Navigating office management during crisis no easy task

For many ophthalmology practices, special times deserve special actions.

In normal times, the physician sets the tone in developing and leading the professional culture of the practice organization. Collaborative partnering approaches between the physician team and the patient help foster efficient and effective patient care. Of equal importance are patient satisfaction and patient retention, which are fundamental to the financial success and sustainability of a practice, according to Suber Huang, MD, MBA.

However, the current times are not normal, and management during the coronavirus disease 2019 requires dealing with a different set of demands. 

Related: Pearls for clinic flow in the age of COVID-19

Five-step plan 

“Office management in the time of a crisis is fundamentally a challenge of leadership,” Huang said and outlined 5 ingredients in the recipe for managing the office climate.

1. Knowledgeable reassurance.
Whether practicing in a solo or group practice, the managing physicians and/or senior administrative staff must set the tone regarding knowledgeable reassurance on handling all aspects of the crisis. 

2. Work short term, think long term.
“Practice leadership must think carefully about all priorities over time, that is, what is immediately important, what is important in the medium term, and potentially what is important in the long term, with the recognition that the long-term outcomes are not at all clear,” said Huang, president and CEO, Retina Center of Ohio, and voluntary assistant clinical professor, University of Miami, Bascom Palmer Eye Institute.

3. Flexibility. Developing flexible strategies for the office is necessary to educate patients, staff, and community as part of a larger public health perspective.

4. Work the problems.
Problems, then, must be prioritized and solved as they arise. “The goal is not to live in the past, not worry about the future, but do what can be done in the present,” he advised. 

The desire to assign blame is rarely productive. Understanding root causes, adapting to challenges, and making actionable plans is a much-preferred approach.

5. You make the weather.
When a physician is anxious, the anxiety will be communicated to the staff and diminish his or her effectiveness. 

“This is the most important factor in leadership,” Huang said. 

Huang offered the following steps to aid employees and patients in an unsettled environment: (1) normalize anxiety by channeling energy into learning and action steps; (2) offer perspective by not over- or underestimating the dangers; (3) shift the spotlight, which has the effect of minimizing anxiety when attention is turned to helping others; (4) encourage distraction by taking a break from information seeking and giving your mind a rest; and (5) manage your own anxiety with the goal of reducing staff and patient anxiety.¹Related: COVID-19: Companies offering new technology to connect physicians with patients

Productivity during downtime
Teamwork is important in a crisis. Take the time to understand your staff members’ concerns and explore potential contributions.  

Huang offered these practical strategies to keep staff engaged and productive by sending letters to patients, rescheduling all nonemergent and urgent patient appointments, developing telescripts for use during patient reminder calls, deep cleaning of the office, updating the procedural manual, and adding hygiene protocols-all things that may not receive sufficient attention in a normal environment.

“Managing during a crisis depends on developing a working plan of action that everyone in the practice can embrace and execute,” he said.

This approach creates work for staff even when the practice income is in limbo. Projects also help alleviate anxiety regarding loss of patient volume.

Related: COVID-19: Survey finds Americans are embracing telehealth services
 

Focusing on the staff 

Huang chooses to focus first on his employees when faced with such an all-encompassing problem such as the coronavirus disease 2019.

He pointed out that it is important to first address the largest looming concern for staffers, which, in this case, is their own health. The second issue is the worry that employees will infect their family members or friends, followed closely by the fear of infecting patients, and last but certainly not least, the effect of the crisis on the practice’s livelihood. 

During this time, staff members can work from home to minimize their exposure to the virus while they are engaged in contacting patients by mail or phone to reschedule appointments or answer health-related questions. 

If the staff alternates between time in the office and time at home, this schedule may provide more of a feeling of control over their health and that of their families and give them a greater chance to socially distance from others outside of their families. Working from home also alleviates anxieties about maintaining their jobs and income by performing tasks that are meaningful to the functioning of the practice. 

Read more coronavirus coverage here
 

Implementing change in crisis
Flexibility can differ in a solo practice compared with a larger practice that has satellite offices and larger staffs. In the former, decisions can be made and implemented instantly. 

“In my practice, we huddle once or twice a day and we can change practices on the fly. In larger offices, there is flexibility but it is harder to move quickly,” Huang pointed out.

In a 2-person group with 2 offices, the principles could consider alternating schedules. 

“In this scenario, the staff members can isolate during the off-week and if no symptoms develop during that time, they can continue on with the alternating schedule,” Huang suggested.

In a practice with 3 or more offices, a pod design is a possibility, in which each doctor would have 1 set of staff members and use 1 office. In this case, if the virus developed in 1 office in a clinician or patient, that office can be closed, quarantined, and the other offices can remain in practice and be unaffected.

Related: Caring for dry eye patients through the coronavirus pandemic

The gift of time
An unexpected blessing during this crisis is the availability of extra time. 

Huang pointed out that during this period, most retina practices are open for emergencies or continuing care, that is, about 25% of the normal time. During the rest of the time, the staff can continue to engage with patients by calling directly from their homes to allay any patient fears about their care and keep them informed. 

The patients who are contacted should include those engaged in clinical research studies as well as regular patients. Those in trials need to be reassured about the study visit protocol during the crisis, and those not in a trial need reassurance about their continuing care and their need for or rescheduling of an examination.

This slow period provides an opportunity to review office efficiency, drill for potential disasters, role-play regarding patient encounters, and prepare for when patients return to the practice.  

“With planning, a surge of patients returning for care need not be overwhelming, instead, it could be a happy reunion of old friends looking to resume timely, compassionate, expert care, Huang concluded.

Read more by Lynda Charters

Suber Huang, MD, MBA
E: DrHuang.RCO@gmail.com
Dr. Huang has no financial interest related to this content.

References:

Damour L. 5 Ways to Help Teens Manage Anxiety About the Coronavirus. New York Times. March 11, 2020. Accessed May 26, 2020. https://nytimes.com/2020/03/11/well/family/coronavirus-teenagers-anxiety.html