The Practice Manager's Guide to Time Management

The Practice Manager’s Guideto Time ManagementMcMasters’ Medical Practice ManagementMcMasters’ Medical Practice Management71 Tulip Street, Cheltenham Victoria 3192PO Box 68 Sandringham Victoria 3191Phone: 03 9583 65331

The Practice Manager’s Guide to Time ManagementIntroductionThe Practice Managers’ Guide to Time Management has been developed to assist both doctors andpractice managers better utilise the time allocated for tasks. It contains numerous practical tips andadvice and identifies the main issues connected to successfully running the practice. It has beenidentified as an area where practice managers and doctors alike have a keen interest, and a lot ofimportant information is contained in the guide.Time is allocated to each of us equally. Sixty minutes an hour, twenty-four hours a day, seven days aweek for fifty-two weeks in a year. No one gets any more or any less than anyone else. Wasted timecan never be reclaimed. However, there is always tomorrow: no matter how time is mismanagedtoday, there is always a chance to do better tomorrow.This guide introduces the concept of time management for doctors and practice staff. It identifiesareas where busy professionals can better balance the demands placed upon them, and offersinsight into crucial skills needed to manage time issues better. This module will assist both doctors2

and practice managers to utilise their time better, increase productivity and achieve a happier andless stressful lifestyle.Topics included in this module include:Reasons for time management strategies;Time management strategies and techniques;Prioritising;Self discipline; andDelegation.Further reading is encouraged on the topics and these will be identified throughout the module.3

14.1 A TIMELY INTRODUCTIONDoctors probably do not see themselves as “executives”. The word "executive" conjures up imagesof middle level managers, driving company cars to company offices, to carry out or create companypolicies for sales, production, and employment. Hospital management, the person next door, or abrother in law is an “executives”, not a doctor.Peter Drucker, the most credible of all management experts, disagrees. He defines “an executive” as:... “a knowledge worker who makes decisions, controls the allocation of resources within anorganisation, and is responsible for the results of the organisation 1 .”Virtually all doctors and practice managers are executives under Drucker’s definition, however,many doctors and practice managers do not see themselves this way. Doctors and practicemanagers are entrepreneurs, using capital to run businesses, responding to the market forces, whichinclude competition, to generate a profit. Therefore, time management, the productive use of time,is a crucial skill. It is also the only finite resource we have.This skill is particularly relevant where doctors face significant claims on available time, other thanfrom patients. These could include pressure from family and friends. It should be remembered thatmany doctors own their own businesses: therefore, there is a much greater incentive to managetime well. It is the practice results that are being improved, for their own benefits and interests, notthose of anonymous shareholders.There is only so much time available, so it should not be wasted. This means making sure time isspent productively, by allocating it in line with personal and business priorities and objectives. Themanner in which a doctor manages his or her time has a direct impact on the practice, as it affectsthe number of patients the doctor can treat, and the level of service that doctor can provide to eachpatient. As the practice manager role is to reduce the principal doctor’s involvement in alladministrative and managerial aspects of running the practice, it is important that practice managersassist doctors with time management, as well as manage their own tasks efficiently.Why time should be managed betterAs a general rule, doctors are good time managers. The economic and physical logistics of practicemean most doctors are very focused on seeing patients: a long line of patients in the waiting roomtends to distract thoughts to how to deal with a lot of work in a short time, yet still achievemaximum efficiency and effectiveness. Years of training in a demanding academic environment alsohelps develop intuitive time management skills.Time management methods should not be perceived as a magic wand to convert a doctor’s day froma hurried experience, balancing loads of equally urgent tasks, to a serene experience whereeverything runs smoothly and without hiccups. That is an unrealistic expectation.1 Butterworth Heineman, 1967, The Effective Executive, Peter Drucker, pages 7 to 8.4

