Eyecare Office Patient Flow: A Guide to Measure & Maximize It

Patient and office flow are essential performance benchmarks for eyecare practices. They not only correlate with patient satisfaction, but also provide an accurate big-picture view of operating efficiency — touching on aspects of staff performance, teamwork, effectiveness of management, and more.

When measured properly, these flows capture every patient touchpoint from scheduling, to admission, consultation, treatment, discharge and beyond (including timely and accurate claims filing, and the resulting reimbursement).

That's why they're incredibly helpful tools for identifying the exact areas in which your practice can improve.

A well-managed practice with optimal patient and office flow will have:

• Less stress for office and practice staff
• Lower patient wait times
• Higher patient satisfaction ratings
• Better patient retention
• And increased profitability for a variety of reasons relating to overall efficiency.

However, at many eyecare practices — of all sizes — I see, time and time again, that efficiency is lower than it could be. Patients are kept waiting before and after admission, staff and doctors feel overwhelmed, morale is lower than it should be, and resources are wasted daily.

Quantifying and optimizing your patient and office flows may not solve every single problem your practice faces, but it's an excellent start!

In this guide, I'll teach you proven methods to increase your practice efficiency and flow from my perspective as an eyecare practice management consultant, with details on the best measurement techniques, Key Performance Indicators (KPIs) for both patient and office flow, and an easy-to-use checklist to get your practice up to speed.

How to Think About Patient Flow and Office Flow

Optimal patient flow is maximizing the number of patients you can see with minimal waiting and downtime.

Office flow, a related measure of efficiency, is about how efficiently data and paperwork move through your system, including the appointment scheduling process, patient forms, optical data entry, claims submissions, and more.

But improving your patient and office flow isn't only about improving the averages; it's also important to remember that greater efficiency can reduce negative experiences for both patients and staff. No patient wants to take half a day off from work, and no staff member enjoys the resulting conversation.

And the results of inefficiency can be a lot worse than that. For example, as an eyecare practice consultant, I've seen situations where patients went back for surgery without the staff verifying their insurance information. This type of error not only results in one-star reviews, complaints, and unpaid bills, but also wastes additional staff time trying to make the situation right and collect payment.

Factors that Reduce the Efficiency of Your Practice

In modern eyecare practices — as well as most other types of outpatient medical practices — there are two opposing trends that increase pressure on staff and doctors:

• Declining reimbursement for procedures means that we need to see more patients than ever before to maintain profitability.
• Yet simultaneously, increased competition (more providers available for patients to choose from) and greater reliance on metrics from patient experience surveys mean that patient satisfaction is paramount.

Essentially, these trends create a catch-22 situation: there's an incentive to cram as many patients into each day as possible, leading to scheduling problems and other issues, while there's also a greater penalty for providing a less-than-stellar patient experience.

Additionally, in a busy, high-pressure practice environment, mistakes and inefficiencies tend to multiply, as we saw with the surgery example in the previous section. A "small" administrative mistake you don't catch early can rapidly turn into a huge waste of time and resources.

Common factors that add friction and reduce practice efficiency include:

• Industry-wide staffing shortages
• High front desk staff turnover
• A lack of consistent, standardized, up-to-date training for new and current staff
• The need for staff to enter the same patient visit data into multiple software platforms (practice management, insurance or benefits submission, optical records, etc.)
• The higher complexity of billing for eyecare compared to other fields.

We can't control things like staffing shortages, but most eyecare practices can boost efficiency over time with some techniques including:

• Consistently reviewing and learning from data entry errors and other oversights so your team can improve over time (and detect issues early, before they become endemic to your practice culture)
• Creating a central training repository and updating it regularly (rather than relying on word of mouth or email to keep office staff current on SOPs)
• Placing long-term, concerted focus on staff retention and morale to reduce turnover.

And in turn, these fundamentals will increase your patient and office flow KPIs, which are explained below.

Every eyecare practice is different, but most practices today face similar problems: hiring and staffing challenges, an overwhelming number of repetitive data entry tasks, and specialized coding and billing requirements unique to eyecare. One solution for these issues is revBot by Revival Health, an innovative automation service that eliminates most repetitive tasks, minimizes mistakes, and helps teams do their best work together.

Making a Plan to Benchmark and Improve Your Patient Flow

The only way to get a 100% accurate understanding of your patient flow is to conduct a time study. A time study involves tracking each and every patient who enters your practice over a given period of time — usually for a full week — and measuring the time each patient spends at each touchpoint.

Software-based vs. Manual Time Studies

You can perform a time study one of three ways:

• Most ophthalmic and optometric practice management software has built-in time study functionality (speak to your product support team to learn how to enable it or extract time stamps).
• Most practice management software is compatible with third-party software that does this (examples: Visual Clinic and Practice Flow Solutions).
• "Old school," manually, with an Excel spreadsheet or a clipboard (I've also included printable sheets you can use in the next section).

