How Do You Monitor the Productivity of All Areas of an Office?

How do you effectively measure the productivity of every area of a health care office? For example, how do you objectively know how well your receptionist is doing at his/her job? Do you use the opinion of other staff and/or the receptionist? Do you go by “feel” regarding how many patients are showing versus cancelling or rescheduling? These are not objective measurements. How do you monitor the productivity of all areas of an office?

We suggest a very specific management by statistics system that takes opinion and guesswork out of how each area of a practice is doing by assigning a relevant production statistic to act as a guideline for the area as well as for the staff member responsible for the area. Without these metrics, you are operating the business side of your practice blindly.

As an analogy, no doctor would decide on a treatment plan without properly examining a patient and performing whatever tests are necessary to determine the proper course of action. This is all very scientific and requires specific metrics as part of the examination process.

Running the business side of the practice is no different. You must have a means to measure and thereby “see” factually what is going on throughout the practice. Just as you could not drive your car without its various gauges operational, you cannot run a business without having proper productivity measurements to refer to.

Here are some questions you might ask yourself:

  • Do I have any idea if my treatment plan acceptance is getting better or worse or if it is even in a viable range? Do I have any idea what a viable range for this would be?
  • Do I have any idea if my receptionist is doing a better or worse job of keeping patients to their schedule, other than “it seems busier”?
  • Do I have any idea if our recall procedure is working as well this year as last year?

I can’t emphasize enough how important statistical monitoring is to the management of a practice. As stated above, without proper metrics, you can’t really see what is going on throughout the business side of a practice.

Another key question you might ask yourself:  how do you determine what the correct monitoring statistic is for an area or job position? The answer to that is something more basic, and that is determining what the actual product is that should be produced by that position or area.

In sales this is usually easy to see. For example, the product of a car salesman is a sold car and his statistic would simply be the number of cars sold.

That one is easy. But what about a receptionist in a health care office? What’s her product? And what statistic measures that?

Here are some ideas you can use for this position in terms of product and statistic for a receptionist:

Product: A patient who arrives at the agreed upon time
Statistic: Percent of patients kept to schedule


Product: Sufficiently full appointment book to keep the office at or above its needed production target.
Statistic: Percent of the appointment book filled

I hope this example gives you an idea on how this basic management tool works. If you want to properly manage your practice, you must be able to easily see the productivity in any area or job position and not operate on “feel” or “how it seems”.

Here’s another example – one for your collections area:

Product: Patient fees collected in a timely manner.

It seems like that would be an excellent product for the collection area to accomplish. If the area accomplished this product regularly, the income of the office should be in good shape with very low receivables.

Now, how would one best measure that so one could actually manage the area by a metric? There are several stats that would give you a good measurement of how the area is doing:

a) Total collections received.
b) Total accounts receivables over thirty days (Graphed as a reverse graph with zero at the top)
c) Percent of collections to services.

Needless to say, one would have to use some “smarts” when looking at the second statistical graph as it would also need to be compared to the production in an office. Obviously if the office’s production was rising, the total receivables would likely be rising too, so a comparative analysis would have to be made. The third statistic above helps with this.

The third statistic is based upon a formula that we’ve worked out that compares several month’s collections to several month’s worth of services, with a time factor built in depending upon the type of practice, how much insurance is used and some other factors.

Again, the first thing you need to do with any area or job position is to determine exactly what the product that area or job should be producing. This may take some figuring out by carefully inspecting the job or area in terms of what you really need coming out of the area.

When managing by statistics you not only have a way to look at what has occurred, but you will now have a way to effectively correct and revert “down” areas. If you can see that, for example, the gross income of the practice has taken a dip and you can look at the other statistics of the practice you can usually find out why. You may find that the percentage of kept appointments has been going down. If less people are keeping their appointments, less income will be generated. Now you have an actual target for correction in the practice. Find out what is causing less people to keep their appointments, correct this problem and you’ll get your gross income back into the proper range.