AN EXAMPLEAssume that just one hour a day, or five hours a week, can be saved by improving timemanagement. Add, say, five hours a week for say, fifty weeks, and the equivalent of more than fivefull working weeks are wasted each year. What could be done with an extra five weeks a year?Answer: see more patients and make more profit, presumably an extra 20%. (Yes, that’s right, anextra 20%). Fees will go up by 10% assuming a 50-hour week, but costs should virtually not go up atall. Assuming costs of 50%, this means profit will go up by 20%. Or more. Alternatively, the sameamount of work could be done, and an extra five weeks could be spent on the beach over summer.Or a bit of both could be achieved.This is why time should managed better. There are two classic books relating to the area of timemanagement, which will be referred to in this module. They are “The Effective Executive” by PeterDrucker” (Butterworth & Heineman 1967), and “The Time Trap” (Alec Mackenzie, AmericanManagement Association 1990). Both books are recommended reading. They underpin virtually alllater writings on time management.Further reading:Kron J, 2010, Australian Doctor, Torn over time, 9 April 201014.2 TIME MANAGAEMENT TECHNIQUES FOR DOCTORS AND MANAGERSIn part 2 of “The Time Trap”, Mackenzie identifies the twenty biggest time wasters, along withsuggestions on how to respond to them. The following extracts follow this suggested format, withsome additional comments and concerns added, purporting a sensible way to survey the range ofpractical tips for managing time better, and achieving enhanced results. As the practice manager is adelegate of the doctor, and needs to assist the doctor with the managerial aspects of the practice,doctors and practice managers should both benefit from the information. Practice managers havethe ability to assist principal doctors, as well as improve the management and productivity of thepractice as a whole.PatientsDoctors create income from treating patients, therefore, the more patients a doctor treats; the moreincome a doctor can generate for the practice. This does not mean that a doctor should see tenpatients an hour, as this habit will most likely result in reduced quality of the services, and will alsobe likely to breach various professional standards. Appropriate allocation of time is necessary inorder to provide an adequate service, while at the same time maintaining realistic time efficiencies.A common concern amongst general practitioners is that patients consume much of the doctor’stime on “small talk”, and only get to the point of their visit towards the end of the consultation. Thismeans that valuable time is spent on ‘socialising’ with patients, which could be more efficiently usedto provide medical advice. It also means that some patients “steal” away from the doctor’s time,5

which creates a backlog in the waiting room. If a five minute delay on a fifteen minute consultationoccurs for 6 patients in succession, the 7 th patient will have to wait an additional 30 minutes for theirappointment.The following steps can be used to encourage efficiency and time management with patients:Control theconversationEnsurepatients areaware oftimerestraintsOnly allow15mins forbulk billedappointmentsAsk directquestionsBook longappointmentswherenecessaryControl the conversation. If a patient goes off on a tangent, politely refer them back to thereason for their appointment;If patients are being bulk-billed, they may have less regard for time than the paying patient.Ensure reception staff inform patients that most bulk billing will only be available forappointments of up to 15 minutes duration;Encourage reception staff to book longer appointments if a patient is known to bring up a widerange of issues;Control the conversation by asking questions, and once the answer has been ascertained, movethe conversation forward; andEnsure that reception staff explain to patients the length of their appointment. Some patientsvisit a doctor infrequently, and are simply not aware that they are allocated a set time.Practice managers need to enforce policies in the practice that clarify to patients’ the consultationduration, the need for multiple consultations, and encourage patients to book their family membersas a separate consultation to their own. If a patient is educated regarding consultation times at thereception desk, and charged appropriately for longer consultations, they may be more mindful ofthe doctors’ time allocation for consultations.Meetings6

