on someone’s personal computer?
3. Who is responsible for the content strategy – content topics, call to action, responding to comments, campaigns\giveaways?
4. How often is content scheduled and posted (daily, weekly, monthly)?
5. What resources and tools do people need? e.g. stock images and photography
6. How is the Facebook page linked to other web initiatives – website, blog, other social media, smartphones, request an appointment online, etc
7. How is success and performance on the page measured? Is it driving business – phone calls, emails, request an appointment online?

Take a look at some of your competitor Facebook pages in your community. If you find that some are not being updated regularly or have been ignored for months, the cause is likely related to not establishing the proper structure (people, tasks, resources) so the page can function for the long term.

The same concept and issues hold true for more traditional and complex clinic business processes: referral workflow, patient scheduling, patient intake, assessment-treatment outcome tracking, post discharge and patient retention, invoicing, payments (AR, AP), payroll, etc.

In theory, a consistent focus on your business processes can:

• Reduce or eliminate any confusion regarding which tasks are required, how tasks are completed, by which staff members or roles, in what timeframes, with what resources, etc
• Save you time and effort in trying to troubleshoot and provide answers to your staff on how to complete certain tasks and work
• Be leveraged to drive new business, generate referrals and retain repeat business (patient retention)
• Establish standards and consistency as it relates to delivering service, patient experience, quality and satisfaction

In reality, I can report with confidence that clinics have very little time, resources, or the right skillsets to ensure all three areas (processes, systems and technologies, business development) are functioning correctly, working together effectively, and are regularly being reviewed and updated.

So, What Can You Do and How Do You Do It?

Let’s first start with some questions to consider as you read on:

• Does your staff regularly ask how something is done or who makes a particular decision?
• Do only one or two people know how certain processes work and the rest mostly take direction?
• Are people in the same role working in their own or different ways?
• Have temporary workarounds become permanent solutions?
• Is it challenging to get responses to questions within a reasonable amount of time?
• Is it difficult to find and get the information you need to make decisions?
• Do you think it is taking too long to complete certain tasks?
• Are revenue opportunities (e.g. referrals, patient retention) being missed?
• Is your staff finding it challenging to use the practice management software?
• Is information being collected on paper and then inputted into your practice management software?
• Does your staff report that they don’t have the proper tools to do their work so they make their own?
• Are staff members performing tasks outside of their job role?
• Are initiatives started but often not maintained or left undone?
• Is it difficult to get new initiatives setup and off the ground?
• Are you finding inconsistencies in patient experience, satisfaction and quality?
• Do you have the feeling the clinic could be running more efficiently?
• Do you only have a general sense of how certain tasks are completed and rely on your staff to know the details?

What Is The Scale of Your Operations?

If you have or are planning on growing your business with multiple clinic locations under a single brand it is worth the investment to have someone come in to map your current processes, identify “pain points” or areas of inefficiencies, provide process solutions (people, steps\tasks, resources), create updated process maps, provide ways to measure process performance, and train staff on the improved ways to complete tasks and work together.

Although originally developed for manufacturing, I use the popular Lean Six Sigma approach to business process management which provides a Define-Measure-Analyze-Improve-Control model to follow. For a company with multiple clinic locations and a start-up or acquisition strategy, without a focus on business process management over time you can be creating a monstrosity (e.g. redundant, one off, siloes, workarounds) of processes which will eventually need to be untangled and standardized at significant cost and effort.

For a single clinic owner, the Lean Six Sigma approach is much too time consuming and expensive. A simplified, modified approach can be undertaken and still have positive impacts on your operations.

Step 1: Document The Process

Start small! Select a business process which you think needs to be updated, for example patient intake to first Assessment. Next, on a piece of paper draw how the process currently works:

1. The steps involved including the tasks and decisions associated with each step
2. The timeframe between each step
3. The people involved in each step
4. The resources\tools required for each step
5. Review the schematic or document with your staff to get their feedback. Are there any missing elements – steps, people, resources\tools?

Step 2: Analyze The Process & Provide Solutions

1. Are there any redundant or missing steps?
2. How is information collected and transferred from one person/role to another?
3. Are any step to step timeframes too long? Identify some reasons why
4. Is it clear which tasks each person\role is responsible for?
5. Are systems and tools (e.g. forms) causing process challenges? If so, how can they be updated?

Step 3: Share The Updated Process With Your Staff and Provide Training

1. Show the updated process to your team. Do they understand it? Collect their feedback
2. Make the changes in a timeframe you can manage, step by step if need be
3. Train staff on how the changes impact their role and tasks

Step 4: Measure Success

Select 3-4 ways to measure the impact of your changes. This may include:

• Feedback from your staff. Is it easier for them to do their work?
• Feedback from your patients. Does your patient satisfaction surveys include process related questions e.g. how easy it is to schedule an appointment, access their home exercises
• View indicators and reports available in your practice management software

Remember…Structure Dictates Function!

Your operations and business processes are fluid! More specifically they are changing all the time – new initiatives, new programs and services, new reports, acquisitions, new clients (e.g. Employer Services), requirements for RFPs, new roles, etc. Documenting, reviewing and analyzing, sharing, and measuring your operations is the first step to any clinic performance strategy.