In today's health care environment, keeping your head above water is no easy task. The swirling currents of regulations, insurance demands, overhead concerns and changing practice situations have left many physicians and their employees exhausted. What's more, those currents have taken some of the fun out of practicing medicine, and inevitably our patients feel the ripples.

To regain some control, some sanity and perhaps some of the sense of family that many practices once had, begin with some practical time savers and morale boosters. The improvements will not only be felt by your staff and physicians, but by patients as well. Here are some ideas:

Consolidate patient questions, precertifications and referrals. To manage the ever-increasing phone calls and requests for information that managed care generates, direct all insurance-related questions to one medical secretary who will become your practice's expert. This person doesn't process insurance claims; he or she answers patients' questions and processes pre-certifications and referrals, relieving the rest of your staff from these time-consuming tasks and helping patients wade through their insurance policies.

For an additional time saver, have your staff expert handle all precertifications and referrals at one designated time of day. Bundling similar tasks like this will increase efficiency.

Use color coding to track charts. To manage chart scatter, we've assigned each of our providers a color. When a staff member pulls a patient's chart, he or she places a colored 3×5 card in the out guide. The color of the card immediately indicates who dealt with that patient's chart last. We also use cards labeled “nurse” for patients scheduled to see a nurse, as well as cards with the various departments, such as insurance or billing. Proper use of the color-card system decreases the confusion of misplaced charts and allows for easier chart navigation through the office.

Use an employee suggestion box. Your practice probably already has a suggestion box for patients, but have you considered making one for employees? It can be a hotbed of great ideas for cutting costs, saving time and making patients happier.

One simple but very useful suggestion we received from our nurses was placing room numbers on all medical instruments so they can be delivered to the appropriate rooms after autoclaving. Another suggestion, from the nurse who oversees the ordering of our durable medical supplies, was to tape 3×5 cards onto the supplies with the information needed to reorder them, such as the name and item number. When an item is taken off the shelf, the card is removed and placed in a box. Each week, the person ordering supplies knows exactly what to order, without doing an inventory. It has saved our practice a considerable amount of time.

To encourage suggestions, hold a drawing each month with the names of all those who made suggestions that were implemented, and offer a prize (perhaps a gift certificate).

Use preprinted progress sheets. For physicians who don't yet dictate their medical records, fine-tuning the progress sheet is critical. By printing the most common patient complaints, lab services and X-ray studies on your progress sheet, you save time by writing less. With check-off boxes, you can document instruction in areas such as breast self-examination. You can also quickly document when a patient should return to work or school by checking a box next to the appropriate instructions and simply writing in a number or date. This can also be an extremely helpful reference when insurance companies and attorneys ask about a patient's disability claim or the date they were advised to return to work.

Make voice mail work for you. Whether you have a solo or multi-physician office, take advantage of the user-friendly features that your phone system can offer patients. A voice-mail option that allows patients to leave their prescription requests has been a huge success in our practices. Another option allows patients to leave nonurgent messages for physicians or staff members. You can then retrieve the messages in an organized fashion rather than letting them interrupt your work flow. Your insurance department also should have voice mail. Patients can record their insurance or billing questions, and your insurance staff can call them back with ready answers. By using voice mail in these ways, you'll eliminate patients' hold time and decrease unnecessary phone traffic considerably.

Use insurance “cheat sheets.” A detailed spreadsheet listing all the practice's participating insurance plans and the details of each one reduces staff frustration and improves efficiency. For example, if you need to know a patient's co-pay or where to send lab work for a particular HMO, you'd simply locate that HMO on your cheat sheet and look under the appropriate category. [For more tips about summarizing these details, see “Making Patient Care Easier Under Multiple Managed Care Plans,” February 1998.] Post this spreadsheet throughout the nursing and secretarial departments, and update it frequently.

Hold regular meetings. General staff meetings, as well as monthly meetings involving only the nursing and secretarial staffs, are critical to keeping your staff well-informed and focused on efficiency and quality patient care. Holding meetings regularly keeps you from being tempted to toss endless fragmented bits of information at your staff through memos or e-mails, and it provides an opportunity for staff members to discuss how best to perform their jobs. Meetings also give the staff an opportunity to offer suggestions and air their concerns, which in turn builds a stronger team, better service and more satisfied patients.

Work on your approach. Perhaps the most important element in maintaining a practice's efficiency and staff morale is the approach its leadership takes. If your staff trusts that you will keep them informed during times of stress and change, their tension and stress will lessen, allowing them to focus on providing high-quality care and patient service. Managers should also help create an environment in which employees have a sense of belonging and involvement, which can be very difficult in today's corporate-oriented medical world. A manager who seeks input from employees and who leads rather than directs will help employees get through stressful times successfully. A manager who doesn't encourage staff members to ask questions but dictates policy and decisions could be asking for mutiny.

Although you may not be able to make working in a medical office as fun as it used to be, you can make your practice's environment more efficient, more comfortable and more patient-friendly. This should help you increase productivity and improve the satisfaction of both patients and employees. If nothing else, you'll all be rowing together to meet the tide.