Surveys indicate that up to half the time spent in meetings can be wasted. In reality it is probablymore: as some of the respondents may not want to admit they waste more than half their time.Some meetings go too long, some meetings should never be held.Practice managers should be familiar with the need to conduct efficient and productive meetingsfrom their studies of The Diploma of Practice Management - Module 10. Given the amount of timewasted on unnecessary meetings, this section aims to remind both doctors and practice managers toavoid this time wasting trap, and conduct meetings only when they are absolutely necessary.Practice managers should attend meetings instead of the practice principals whenever practical.Before calling or attending a meeting, consideration should be given to the following areas:Does there need to be a meeting? Perhaps others can simply set out proposed solutions, and askothers involved if they are agreeable. Can the meeting be deferred? Why are so many meetingsheld on a monthly basis? Can schedules be altered to “an every second, or even third monthmeeting”, rather than a monthly meeting;In a larger practice with several partners, it may be more relevant to nominate one partner asthe managing partner, and delegate all routine decisions (e.g. hiring a new receptionist, liaisingwith the practice manager etc), and make the practice meetings quarterly. This will allow theemphasis to focus on more important issues. The managing partnership role may be rotated, ora time allocation may be made to compensate for lost earnings (assuming the partnership doesnot share profits equally). It is much better for one practitioner to spend time on practicemanagement matters, than for four doctors;Check whether it is important for all participants to attend;Decide who should attend. People should not be invited out of courtesy. Unnecessary attendeesmay feel obliged to participate, regardless of whether it is appropriate;Prepare and circulate an agenda allocating time to each matter to be discussed; andStrictly follow the agenda and the time allocations.Staff meetings and meetings with co-owners should be distinguished from a social catch up. Alwaysbear in mind the opportunity cost sacrificed to attend the meeting, and ensure that all information isascertained in the most time effective manner.TravelTravel can be a big time waster for doctors. It is an advantage to live near the practice (but not soclose as to lose privacy). Driving an additional 20 minutes each way, twice a day, for example, addsup over a year. A long drive to and from work every day can be draining for doctors, and impact onthe efficiency and effectiveness of their working day.Doctors and managers should avoid other forms of travel when possible. The use of couriers,phones, e-mail or faxes, teleconferencing, and online video conferencing can help minimise travel.Clinics need to devise clear boundaries when evaluating time for home visiting services for patients,in order to provide effective overall care for the clinic demographic.7

If travel is required for a conference or a meeting, check any alternative or quicker options. If youare required to attend a meeting which requires extensive travelling, consider using ateleconference or Skype instead.AN EXAMPLEIssues relating to finances, where a meeting with an accountant could involve hours of travelling(particularly if a rural doctor is concerned), can be substituted with a Skype conference, eliminatingtravel time.Skype is free of charge, as long as both parties to the conference are online at the same time, andmost new laptops now come with an inbuilt video camera which makes this option even easier.Once Skype is installed, and doctors are comfortable using it, a video conference meeting can beheld, even if it is only 20 minutes away, avoiding the need to travel in traffic or search for parking.Naturally, any travel related to provision of medical services cannot be substituted via a Skype videoconference, but this option should always be used where practicable. Skype can be downloadedhere: Install Skype .The telephoneThe telephone can be a big time saver, or alternatively, a big time waster. Properly handled it is apowerful tool that generates significant savings and efficiencies, and is an integraltelecommunication tool in the day-to-day operation of the clinic. For a practitioner, the mostimportant telephone rule is to have an effective screening mechanism. Calls must be filtered, so onlyurgent calls are taken straight away and other important calls are deferred until it suits thepractitioner. A staff member should handle less important calls, and other calls should be, if notignored, handled briskly and efficiently by a staff member. Staff should be encouraged to tell anunwanted caller (for example a salesperson), in a professional manner, that their call is unsolicited,and not to call back. This is the best way of making sure no more time is wasted.The other potential problem is spending too much time on a call. Politeness is essential, butdigression from the purpose of the call should be skilfully managed. Use verbal cues to directincoming calls to business issues, and exclude non-business issues: “what can I do for you” isbrilliant. It smacks of service, is an offer of help and focuses on the issues at hand. Practised lines forending the call are also needed. To close politely say “well, we will see you next Tuesday at 9.00am”or similar words to tell the other person the call is closing, and then close it. And if something elseneeds to be discussed this is a very quick way of prompting it.Effective communicationClear communication can save a significant amount of time for doctors and practice managers. Thisinvolves listening, reading carefully, and speaking and writing meticulously, to clearly understandwhat information is being conveyed. A staff member coming back for a further explanation of a task,costs time for both the doctor and the staff member. There is also the time spent by the staffmember inefficiently, before deciding to revisit the issue with you. When instructing someone, test8

