Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How to provide individualized care in an era of standardized office processes and procedures

Yul Ejnes, MD
Physician
November 29, 2016
Share
Tweet
Share

acp new logoA guest column by the American College of Physicians, exclusive to KevinMD.com.

It’s been several years since we transformed our practice into a patient-centered medical home and started to truly work as a team. As I’ve written before, working as a team is one of the biggest reasons for my practice satisfaction increasing over the past few years.

While I am more satisfied with my practice than I have been in a long time, I would not say that practicing in this new model is without its frustrations. One of them has been the effort to standardize office processes and procedures. Most practicing physicians reject the development of “standardized” ways of doing things as being more appropriate for factory assembly lines and counter to the principles of individualized care that are the core of the patient-physician relationship. As a result, there can be tension between practice administrators who seem to want to standardize everything in the name of efficiency and reducing variability, and physicians and their support staff who want to do things their way.

In our practice, we’ve managed to navigate these waters by standardizing those processes that it makes sense to standardize and leaving the rest alone. So while we all need to enter tobacco use histories in the same field in our EHR, documentation of data that is not “mined” for reporting is left up to the physician. Referrals, from sending the request, recent office notes, and labs to tracking whether the patient showed up are handled in the same manner by medical assistants (MAs). All of us are expected to do pre-visit planning, but how it is done by each team varies slightly.

The importance of the team and the role of standardization hit home for me a few weeks ago when my MA went on leave for three months. We’ve worked together for a few years, and without a doubt, she has been my right hand (actually my left hand since I’m left-handed). My office manager refers to us as a “well-tuned machine,” and I have to agree. When I decide that I need something, more often than not she’s already working on it before I ask. My patients feel comfortable with her being their point of contact and communication with me.

Faced with the loss of my MA, I worried about whether I would have to do things that I had long ago delegated to others. Fortunately, one problem that I did not have was finding a replacement MA. While we can’t afford to overstaff our office, it is large enough to allow us some flexibility in how staff members are deployed. The bigger question was not whether I would have help – it was would I still have a “team”?

Fortunately, I did. This is where standardization came in. I did not have to “break in” my fill-in MA, a long-time staffer who was well-versed in our standard procedures and very capable of learning how I do the things that are not standardized. In fact, my regular MA spent a half-day teaching her my various quirks (I’m surprised she got it done in only a half day). While I don’t have the almost telepathic team that I’m accustomed to, I am still getting my work done as efficiently and hassle-light as I was before, to a great extent because most of the functions that were delegated to the MAs as part of our team-based model were amenable to standardization.

How relevant is this to the ultra-small practice, where getting staff to fill in for leaves, vacations, and resignations is a major headache? I think that much of it can be applied. Reviewing all the tasks that members of the staff perform and identifying the ones that can and should be standardized and which ones can be left to the individual is a good start.

Examples of tasks that might be standardized include:

  • How non-interfaced labs results that you are tracking are entered into the EHR.
  • How standing orders for flu immunization are handled.
  • How medication refill requests are processed.
  • What the MA does when he or she brings a patient into the exam room, such as obtain vital signs, medication reconciliation, and depression screens.
  • How patients on warfarin are managed and monitored.

What are the lessons here? First, standardization of office processes and procedures is not incompatible with the “personal touch.” While each team member brings something unique to the team and the patients it serves, the ability to seamlessly reconfigure teams when necessary is valuable and does not diminish that uniqueness. Second, when “team-based care” is more than jargon, the importance of all members of the team, regardless of their title, license, or level of training, transcends being “just another body” to get things done. Finally, having a set of standard policies and procedures, while important, is not enough – members of the team must communicate, so each understands what the other expects of them and to allow the team to be more “personal” to patients and team members. This promotes greater provider satisfaction, one of the four components of the “quadruple aim.”

Yul Ejnes is an internal medicine physician and a past chair, board of regents, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

Image credit: Shutterstock.com

Prev

A physician-mother's call to action at a medical meeting

November 29, 2016 Kevin 0
…
Next

Time is fleeting and doctors must focus on what’s important

November 30, 2016 Kevin 1
…

ADVERTISEMENT

Tagged as: Primary Care

Post navigation

< Previous Post
A physician-mother's call to action at a medical meeting
Next Post >
Time is fleeting and doctors must focus on what’s important

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Yul Ejnes, MD

  • Different perspectives but the same goal: providing the best possible care to patients

    Yul Ejnes, MD
  • Rising premiums, high deductibles, and gaps in coverage before the ACA

    Yul Ejnes, MD
  • Improving physician satisfaction by eliminating unnecessary practice burdens

    Yul Ejnes, MD

Related Posts

  • How social media can help or hurt your health care career

    Health eCareers
  • Health care delivery after COVID-19: Move more procedures to the outpatient setting

    Shikha Jain, MD and Krishna Jain, MD
  • Why health care replaced physician care

    Michael Weiss, MD
  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Care is no longer personal. Care is political.

    Eva Kittay, PhD
  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD

More in Physician

  • Removing vaccine advisers could jeopardize lives

    J. Leonard Lichtenfeld, MD
  • Why would any physician believe that the practice of medicine will become less abusive for them in the future?

    Curtis G. Graham, MD
  • The hidden war on doctors: Understanding administrative violence

    Maryna Mammoliti, MD
  • How doctors can stop frivolous lawsuits before they start

    Howard Smith, MD
  • How the 10th Apple Effect is stealing your joy in medicine

    Neil Baum, MD
  • When a doctor becomes the narrator of a patient’s final chapter

    Ryan McCarthy, MD
  • Most Popular

  • Past Week

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
  • Recent Posts

    • 9 domains that will define the future of medical education

      Harvey Castro, MD, MBA | Tech
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • What led me from nurse practitioner to medical school

      Sarah White, APRN | Education
    • Why local cardiac CT scans could save your life

      Benjamin Cohen, MD | Conditions
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
    • How the 10th Apple Effect is stealing your joy in medicine

      Neil Baum, MD | Physician
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
  • Recent Posts

    • 9 domains that will define the future of medical education

      Harvey Castro, MD, MBA | Tech
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • What led me from nurse practitioner to medical school

      Sarah White, APRN | Education
    • Why local cardiac CT scans could save your life

      Benjamin Cohen, MD | Conditions
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How to provide individualized care in an era of standardized office processes and procedures
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...