Chiropractic Practice Bottlenecks: How to Increase Capacity by Removing Hidden Barriers

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The theory of capacity management, as developed by Eli Goldratt and explained in his books, including the best selling The Goal, discusses the theory of constraints as applied to a manufacturing environment.

The same principle applies to chiropractor’s business. According to Goldratt, “Capacity is the available time for production.” A bottleneck is: “what happens if capacity is less than demand placed on resource.”

Bottlenecks can be hide anywhere in an office.  For example:

  1.     Peak Periods. Between the 4-6 pm slot, where there is extra traffic, extra staff or increased capacity is not provided.
  2.     Paperwork. Old forms that are redundant.
  3.     Poor scheduling of patients: (not cluster booked, not booking for NP paperwork)
  4.     Doctors waiting for therapy patients. (No CT or therapy after adjustment)
  5.     Front Desk doing insurance and scheduling at each visit (no MAP and PIA)
  6.     Not enough exam rooms
  7.     Clutter in front desk/insurance area
  8.     Quitting time. After a long day, all staff and doctors are looking forward to leaving and really don’t want extra patients to call or come in. Patients are inadvertently discouraged to come in extra, bring in friends or family , or call in during the last hour.
  9.     Backlogs. Undone reports from the two summers ago, partially completed projects, cluttered desks or office space, all discourage more an increase in production. You only have so much mental capacity, and if it gets frittered away on projects that are not completed, you will have “too many irons in the fire” to add any more. Finish what you started, and make room for more.
  10.     “Difficult people“. Some staff, or patients, will seem to drain you of your energy, or consume too much of your time trying to keep them happy.

Warning: Too much capacity can also be a barrier.

A) Personnel. A staff that has to make up work can retard production. Happy staff are productive staff, and the opposite is also true. Unhappy staff will not make for happy patients. This will also suck up the doctors time to try to remedy his “staff problems.”

B) Space. Too large of a space can disconnect the staff from each other and the patients and minimize the synergy.

 

Exercise – Getting Rid of Capacity Restraints and Bottlenecks.

Make a list of any bottlenecks in your office. Start by considering the flow of patients, of paper, and anything that slows it down or gets in its way. Consider patients waiting, paperwork waiting, any times of the day or days during the week where there is a slow down or back log. You can organize it into four categories:

Physical space
Personnel
Procedures
Difficult people
Incomplete projects

Once you have listed these, give yourself 30 days to fix all these capacity restraints.

NOTE: Bottlenecks can sometimes be difficult to locate, and even more difficult to remove.  Need help: Give us a call. (414) 332-4511

Procedure on No-Charge Family Check-Ups

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Office Policy for No-Charge Family “Check-Ups”

This is an example of an office procedure written for all staff. It encourages patients to bring in their family for a simple spinal screening. Review this and adapt it for your particular office, and go over it at a staff meeting so that all staff understand its purpose and can apply it.

[OFFICE LETTERHEAD]

TO: ALL STAFF/DOCTORS

Our office has a policy that all family members are encouraged to come in for a no charge “Checkup”. The checkup is a brief consultation and screening.

There are a number of reasons for this.
1. Spinal abnormalities can be generic, and though the family member may not be experiencing any symptoms, it can never hurt to get the spine checked.
2. Additionally, part of our mission is to reduce the incidence of back problems occurring due to long time untreated and unknown spinal misalignments. It is much easier to align the back before major problems occur.  Many spinal problems start without any sign or symptom and it is easier to correct them if we can detect them before they become chronic or the patient gets older.
We unfortunately see many people only after a major injury or problem occurs, and then it takes a great deal of work to correct the problem.
Compare this to dentistry. Often, a dental problem can exist long before any pain or symptoms show up. With just a little work, the dentist can correct the problem and prevent a more serious condition in the future.
3. We firmly believe that an ounce of prevention is worth a pound of cure.
4.  Lastly, this is courtesy we provide to all of our patients.

This can be explained nicely during the financial consultation/post report of findings. It can also be explained to the patient during the 6th visit, or re-evaluation visit.

For example: “Mrs. Jones, I am not sure if Dr. Smith explained to you our “Family Check Up” policy.   Because we want to make sure your entire family is healthy, Dr. Smith recommends that all the family members of each patient get scheduled sometime for a complimentary spinal screening.  There is no charge for this and it only takes a few minutes.  Sometimes, children can have similar problems with their spine as their parents.

You can bring your family in at the same time as you come in for one of your appointments.  Just let us know beforehand, and we will schedule an extra few minutes for the screening.  We would like to do the screening of your children and (husband/wife) with you present so you know what is going on with them.  We can make a schedule for you today, or you can call and let us know at your earliest convenience.”

Obviously, try to schedule them that day, but if they do not schedule, schedule a follow up consultation after the fifth visit or twelfth visit, in order to implement the “Family Checkup Policy”.