for receptivity. It is important to ask questions and invite feedback to gauge understanding. Clearlyand succinctly explaining instructions initially saves time in the long term.For matters of clinic policy, consider a memorandum on the topic and give it to everyone involved.Think about amending the practice manual so there is a permanent note on the matter, toencourage retention of information and for future reference when training new staff. Considerreferring the question to someone else “John can show you how to do that”, therefore, staff traineach other and the onus is not left to one person.Delegation of management tasksResponsible for treating patients, doctors should be doing very little in regards to managing thepractice. Each practice should have a practice manager, who deals with all other managerial andadministrative issues of the practice. All employees of the practice should be focused on assistingthe doctor with providing efficient service to patients, as this the focus of the practice, and withoutwhich the practice would not exist as a viable business.Some practitioners hold the view that unless it is done their way, it is done the wrong way.This is a very self-limiting view of the world. By undertaking to do everything oneself, it is unlikelythat much will be achieved, or at least not as much as if the art of delegation had been mastered.Delegation is an art, and an essential feature of all good practices. The most effective concept is toemploy qualified staff, train and induct them thoroughly, and to empower them to undertake theirroles. Comprehensive position descriptions and clearly outlining responsibilities are very important.Communication is also important to ensure all team members are aware of the “big picture”, ormission of the organisation, and the part they play in it.Doctors’ time is a scarce commodity, and it makes sense to ration it. Delegating all appropriate tasksto responsible people, and concentrating on patient service delivery, is the key to running asuccessful practice and getting home before dinner each night.Many doctors find delegating tasks a challenge. If a task taking three hours is delegated from apractitioner to a staff member, the practitioner is able to see fifteen more patients. This may add,say, $300 to the week’s profit (remember, the incremental patient does not add to fixed costs, sothe extra fees are almost all profit). This means the staff member undertaking the particular task hasmeant $300 in extra profit for the practice. If the staff member did not undertake the task, practiceprofits would be $300 less. Therefore, the extra profit can be attributed to the staff member.This outcome is the essence of delegation: free up the practitioner’s time so the practitioner canearn profits. “Support staff” is a very accurate term. Staff should support doctors by takingresponsibility for non-medical tasks, and allowing them to concentrate on treating patients. Whenmore patients are seen, the practice will improve its reputation (from a patient accessibility point ofview), and profits will commensurately increase.9

This is what economists call “opportunity cost”, i.e. the cost of the next alternative. It is a good wayof looking at things and allocating time and other resources. The question needs to be askedwhether someone else could efficiently do the job, other than the practitioner, and whether it isworth spending $300 to get it done. The opportunity cost needs to be examined, and assessedwhether it is worthwhile. When the answer is no, then someone else should be doing the job.Some practical guidelines for effective delegation include:Small mistakes should be expected; they are rarely fatal, and staff will learn from them. When amistake occurs, look at the system not the incident. If the system is in place and appropriate theincidents will stop;Perfection should not be expected. In some cases “adequate” is enough. “Adequate” costs lessand takes a lot less time;Results should be examined, rather than the process. It is the end result that matters: if thedesired result is achieved by someone else using a different method,(within reason) it does notmatter; andStaff should be loyal and reliable.Paper workPaperwork is an essential aspect of practice. The electronic revolution is often criticised as adding topaperwork not reducing it. The problem with paperwork is that it takes time to create, read, andstore. Introducing efficient paper handling procedures saves time. Some good ground rules are:Paper should be handled only once. Decisions should be made quickly: more than 80% ofmatters can be handled at the first thought level;The waste paper bin should be used. If it is not required to be kept, then bin it, don’t store it;andPaper work can be reduced and simplified by developing systems, including standardised formsand common filing systems.The right staffPractices need efficient staff; it is not a myth that the people within the practice can “make orbreak” the day. The right staff can also impact on your practice’s reputation. Patients can react to,and make decisions based on the staff, just as much as they do on their interaction with the doctor.Without effective and well-trained support staff, the best efforts of a practitioner can be wasted,and effective delegation of administrative tasks can become impossible. When inefficiencies set in,the workload increases rather than reduces.Two things are critical: sound selection criteria; and sound training programs.Selecting appropriate staff, and then developing their skills further, both in an “on the job” settingand a more formal external setting, is essential. External training should emphasise people skills androutine management skills, including personal organisation, and time management skills.When recruiting staff, time should be spent getting to know the candidates. Although instinctsshould always be trusted, time should always be taken to personally check references. Regardless of10