It’s very important to not let a staff member tell you “people just aren’t coming in” or “I’m doing everything I can, it’s just gone down”. That is just an excuse. Look at when the statistic started to drop and then find out what changed. Maybe a new front desk person was hired and they are scheduling appointments differently than the old person was. Maybe the front desk person changed what they were saying when scheduling appointments. Maybe you changed your hours of operation and that has affected scheduling. Whatever the case, find out what changed and revert it.

Please note: this does not mean that you take the important human element out of your practice. I’ve heard people say that watching statistics takes the “humanity” out of a practice. These are not mutually exclusive activities! The “human element” is more important than anything else as it is people, working together as a team in a mutually created enjoyable work place that makes a practice a fun, pleasant and productive place to work. But, at the same time, you must also be able to logically see how the productivity of each area and job position of a practice is doing or you won’t be able to manage the practice as a whole and take care of your staff.

Letting a staff member flounder around, not really knowing how they are doing, is not a fair way to treat any staff member. Neither is letting a poorly producing staff member attack in subtle or not so subtle ways a good producing staff member. Having a proper statistical monitoring system in place helps your staff know how they are doing and protects the good producers. That makes a happy and productive place to work.


Larry Silver

The practice Solution Magazine is published by


From the Editor

Hello and thanks for taking the time to stop by The Practice Solution Magazine. My name is Ken DeRouchie and I am the newly appointed editor of the magazine and this is my first From The Editor article.

Ten years ago, in 2002, I helped launch this magazine and bring it from concept to fully functioning web magazine. In the past 10 years I’ve also been a contributing writer in every issue.

I’d like to give you a little of my history. In July of 1990 I came to work for Silkin Management Group and have been an analyst for the company ever since. I spend much of my day talking to doctors from all over North America about the challenges they are facing in private practice. I help them pin point the causes of these issues and give them recommendations and solutions to these problems.  (For more information about Silkin, visit the website at

I also have a background in writing so, combining my experience working with doctors and my past writing,  It was a natural progression for me to get involved with the magazine.

In this issue of the magazine we have addressed problems ranging from staffing, employee conflicts, case acceptance, net profit as well as other topics.  I hope that we have offered some sound advice to you that will help you with some of these issues.

In past issues of this magazine there has been a mix of practice management related articles as well as articles about clinical issues impacting doctors and patients alike. In this issue and future issues I plan to focus on just practice management aspects that impact practice owners.

I welcome your feedback and would love to hear from you. Feel free to email me at or feel free to call me at 800-695-0257.


Ken DeRouchie
Editor – The Practice Solution

Hiring Interview Questions

In some of our articles in this and past Practice Solution issues we’ve discussed handling different types of difficult job-interviewemployees. The best solution to a problem employee, though, is to not hire them in the first place. The right hiring interview questions can help you determine that from the get go.

Easy to say, but how do you do that?

Although there is no perfect method, there are many different screening and hiring techniques including proper ads, group interviews and using the right type of testing that will greatly increase your odds of finding the best potential employee. This article is not written to detail those steps, but using such steps will help you reduce your candidate pool to several good prospects. At that point you’ll want to individually interview them.

Interviewing is a skill unto itself. As part of that process it helps to have a template of questions to use when you go into such an interview. Below are 15 basic questions one can use to help determine motivation and willingness, two essential points in finding the best potential staff member.


This is a key area to get a very good feel for when hiring. Motivated and willing staff are easy to train, usually no matter their background, and are great to work with. The less motivated and willing they are, the worse potential employee they will be. Given that they are looking for a job, they will likely attempt to appear to be motivated and willing. You must, through questioning, attempt to find the truly willing versus the ones who may just be paying it lip service. Below are some questions you can use that will help in this area.

  1. Why do you want to work here? What is it you are looking for?
  2. What kind of job supervision do you prefer?
  3. Are you willing to attend seminars to enhance job training?
  4. Do you like to work by yourself or have others around?
  5. How do you work under pressure?
  6. What are your weaknesses?
  7. What in your background particularly qualifies you for this job?
  8. Why have you applied for this job?
  9. What kind of pay are you looking for?
  10. Would you prefer a job situation with a stable wage with standard incremental increases or a job situation in which your base pay was perhaps slightly lower, but with the opportunity to make much more by setting and meeting performance goals.
  11. If you were an employer and had an employee who was not responding well to high demands, how would you handle this situation?
  12. What is the most difficult thing you have ever had to overcome in your life?
  13. How did you overcome this?
  14. Would the hours of this job present any hardship for you or your family?
  15. What have you done in the past 90 days to improve yourself?

