The NittyGritty of Office Operations Policy and Procedures

The Nitty-Gritty of Office Operations: Policy and Procedures Manual David Kolva, MD Practice Management Seminar

Seminar Learning Objectives n Understand Why Most FP’s Offices are INEFFICIENT and CHAOTIC n Advantages in Using a Well-Planned Manual and Job Descriptions n Develop a “User-Friendly” Policy and Procedures Manual and Stimulate Use of Same.

What do BABIES and Office Staff Members have in Common? n They both Learn VERBALLY! Is This the Most Efficient Method - or Just the Most Convenient at the Moment? n

Problems with Verbal Teaching (Folklore Approach) n Inconsistent Content between Teachers (i. e. preceptor’s room) Teacher’s Tendency to Forget or Misinterpret Policy (“put own spin”) n Dependent on Teacher’s Presence n n The Person Most to Gain (Owner) is LEAST Likely to be the Teacher!

Purpose of Policy Manual n n n Greatest TASK of Leader = articulate the vision. The Manager creates the road map so everyone knows their role and expectations. Without a clear policy manual, mistakes are made repeatedly - consumes an inordinate amount of time and energy to remedy.

Glossary n POLICY - Making a recurring decision just once. n PROCEDURE – EXPLICIT set of instructions about how to carry out the policy.

Advantages of P & P Manual n Save TIME: no need to debate what to do! If situation fits, do the procedure! n Decrease Chance of Misunderstanding/Resentment: Each staffer is treated the same each time. n Quick Quality Decision-Making n Staff gets to OWN policy & procedure if they are part of formulation = better compliance

Advantages of P & P Manual n Decreased Training-Time of NEW Employees and Encourage Cross-Training of Positions n Reduce Variations in Patient Care n Improved Risk Management: Comprehensive P & P establishes “Usual Practices” and Averts Carelessness

Job Descriptions Absolutely Essential! Most Failing Practices DO NOT have Job Descriptions. n Explicit Outline of Duties for each employee. n – Specificity directly predicts performance. – Teamwork improves if everyone knows what is expected of them!

Policy Manuals n Paper-Based Book: – Looks nice, but less utility & hard to update! – Loose-leaf cheaper and easier to update, – Each employee & work station needs own copy – Many existing templates n Computer Based: – Better utility and easy to update! – Requires computer literacy – Security issues – CREATE YOUR OWN PRACTICE INTRANET!! n HTML

As A New Employee……… n If joining an established practice, perfect opportunity to create or update the practice’s P & P manual. v. You are probably more computer literate v. Forced learning of ALL practice’s details v. Your suggestions more likely to be accepted if you are doing the work

Manual Essential Elements *Front Office* Reception/Check-in: Script Greeting n Demographic Information Gathering n Patient Insurance Registration and Method of Payment for Services. Credit Cards. Co. Pays. n PRACTICE NOTICE OF PRIVACY PRACTICES and HIPAA Acknowledgement n PHONE ETIQUETTE and TRIAGE. n

*Front Office* Appointments and Scheduling, Walkins, Sales Reps n Filing Insurance Claims. Medicaid. Professional Courtesy n Bad debt and Past due accounts. n Photocopies. n Completion of Forms. n

*Front Office* Referral Specialist. Prior authorization requests. n ABUSIVE PATIENTS n EMERGENCIES [Basic CPR certif. ] n n REMEMBER: The quality of the practice is mirrored and represented by the front office staff!

Manual Essential Elements *Clinical/Nursing* Telephone Advice and Triage. Get Standardized Manuals and Rehearse! n Prescription Refills n Patient Visit Preparation. Vital signs. Lab/Test results. Recording History. n Nurse-Only visits n Medical Supplies Inventory n Chaperones n

*Clinical/Nursing* Medical Emergencies n Employees as Patients in Practice n Controlled Substances. Storage and Dispensing. n State Vaccine Program n In-Services and Conferences n

SPECIAL MANUALS n H. I. P. A. A. = Document training of Employees n O. S. H. A = Specific Infection Control Procedures and Documentation of Training n C. L. I. A. = Specific Laboratory Procedures, Quality Control and Proficiency Training

Manual Essential Elements *Personnel* Type of Employment “at will” n Confidentiality of Personnel Files n Dress Code n Conduct – Immediate Termination n Personal phone calls and family visits n Compensation n Benefits Package n Work Schedules/Vacations/Holidays n

Manual Essential Elements *Personnel* Schedule of Performance Appraisal and Feedback Method n Sexual Harassment policy n Some States consider personnel manuals as implied contracts …… need ATTORNEY REVIEW! n Some national firms now provide personnel management services and printed P & P manuals. n

General Principles Clear and concise. n Good policy and procedure manuals create: n – – n good quality care teamwork enhanced patient safety lowered legal RISK Use Constantly and Consistently