how impressive a new recruit may appear, it wise always to implement 3 months probation asstandard; as this allows many decisions that may have “seemed like a good idea at the time” to bereversed.Investing time and effort in your staff has the benefit of a better-trained, and a more knowledgeableteam, with a correlating high productivity. It also sends the message that the practice values its staff,and this in itself can help produce excellent results through supporting a motivated team.Self disciplineAs a discipline, medical doctors are generally known for their organisational skills. Vigilance and aregular return to basics helps maintain high standards of self-discipline that convert to better timemanagement and personal productivity.Self discipline can be improved fundamentally, by setting goals. These should be for the long term,the short term and the immediate. The degree of precision and detail is greater with a shorter timeperiod. Committing goals to paper and constantly refreshing your memory and consciousness ofthem, creates focus and facilitates achievement. This process should be systemised: a few minutesplanning each morning and a brief review each evening, to a more formal process for long termgoals. It is difficult to achieve goals if the goals have not been identified. The title of Wayne Dwyer’sbook “You will see it when you believe it” speaks volumes: the mere act of putting pen to paper canfacilitate achievement by channelling attention to the tasks that most require it.This task could be as simple as writing a “to do” list, or as complex as a large scale business plan.Goals should reflect priorities, and should distinguish between important tasks and urgent tasks. Theimportant things should time defined, and if something must be omitted, ensure it is not important.The practice manager should also use goals, budgets, and checklists, to ensure they are performingto their best abilities. Practice managers should keep in mind that support staff will be observingtheir behaviours, and will assume expected work ethics and the organisational culture from theirexample. It is critical for the practice manager to be sufficiently skilled in these areas, in order to setappropriate standards of efficiency and expertise for all staff.PrioritisingThe nature of the role of a doctor or manager in a busy practice will mean there will always besomething to do. Most doctors and managers thrive on a challenge, like to be stimulated at all times,and enjoy the responsible nature of their respective roles. This includes being faced with a variety ofchallenges, meetings to attend, patients to see, practical time related tasks to attend to, etc.High calibre performers such as executives and politicians manage to perform their roles effectivelyby prioritising their time well. Confidence is required to decide which tasks can be performed at alater stage, which tasks require more time and attention, and which tasks can be performed bysomeone else. Successful leaders are not the ones who manage to do everything, but the ones whoknow what needs to be done and when it needs to be done. Many doctors and managers fall intothe trap of performing many tasks at the same time. This is likely to compromise the quality of the11

performance, and increase stress levels. A calm and clever approach to the day’s tasks should betaken, as well as planning ahead.Urgent tasksUrgent tasks are the wild card: this is “urgent” in the sense of time, not importance, and there is abig difference. Techniques need to be developed to handle the urgent, unimportant tasks routinely:for example, setting aside an hour a day for returning low level calls and correspondence (or, evenbetter, assigning someone else handle these). Administration staff should be trained to screen callsand prioritise matters, so that they only address the doctor when his or her immediate attention isrequired. When a doctor is in consultation with a patient, full attention should be given to thepatient. All other medical and managerial requests should be dealt with when the doctor is not inconsultation.It is a good idea to set aside time on the weekly planner for the (expected) unexpected urgent tasks.A blank hour scheduled can make all the difference: for example not scheduling any meetings orroutine work between, say, 1.00pm and 2.00pm each day, leaving this space for routine importantmatters.Monitor progressSelf assessment is a useful tool. Tasks need to be completed in a timely and competent fashion. Thesame applies with goals: progress needs to be monitored, and self correction enlisted if there hasbeen a deviation from the course.Healthy competition is a powerful motivator. Setting budgets and standards that need to beachieved by each doctor in the practice, can increase productivity and enhance self motivation.Achieving measurable, achievable goals can be highly satisfying and increase motivation.Utilise technologyThese days, businesses have the benefit of superior technology that was unavailable twenty yearsago. This can vastly improve efficiencies in many areas. Personal computers, fax machines,automated practice systems, including patient recording systems and prescription systems, andnewer developments, such as the internet and internal and external e-mail systems, supportproductivity and profitability. The cost is minimal compared to the benefits.Recent developments in the technological industry include phones with internet access, and videoconferencing. Gadgets such as blackberries and iphones ensure that doctors and managers haveaccess to their emails and the internet, whenever and wherever they are. Video conferencingsoftware such as skype ensures that doctors and managers can arrange non clinical meetings withanyone in the world from the comfort of their home or office, at no out of pocket costs. This givesdoctors a flexible and quick option to be able to attend meetings, with little or no disturbance totheir working day.SocialisingThis is often an area where big time savings are possible. At work, social time should be pruned tothe minimum. Learning how to politely discontinue non-essential discussions and re-focusing12