The software options may sound attractive and convenient. However, there are a few downsides to know about:

• A staff member must spend time contacting support for information on how to enable a time study, or comparing available third-party options, and then setting it up and testing for accuracy prior to full implementation.
• A software time study is only as good as the data it receives. This means it's skewed by common data entry errors.
• It provides a less complete data set compared to the manual method (for example, PMs may not capture a patient's time spent waiting before admission accurately, or may require that certain team members' names be entered manually or derived from that week's schedule).

You will need to determine which option will provide your practice with the best results. A manual study is intrusive and asks each team member to add to their workload, but the results will be well worth the effort.

How to Conduct a Time Study and Analyze the Results

First, you'll need to prepare for the time study by meeting with your team and sharing expectations with them. You'll need to assign or nominate a senior team member as the master timekeeper, and provide everyone with individual time sheets (or instructions on using your chosen software).

If you're using the printable tables below, it's best to fill out the first two columns of each sheet at the beginning of the day (patient number and appointment time, with the scheduler's initial, if available) according to the order of appointments. It's easiest to write every scheduled patient in on everyone's sheet, then have an employee draw a line through the entire patient row if they didn't have contact with that particular patient for whatever reason.

Use caution with details like patient initials, since they're considered protected health information (PHI) under HIPAA. If needed, you can also cross-reference appointment times to confirm which patient was which later on, or write non-identifying details in the "Notes" column on the far right of the master timekeeper sheet.

Printable Time Study Sheets for Eyecare Practices

Print as many sheets as needed for each employee (each sheet has room for ten patients) in Landscape orientation, or use the individual patient time study sheet for each patient.  

You can also have these files emailed to you as high-resolution PDFs here (you'll also receive PDFs with a list of KPIs and patient and office flow checklists from this article).

Tips for a Successful Time Study

In a perfect world, the master timekeeper makes the rounds and tracks patients in real-time. But this often isn't possible during peak hours, especially at larger practices.

Ensure each employee who has patient contact records the beginning and end time of their contact. That way, the master timekeeper can cross-reference their sheet with the employee sheets in case they miss a transition. And you'll save the employee sheets for further analysis later on, too.

Also be sure that everyone is using synchronized clocks or other methods of timekeeping that match perfectly — double-check them at the beginning of every work day during the week of the time study.

At the end of each day, collect all the time sheets and make sure they're legible and filled out correctly. And if you're going to enter the data into Excel or another spreadsheet, it's smart to go ahead and do it each evening rather than letting the sheets pile up for the full week.

Digital spreadsheets are an excellent way to get a better understanding of the data with automatic functions (such as automatically deriving the number of minutes from one touchpoint to another, or even creating data visualizations).

You can also do the math manually to figure out time spent from one touchpoint to another, then input that into the spreadsheet rather than the recorded times.

Along with the specific KPIs listed later in this guide, you can use the manually-written timesheets to look for:

• Patients who were skipped over
• Unusually long transition times occurring at any stage of the process
• Other outliers
• Average differences between employees in the same role

As with the front desk observation exercise I described in the previous section, this process is much more effective when you dig deeper, investigate, and ask "Why?" And then ask additional follow-up questions!

You may want to perform the qualitative analysis described above at the end of each work day, when your staff's memories are still fresh.

Most importantly, when the time study is complete, decision-makers at the practice need to:

• Digest the insights
• Make a plan
• Propose process improvements with team input and consensus to increase efficiency based on lessons learned.

I recommend making time studies a regular part of your practice's culture and conducting one either every six or twelve months as resources allow. Make sure your team understands the benefits to them personally and that it's not a form of punishment.

Qualitative Methods to Assess Your Practice's Efficiency

What if you're not prepared to do a time study yet? No problem!

While you won't be able to obtain quantitative patient flow data without a time study, there are several highly effective qualitative methods which you can use to increase efficiency with less commitment and resource use compared to a time study.

You can also use this approach along with a time study — in fact, they work very well together (but not during the same week!).

Front Desk Observation

Step one: have a senior employee or front office manager sit at the check-in area for a designated period of time and observe the check-in process passively.

Because many problems with both patient flow and office flow begin at check-in, you can often find a plethora of areas for improvement here.

Here's what to keep in mind:

• Spend at least two full days, preferably three, observing. (This helps the front desk employees relax, and a longer observation period provides a far better reflection of what's actually going on.)
• Don't use the observation period itself as a training opportunity. (If you correct every minor issue you see on the spot, you'll stress your staff out and won't get as many actionable insights. Make an exception if you see a preventable disaster about to happen, but keep it upbeat.)
• Take notes on what you see going well (consistently following SOPs or best practices, efficiency, coping with distractions, good attitude, helpfulness to patients) and not so well (inconsistency with SOPs, skipping steps, poor time management, things that don't seem to make sense, spending too much time chatting or oversharing).

