Clinical efficiency isn’t enough – but clinical effectiveness is

What happens when clinical efficiency isn’t enough?

In medicine, clinical efficiency is the ultimate goal and an absolute necessity.

Do more, in less time. Be better at it, in less time. And once you can achieve that at one level, start adding more as you work up the educational training ladder. In medicine, it is more more more. 

If you’re reading this, you are efficient. You’ve had to be.

Clinical rotations, residency and practice – we’ve been progressively forced to do more tasks in less time. We are masters of inhaling unsalted crackers while charting and answering pages. Seeing the urgent add-on at the end of the day while texting the accountant about tax documents for employees. 

For a long time, I believed that if I could just keep doing all of the tasks to the same quality but more quickly, I’d arrive in this elusive “flow state” the gurus talk about. And if not flow, at least some degree of feeling less like a scrambling chicken. 

Despite how clinically efficient I got, I never arrived. This chicken was still running. 

An audiobook changed my professional life.

No that is not an overstatement. In his book Buy Back Your Time, Dan Martell focuses on concept of getting the job done effectively.

He argues better question to ask ourselves: what is the best way to get the work done? What is the most effective way to get X, Y, Z task done?

This was a paradigm shift. A pause-the-audiobook-and-replay multiple times moment.

For years I’d been working to do the tasks as quickly and streamlined as possible. But was this the best way to get things done? Was I the only one who could do every task on my plate? Did I have to be the one to do every step of every task? 

“That only works in business.” I’ve had the same internal monologue.

Question: do you expect your dentist to also be the one cleaning your teeth? I don’t. And the hygienist really contributes to my appointment experience. 

How being effective applies to your practice.

Stepping back and looking at all the tasks that needed to get done in a clinical day it became very clear: I didn’t need to do all of them. Or many didn’t need me for the entirety of the task. 

Was I humbled since doing all the things contributed to feeling needed and valuable? Yes.

But has this question turned out to be to single most professionally freeing question I have asked myself since starting medical school? Resounding yes.

I began to separate my clinical tasks into 3 categories:

1. I don’t need to do it
2. I only need to do part of it
3. I need to do all of it

Turns out, a lot could be put in the ‘don’t need to do it’ or ‘don’t need to do all of it’ categories.

Interestingly, as I got more creative in my thinking, the ‘don’t need to do all of it’ category is the one that has become reclaimed the most time and energy. 

Doing one step of documentation more effectively saves me hours per week.

A real life example: for a lot (most?) of us, completing the documentation for a patient encounter arguably takes up the most time outside of seeing the patient. And let’s be honest, sometimes the note takes more time.

I realized that the longest part of finishing a consult note was entering the past medical history, medications and allergies. The rest was quick with my templates. 

The practice-changing aha moment was realizing that the past medical history, medications and allergies came on most referrals and the action of copying that information into a note didn’t require a MD. Someone else could spend the time to add this information. Or it could be collected before the visit with an online form. 

Now before I open the chart, the consult notes are pre-loaded for each patient and have all of this information entered by an employee. This means that I can quickly verify accuracy and click through my template before finalizing. This often saves minutes per note. 

Multiplied by 25+ consults some days, off-loading this one step of clinical documentation has reclaimed upwards of an hour plus on a busy consult day. 

This. Is. Practice. Changing.

How much time, mental bandwidth and energy do you think you could reclaim by applying this to multiple areas of your practice?

You don’t need to start by looking at the mountain of everything you do. Just start by assessing something that you do.

Can you identify 1-2 tasks that regularly take up your time or mental space that don’t need to be done by you at all? How can you get those off your plate? Is there someone else that can do these (for less than your hourly rate) or is there technology that can manage it?

Maybe you start by reclaiming 10 minutes/day. That’s almost an hour per week. Reclaiming 30-45 minutes/day is half a clinical day or an evening. Small changes ripple and start looking like meaningful chunks of time. 

You can have both: a sustainable, fulfilling practice and the life you want. It’s not about how much you can force in less time but about finding the best way to get the tasks done. 

To get started, here are a few ideas for each category:

“I don’t need to do it”

• Talk to your accountant about automating employee payroll, pay slips, tax documents.
• Pre-authorization all regular overhead payments. 
• Office supplies: Set up subscriptions or ordering guidelines for employees (ex. paper, envelopes, blank stickers, printer ink, etc.).
• Clinical day scheduling. I set parameters for my schedule (hours, numbers and types of patients, dedicated times where add ins can be slotted) and my admin does the rest. If anything out of the ordinary comes up, she can quickly run one question by me rather than several. 

“I only need to do part of it”

• Clinical documentation
  • What others can do
    • prepping all consult, procedure and follow up notes for the week 
    • loading patient’s past medical history, allergies and medication to the EMR/EHR 
    • Complete the straight-forward parts of insurance paperwork 
  • What I have to do
    • Update and finalize notes after seeing the patient
    • Fill in the final care plan and sign the insurance form
• Communicating straightforward results with patients
• Calling patients who have questions or concerns and only getting involved if the concern can’t be answered by a practice extender
• Creating new templates and pre-populating more forms
• Researching new clinic resources or supply companies – ex. treatment, devices, technology
• Pre-loading syringes with (room temp stable) medications (ex. local anesthetic, cortisone)

“I need to do all of it”

• Direct patient care
  • Meeting and examining patients and finalizing the care plan
  • Doing the procedures
  • Communicating unexpected results or those that need more surgery/work up
• Building relationships, work culture and giving feedback to employees
• Meetings and committees

This is just the beginning and the possibilities are huge. The only barrier is your creativity. Are you excited? 

He doesn’t know it, but Dan Martell changed by life. Hopefully, he can change yours too.

The goal is no longer clinical efficiency. Effectiveness is.