Having the right staff makes a big difference in whether or not you have an efficient, productive and profitable practice. Try using the above questions to help you find the most motivated and willing employee.

The practice Solution Magazine is published by


Generating New Patients by Using Surveys

How do you market for new patients in a cost efficient and effective manner? Internal marketing is always the best avenue to begin with as it produces the most cost effective return, which is of utmost importance in managing a practice. Surveys are one method of internal marketing. But how do you go about generating new patients by using surveys?

Here’s an initial tip that you can use to more effectively market. You can do a simple survey with all new patients that come in to find out what brought them to your practice. This can be done as part of their new patient intake forms or verbally done by the receptionist or any other designated staff member.

We have a variety of prepared surveys for our clients to use. Here are some question types you can use to make your own survey:

  • If you were referred, who referred you and what did they say that interested you in our office?
  • If you responded to an ad, which one did you see? What about it attracted you?
  • If you responded to our website, how did you locate it and what about it interested you?

A second tip is the use of surveys on your existing patient base. Start by going through your existing patient records and find about 50 of your “A List” patients/clients. Do a demographic study of where your best patients/clients are from. Then write a survey for those patients/clients and find out:

  • What attracted them to your practice?
  • What keeps them coming back to your practice?
  • What do they like the most about your practice?
  • Are there any services they would like to receive from you that you don’t currently offer?

You can then use this information to target the greatest demographic area of your “A List” patients/clients and use their survey answers as “hot buttons” in a marketing campaign targeted to generate more patients/clients that are similar to these “A List” patients/clients.

This is called targeted marketing. It’s all about generating quality patients and clients, not just people walking through the door. Quality patients keep their appointments, follow your treatment programs, pay their bills, spend more than their insurance allotment etc. These are the kinds of patients/clients you want to generate for your practice.

If you can determine what area your best patients/clients are from and what brought them to you in the first place, you can then design a marketing campaign to generate more of those type of patients and clients.

Don’t just guess at what you think will bring new patients/clients in the door. Find out what got your best patients/clients there and use that information to your advantage. “Know before you go” is the motto of all good marketing. You find out the “know” by surveying.

Ken DeRouchie

The practice Solution Magazine is published by

Where is Your Net Profit?

You have worked hard all week; the office atmosphere has been snap, crackle, pop. The staff have been getting along with each other and you are proud of the team spirit they have each shown. In fact, your staff have almost read your mind and anticipated your every need. The patients have all arrived on time for their appointments, and the majority of them have even listened to you and accepted your treatment plans!

Now it’s Friday afternoon, the staff have their paychecks, which include production bonuses because the office has done so well this week. But you look at your bank balance, and you are surprised and seriously disappointed at the lack of funds left over for you.

Where is your net profit?

Did you work hard all week to earn less money? The bank balance should be going up, not down!

You wonder if it’s worth it. You worked hard all week – only to earn less money. All of that increased production may just have landed you into a “higher office-overhead/higher tax-bracket” situation. It’s that frustrating income vortex – the place where despite producing and collecting more, you take home the same or less. And after a few of these “successful” weeks you shake your head and realize that if you have much more of this kind of success, you’ll go broke. What should you do?

I would start by taking a look at what might have happened:

  • Do your staff work overtime? Do you have systems in place to prevent this without being notified?
  • Do you have redundancy in your staff scheduling? Are you scheduling for efficiency? Do you have 5 staff members on duty when 4 staff will do during the slower times of the day?
  • Can you consolidate your equipment and/or practice loans into one loan, thus saving you interest and lowering your payments?
  • Can you reduce the amount of inventory the practice holds?
  • Are you collecting all you bill? Are your collections 97% at least?
  • Are any staff functions overlapping?
  • Do you have an efficient office communication system whereby staff are not interrupting other staff when they are doing their jobs, thus reducing efficiency?
  • Do you have any monitoring system to know, factually and statistically who is productive and who isn’t?
  • Is there any gossiping going on in the office?
  • Are there any problem staff members who aren’t being handled?
  • Do you have office policies?
  • Does each position in the office have a fully delineated job description?
  • Do you do regular job reviews?
  • Do you know how to screen and hire the best possible staff?