After the observation phase, you'll have plenty of time to get to the bottom of issues you observed.

Post-observation Debriefing, Q&A, and Problem-solving

At the end of the observation period, sit down with the check-in staff for a debriefing. Now is the time for you to ask questions and learn the reasons behind any issues you noticed.

While it's fine to offer some feedback at this point, I urge you to keep it mostly positive, while inquiring in a neutral, nonjudgmental manner about any potential problems you observed from your detailed notes. The purpose here is to learn about what's happening, not to chastise individuals.

The most helpful question you can ask is often: "Why did you do that the way you did?"

Very commonly, staff will answer that: "We've always done it that way."

Many times, you may find an opportunity for an unplanned followup question. Dig as deep as possible into each issue you find.

For example: "When did this problem start? Is there a specific reason you didn't communicate about this at our last meeting?"

Now, if your practice is relatively small, you may be able to segue directly from the debriefing to providing feedback, but I would recommend that instead, you spend another day or more figuring out global solutions to these problems and holding a separate meeting.

If there are any remaining individual performance or personality issues to straighten out that are unrelated to the staff as a whole, it's best to address them one-on-one with the person in question.

Key Performance Indicators for Patient and Office Flow

For the time study KPIs below, be sure to compare your improvement from one time study to the next (either at a six-month or twelve-month interval).

For the others, which are easy to collect consistently and track without doing a time study, I recommend that you analyze and compare them quarterly.

Time Study KPIs

• Average patient wait time from check-in to admission
• Average patient time from admission to checkout (sorted by type of visit, if possible)
• Average patient time spent with specific provider or other employee
• Average patient time spent waiting for specific provider or other employee
• Number of patients skipped or overlooked at any stage
• Also remember to look closely for individual outliers (abnormally long time values, whether overall or at a specific stage, or other data that looks unusual) and investigate them thoroughly.

Other Patient Flow KPIs

• Number of complaints about wait time before admission
• Number of complaints about wait time after admission
• Number of other complaints regarding scheduling
• Number of patients sent back without completing admission forms
• Number of patients sent back without verification of insurance or benefits verification

Office Flow KPIs

• Number of patients whose information was not verified as current before the day of the appointment
• Number of patients whose benefits or insurance information wasn't entered manually before admission (for example, scanning a card without typing the accompanying number)
• Number of billing issues caused by incorrect (non-verified) or missing insurance or benefits information or other incorrect or missing information

Number of any other data entry errors that caused problems or were otherwise detected

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Eyecare Patient and Office Flow Checklists

Use these checklists to ensure you're maximizing your patient flow and office flow.

Time Study and KPI Checklist

• Conduct a one-week time study as often as needed.
• Analyze metrics, investigate issues, solicit input, give feedback, and update processes as needed.
• Consider qualitative analysis (such as observing the front desk).
• Constantly track complaints, incomplete forms, incorrect or missing billing data, and data entry errors. Fix issues as early as possible, then discuss the numbers quarterly.

Front Office Checklist

• Always verify the patient's insurance and eligibility before the appointment.
• Patients must complete forms and sign necessary documents before being seen.
• Schedule the patient's next appointment during checkout.

Team Meetings

• Hold team meetings and review patient and office flow KPIs as well as any SOP updates.
• Solicit input on potential issues and how to fix them.
• Set measurable, KPI-related goals together.

SOP and Best Practices Repository

• Create a centralized, easily-updated repository (cloud services that allow a HIPAA-compliant Business Associate Agreement such as Google Drive, Amazon Web Services, or Microsoft Azure work well) to keep your team on the same page instead of using email, word of mouth, or a binder.
• As soon as SOPs change for any reason, immediately update your team verbally, direct them to the repository if needed, then discuss the changes during the next meeting.
• As you review your KPIs, qualitative analysis, and other measures of patient and office flow, look to improve your process globally.

Closing Thoughts

Benchmarking and improving your practice's patient flow (maximizing the number of patients you can see with minimal waiting and downtime) and office flow (how efficiently data and paperwork move through your system) is an excellent use of time and resources.

Optimizing your patient and office flow results in less stress for staff, lower patient wait times, higher satisfaction and retention, and increased profitability.

To get an accurate picture of patient flow, it's necessary to conduct a time study by enabling time-logging functionality in your practice management software, keeping records with printable time sheets, or utilizing third-party time study software.

A less time-consuming way to improve your patient and office flows is to conduct a front desk observational study to observe potential inefficiencies, ask follow-up questions, and then debrief your staff and update your SOPs accordingly.

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