Before You Hire, Look at the Work

A job description that says "jump in wherever needed" deserves a closer look at wherever.

In a dermatology office, that might mean re-entering intake information, answering the same preparation question for the fourth time, or leaving a procedure room to find supplies. Add a capable person and the day may get easier. But the same work will still be waiting tomorrow.

Take the team's request for help seriously. As you consider next year's staffing, spend a little time understanding what kind of help would make the difference. If patient safety or essential coverage is already at risk, arrange support now; process improvement can happen alongside it.

At your next huddle, ask: "What's one thing you had to do twice yesterday, or stop someone else to get done?" Start with the people doing the work. The receptionist who answers the phones can tell you which instruction patients never seem to receive.

Then have the administrator follow one recurring task through a busy hour. For example, a patient booked for an excision calls with a preparation question. Reception sends a message. A medical assistant (MA) finds the instructions, calls back, and discovers the appointment was booked under the wrong visit type. One phone call has become work for three people.

Keep notes about the steps, not a scorecard on the employees. AHRQ's workflow toolkit starts with understanding how work actually moves through a practice. A few examples are enough to pick a starting point; nobody needs a minute-by-minute diary.

Take those repeat preparation calls. Before hiring another person to answer them, check whether the right instructions go out when the visit is booked. Ask a patient to explain the next step in their own words. A PDF sitting in the portal isn't much help if nobody knows it's there.

Keep a phone option for patients who need help, and route clinical questions to clinical staff. The goal is fewer avoidable calls, not making the practice harder to reach.

Incomplete intake is another place to start. If staff keep asking for information patients already entered, look at where it lands and who can see it. One clear check before rooming can spare the patient a second telling and the MA a second search. We covered how those early steps affect the rest of the visit in our guide to the revenue cycle.

For procedure-room interruptions, begin with something equally small: an agreed list of biopsy supplies, a person who checks it, and a time to restock. Ask the MA what is repeatedly missing.

Sometimes the missing resource is permission. If every routine scheduling exception needs the administrator, the team has learned to wait for an answer.

Choose one repeat decision and agree on the boundaries. For example, reception can offer designated return-visit slots without asking each time; requests that change the visit type or clinical timing go to the clinical team. Put the rule where people actually look, and name a backup for questions.

An extra employee won't remove a queue that still ends at the same manager. Clear authority gives the current team a way to finish the work.

Choose the change with the team member who will use it. Test it with one provider or visit type for two weeks. That follows the Institute for Healthcare Improvement's small-test approach: try a change on a limited scale, learn from it, and adjust before spreading it.

For the preparation example, make a simple tally of repeat calls before and during the test. At the check-in, ask whether patients arrived better prepared and whether anyone stayed late or the work shifted to someone else. Fewer calls don't count as progress if patients have stopped getting answers.

Don't spend every recovered minute before the test is over. Ten minutes freed up across six different people's days is an hour in total, but it isn't necessarily an hour of coverage when the phones are busiest. Some of the benefit may be a lunch break that happens on time.

And keep the software demo out of this first conversation. Our vendor-hall test applies here: name the work you need changed before deciding a new tool will do it.

If callbacks still pile up, overtime continues, or rooming capacity cannot support the care you need to deliver, hire. The exercise should help you specify the role, not keep moving the goalposts for a tired team.

Perhaps the gap is phone coverage during the morning rush, an MA for a growing procedure schedule, or a lead who can train new staff. Those are different jobs. Name the work, the hours, and who will train the person instead of advertising for someone to "help with everything."

Clarity RCM manages revenue cycle for 200+ dermatology practices across 44 states. It's all we do. See how we work.