When something in a practice runs slow, most of us respond by adding to it. We hire another front desk person, write a new checklist, or buy software. I've done it myself, and I've watched plenty of clients do it.
David Carneal would tell you to hold off. David runs Digital Efficiency Consulting Group and spends his days figuring out how work actually moves through an organization. When he came on Eye Care Leadership Live, most of his stories came from manufacturing and corporate settings. I kept thinking about eye care clinics the whole time.
Diagnose first
David follows a channel where a car dealership's service manager reviews customer calls. In one, a customer has looked up a code online and wants his oxygen sensor replaced. She tells him they'll run a diagnostic first, because the code might point to a bigger problem, like the catalytic converter.
Clinics skip the diagnostic all the time. Patients complain about wait times, so the practice adds a front desk position. Meanwhile the real backup is in pretesting, or in a doctor's template that's double-booked every Tuesday afternoon. Before you change anything, follow a patient's visit from start to finish and watch what happens. It rarely matches the process on paper.
Look past the person
This one hit home for me as an HR consultant who supports clinical healthcare businesses across the country. When a staff member looks like they're slacking, leaders tend to focus on that one person. David says to look at what's happening around them. The tech leaning on the counter might be waiting for a chart that's stuck with someone else.
In his experience, people are usually the symptom. Sometimes it really is the employee, and sometimes it's a good employee in the wrong role. Either way, you won't know which until you follow their work through the whole process. I'd do that before any write-up.
Processes grow when nobody's looking
A practice that's been around a while has added a lot over the years: new doctors, new services, payer rules, compliance requirements. Each change gets tacked onto the existing workflow. David described a process that should take 17 steps turning into 45, with several people each doing part of the same job.
His suggestion is to review workflows the way you review your finances. For most practices, that's once a year. If truly nothing has changed, he'd still look every five years or so.
Ten seconds adds up
My favorite story from the episode: one of David's clients had a step that added 10 seconds to every line item on every order. I gave him a hard time about it on the show. Ten seconds?
Then he did the math. Across roughly 300 orders a day, with around 100 line items each, it came to about $250,000 a year. That was more than the system upgrade they'd been trying to budget for.
Every clinic has a few of these. Maybe it's an intake form that asks for the same information twice, or a recall list somebody builds by hand each week. David calls fixing them "twisting knobs and flipping switches." They're small, and they're usually where the money is.
Ask the people doing the work
David thinks your frontline staff hold about 70% of what you need to know to fix a process. They see the problems every day. He asks them two questions: "What bothers you day in and day out?" and "How would you fix it?"
Don't expect a finished plan. You'll get something rough, and that's where the useful ideas start. Your bigger job is making it safe for people to speak up without getting talked down to.
Start with the patient
David ended with the point that matters most for us. Design your workflow around the patient's whole visit, from booking to checkout, instead of tuning each department on its own. He told me about a visit where he had labs drawn, saw the physician, and walked out with a prescription in 36 minutes. He said he felt cared for and listened to.
Where to start
If you want to try this in your practice, here's what I'd do over the next month:
Shadow one patient visit from scheduling to checkout, and time each step.
Ask one person in each role David's two questions, and write down what they say.
Pick one small step that happens on every visit and get rid of it.
Put a yearly workflow review on the calendar next to your financial review.
Before your next disciplinary conversation, follow that employee's work through the process.
You can hear the whole conversation with David on Eye Care Leadership Live, on Apple Podcasts, Spotify and YouTube. Links below.
Apple - https://podcasts.apple.com/us/podcast/healthcare-leadership-live/id1824450384
Spotify - https://open.spotify.com/show/3ORgeP9UqtEcEco3lEQaaS