These are just some of the areas that you should be monitoring every day to help you with the management of your practice and figure out any problems with your net income.

Your net should be between 25%-55%, depending on your profession, length of time in practice, demographics etc. If it’s not, there’s something wrong with the management of your office.

The best way to increase net income of the office is to increase the efficiency of the staff. But, this starts with you as the practice owner. YOU have to put the right systems together and the right monitoring, training and correction in place in order to create efficiency in your staff.

For example: If your training consists of verbally telling someone how to do something, you are leaving it up to “selective memory” that they will completely duplicate what you are trying to teach them. You need to have very detailed job descriptions in place for EVERY aspect of your practice so that people have something IN WRITING to refer to when learning and training. You will get compliance and consistency from your staff this way.

A job that needs to be done only once is a job efficiently done. The more efficiently the staff works, the less people it will take to do the jobs in your office. Efficiency = profitability. It’s just that simple.

The practice Solution Magazine is published by

The Benefits of Regular Practice Newsletters

Marketing is a vital part of the management of any business, whether a health care practice or any business in general. Implementing successful marketing actions that help increase the number of new patients/clients as well as help facilitate the retention of existing clients and patients is important to the success of any practice. Are you taking advantage of the benefits of regular practice newsletters as part of your marketing activities?

One of the best and least expensive tools in your marketing “tool box” is the newsletter. A newsletter is a tool that can be used to reach not only existing patients/clients, but potential patients/clients as well. As an internal device, it is an excellent way to stay in touch with your patients/clients and keep your name, your practice and your brand in their mind on a regular basis.

A practice newsletter provides advantages for the practice that other promotional and marketing methods don’t always offer. It provides a simple and compact way to communicate a longer message and can easily be put onto your website as well. It also creates a perfect forum for continuing education.

In years past, creating a newsletter involved costly printing and postage. In today’s computer driven society, most of us have a home computer allowing for email newsletters to be used. Email newsletters have a much higher likelihood of being seen and read by your intended audience as it shows up right in front of them when they open their email program. It’s simple math: they more of them that are seen, the more of them that will be read.

Here are two other major advantages of regular newsletters:

  •  The more contact you have with your current patients/clients, the more likely they are to respond to recall reminders and schedule appointments. Familiarity breeds response.
  • Email newsletters give you the opportunity to market for referrals and generate new patients/clients.

Here are a couple of inexpensive but feature rich services we recommend for email newsletters.

Constant Contact:


Neither of these services requires any kind of programming knowledge. They are very simple to use. You simply create a user account and then log into it. You can then pick from hundreds of pre-made newsletter templates which also allow for customization with your own graphics. You can cut and paste your own content into the template and save.

The maintenance of the database is simple and automated. You can upload your email data base list as a Microsoft Excel spreadsheet or as a comma delimited text file. Once the newsletter is sent, the people on your list have the ability to remove themselves from the list with just one click if they don’t want any future emails. If there are any bad email addresses on the list, they will show up in the statistics as “bounced” emails and you can remove them.

Both of these services offer good statistical tracking of the emails you send – i.e. how many were opened, what links people clicked on, etc. so you can see what people find of greatest interest. This is useful in tailoring future newsletters.

The cost for these services is extremely low. They both work on a sliding scale, depending on how many email addresses you have in your database. The starting range for up to 500 email addresses is only about $15-20 per month! That’s a far cry from only 10 years ago when putting a hard copy newsletter together and mailing it to your patient/client data base could easily cost more than $1000.

If you aren’t now sending out regular (monthly or quarterly) newsletters, we highly recommend that you begin doing so. If you do so you’ll find greater patient retention and more referrals walking through your front door.

Ken DeRouchie

The practice Solution Magazine is published by