Continuous Flow

It is more efficient to have a nice day with positive flow. The assembly line should flow continuously with as few interruptions as possible. Here’s a question, asked previously but now is the time to really answer. How much time does the typical patient spend in your office? Most EMR programs have ways to record this data, pull a report by provider, location, and day of week. If you do not have that luxury, simply track the first established patient per hour per provider per location for one week. So for Dr. A at 9 AM on Monday established patient one checks in and checks out, record that time on a log. At 10 AM the first established patient checks in and check out. Do this for a week. This will give you the baseline to know the answer.


Together with your overall cycle process map you now have two tools, which will help you, identify the gaps or bottlenecks that are facing your daily flow. The goal here is to make this flow as continuous as possible.

Here is where things get a little dicey when we think about your practice. The doctor is late, slow, takes phone calls, etc. That may be true and would need to be pointed out. But more in line with the argument is that each patient is different and therefore, having this data and goal does not make sense. If you are honest with your assessment, you may find that 80% of your patients, regardless of reason for visit, require the same amount of resources. Resources would mean time for staff, supplies, etc. If this is true, then you can set your systems to manage these 80% patients very simply. Meaning your systems will be set and geared to manage this flow as continuously as possible. The exceptions are where you will then focus on when they occur you will be ready to deal with that blip in the process.

One simple tool to use here is the “huddle” where the doctor and medical assistant and/or other staff meet three to five minutes prior to the start of the clinic to review who and for what reason the patients are coming in. Certain diagnosis or even certain established patients will take more time by communicating at the huddle you have all become aware of the patient that fits into the other 20% and be better prepared to manage the bottleneck.

The examples used relate to patient and patient flow. But these principles can apply to issues seen with the flow of charges and payments through the revenue cycle. How about the processing of accounts payable checks? It is not enough to think of these principles as only dealing with patient flow.

There are steps in every process that bring value to the business. Without these steps and improving them there would be little business value add, BVA. Here we have another concept that is critical since without efficient business processes the patient flow and eventual outcome would cause significant problems.

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