thoughts on the matters at hand will minimise wasted time in a busy schedule. The “minimum” is, ofcourse, a personal thing, and taking this tactic too far can lead to loneliness and isolation.Socialisation is a work place lubricant that helps create and maintain good relationships with peers,staff and patients.In finding the right balance, it is relevant to bear in mind that studies have shown more than a thirdof an executive’s time can be spent on non-business interactions. In professions where time ismoney, and time is scarce, this sort of pattern is not acceptable, and leads to sub-optimalperformance. Doctors need to learn how to curtail lengthy interactions firmly, but with tact. Doctorsand managers should not feel every personal reference requires a response from them. Avoidemploying overly social people, (or timewasters): actually ask about this when checking references.Whilst it is critical for staff to have good communication skills, and it is commendable for them tohave the ability to socialise well with other staff, a balance is necessary in order for the practice torun efficiently.The practice manager should enforce a work-focused culture and always lead by example when itcomes to socialisation in the work place. Well-developed social skills do not include chatterboxtendencies. Every time a staff member spends five minutes regaling someone else with the story oftheir weekend, the practitioner can lose valuable staff time. This costs money and, can also cost thepractitioner time.A note to practice managersThe role of the practice manager is unique, as the principals of the practice entrust practicemanagers with the all non clinical aspects of managing a medical practice. Practice managers are‘agents’ of the principal doctors, and act as their eyes and ears when the doctors are busy treatingpatients. The core of the relationship between the principal doctors is one of utmost trust andconfidence, and this should be recognised by the practice manager and doctors at all times.Practice managers should do everything in their power to free the doctor’s time. It is important thatthe role of the practice manager is defined, and that the principals of the practice outline theboundaries of the practice manager’s authority. With time and experience, the practice managershould determine which matters the doctor wants to delegate, and which matters the doctor prefersto deal with personally. For example, some doctors involve their practice manager with theirpersonal finances, bookkeeping and taxation matters, whilst others keep personal affairs strictly outof the medical practice.Practice managers should also remember that their own time is valuable and delegate all noncomplexadministrative tasks to other lower paid staff. As the practice manager is the highest paidnon clinical staff member, it is important that they spend their time only with matters which noother administrative staff can handle. This approach will ensure that the wage paid to the practicemanager is utilised most effectively and that the practice receives value for their investment in thepractice manager.13

Finally, practice managers should keep in mind that they are a role model to all other staff, andshould lead by example. If practice managers take a systematic, well planned and well organisedapproach to time management, it is very likely that staff members will do the same.CONCLUSIONTime management is an essential skill for doctors and practice managers alike. Doctors and practicemanagers must learn to delegate and prioritise tasks. Effective use of the telephone,videoconferencing, and the development of new technology, can assist in ensuring that the doctor’stime is utilised efficiently, and that time wasters such as travelling, paper work and small talk, arekept to a minimum. Practice managers should assist doctors to achieve a productive and efficientwork environment at all times.FURTHER READINGSRACGP, Healthy Doctor Initiatives, http://www.racgp.org.au/healthydoctor (accessed 24 May 2010)Mid North Division of Rural Medicine have written an article about doctors looking after their ownwellbeing, and provides links to doctors for doctors. It can be viewed at Doctors looking afterthemselves.There are a number of other articles written by general practitioners, and published under theresources section of the Monash Division of General Practice that emphasise the importance of timeand stress management. They can be found at the following links:AuthorSarah CallegaDr Sanjiva Wijesinhaby Dr Sanjiva WijesinhaDr Susan KlootDr Gary KilovDr Tim FooDr Peter TsoiAssociate Professor Peter SchattnerDr Marion LustigLinkAre you assertive?Enjoyable very busy daysThe rule of threeLaughterWhy you need your own GPBetter healthAre GPs more stressed than lawyersGPs are human tooPeer support: Balint groups as reflective spacefor GPs14