The Executive Suite: How to increase clinical efficiency with smaller staff

Two years of facing the challenges of the COVID-19 pandemic and we’re still adjusting our operations and learning ways for our providers and staff to increase efficiency. Born out of necessity, these strategies are helping our independent hand and orthopedic clinic streamline to meet a new challenge – returning to pre-pandemic patient numbers with a smaller staff.

For example, we now have a clearer picture of how to use technology to reduce time-consuming tasks that we put up with before the pandemic. This insight helped us figure out practices that allow us, and hopefully other orthopedic practices, to better utilize the valuable time of our physicians, staff, and patients.

We eliminated paperwork. By switching our electronic medical record to a cloud-based, specialty-specific EHR system during the pandemic, we dramatically reduced the time we spend on faxing and scanning paperwork.

Unfortunately, a round of layoffs in the early stages of the pandemic was part of the impetus we used to start looking for ways to do more with fewer employees. In reality, we simply no longer had enough people for a paper-heavy documentation system.

We’re not the only orthopedic practice that experienced the effects of COVID-19. A survey of US hand surgeons reported multiple furloughs, layoffs -- and even COVID-19 infections among nursing and support staff – in a study in the December 2020 journal Cureus.

Even with staff reductions, the researchers noted that most hand surgeons continued to perform urgent and emergency surgeries during the pandemic. So we were not alone there either.

In January 2022, 93% of practices surveyed were experiencing staffing shortages, and these shortages are having an impact on surgical volume, according to a survey of hip and knee surgeons published in the Journal of Arthroplasty.

We also upgraded our front desk technology during the pandemic. For example, we replaced manual check-ins and appointment scheduling with e-check-in options for patients. This also helps us thrive with fewer people.

In addition, we transitioned to a patient engagement platform that emphasizes easy communication with our patients. The goals are twofold -- to make contacting our practice more convenient for patients and to free up our staff from answering telephones. As a result, staff can spend more time on in-office, patient-related tasks.

We also rolled out a patient portal during the pandemic to change how patients communicate with us, and us with them. This feature also gives patients easier access to their medical records where and when they need them, without the need to scan or fax it to them.

All these actions were fueled by our new digital-first approach with patient convenience and practice efficiency in mind.

We also wanted to make the workday easier for our staff. Ditching our paper-heavy record system meant no one had to spend hours on manual data entry duties. In turn, we found success in spreading out our EHR documentation responsibilities, making everyone’s workday more efficient.

We moved billing staff to remote work. The pandemic necessitated transitioning our billing department to full-time remote work. In so doing, we eliminated the cost of maintaining a building for our billing staff members.

The American Association of Orthopaedic Surgeons (AAOS) is well aware of the business pressures the pandemic is putting on its 39,000 members. “The COVID-19 pandemic exacerbated the preexisting labor shortage in healthcare,” notes Ajay Srivastava, MD, in a January 24, 2022 blog post for the AAOS. Srivastava explains, for example, that the pandemic prompted many healthcare workers nearing retirement age to quit the workforce early.

There is a limit to how many people an orthopedic practice can lose and stay in business, however. “Orthopaedic surgery, like other medical practices, is heavily dependent on trained people. Staff and medical assistants are required at all times to run a practice.”

Still, Srivastava continues, “private practices have been attempting to meet the demand and continue to provide care in a variety of ways” as a result of the pandemic-related staff shortages. In our case at Michigan Surgery Specialists, that meant taking a ‘technology-heavy’ approach.