Use batch processing and stop working like a dog

Do you find yourself spending too much time on things that have nothing to do with seeing patients, and then getting home later than you would like?

Do you notice that for every 15 minutes you spend with a patient you spend way more than that messing around in the EMR and being distracted by things like prescription refills, test results and a hundred other forms of two bit clerical work in your day?

Does your organization expect you to access your EMR from home to complete chart notes in the evenings after you have tucked your kids into bed?

I wish I had a chance to shadow you in your office, because there are a number small changes you can make right now that will shave hours off of your non-clinical activities.

They don’t teach these things in residency. So let me share a powerful tool to get you home on time , with your charts done, more often. If you are not using this technique every day in the office you are working way too hard and getting home at least a half hour later than you have to. What’s this tool I am talking about?

Batch processing

Doctors are a lot like dogs in some ways. If a dog is sitting on the porch and I get their attention and throw a tennis ball, they can’t not chase it. They can’t resist.

With doctors, the tennis ball is a refill request that pops up on your EMR screen. It is not  urgent and yet how often do you drop what you are doing to address it?

We mistake every action as a urgent one and chase them just like the dog and the tennis ball.

Add in test results, phone messages, referral paperwork, and your day is fractured into a hundred pieces for one simple reason. You are taking care of these items one at a time and allowing them to interrupt your patient flow.

Sure, they only take 2-3 minutes each. Add it up though and you will get 60-90 minutes of wasted time in your day. No other industry would allow that kind of inefficiency. Yet in medicine, it is every doctor for themselves when it comes to figuring out how to handle these non-urgent tasks. AND no one teaches you how to do a good job.

The solution is batch processing.

All the tasks that are non urgent should be batched and done in a batch twice a day. In the days of paper charts we used to put out a basket for each task type. Refills go in this basket. Test results go in that one when they return.

Twice a day you “run the basket” and boom, boom, boom: all of the tasks are done.

In a standard office day where you have an AM and PM schedule, some good times to do batch processing are 11:30am and 4:30pm. That way the morning’s work is done before lunch and the afternoon’s work before you go home.

EMR’s make this a little different because often these non urgent tasks pop up as alerts on your tablet, laptop or desktop screen. These prompts are equally enticing to our dog-like “fetch” mechanism and even more powerful time wasters.

Batch these too by not addressing them when they come in. Make a virtual basket that you run in a batch twice a day.

What can you batch in your practice?

Your answers to this question is a key to getting home on time more often.

Power tip #1

Ask your team these questions and let them join in the effort to get you out of the office by 6pm:

“What tasks happen every day – things that are not urgent, yet have to be done before the day is over – are one’s can we put in batches and do all at once, in batches twice a day?”

“Which ones require MD-level attention and which can be done by someone else on the team?”

Power tip #2

I have a client who was extremely distracted by the instant messenger function on her EMR. All of  the staff would relay IMs for each patient, phone message and refill. They would pop up on her tablet computer as a little flashing counter, like the old “you’ve got mail” function back in the day.

Her IT people said there was no way to disable the counter so we went old school.

Now she uses a little post it note. She puts in on the screen over the counter so she can’t see the messages as they come in. That small portion of the screen is covered by the post it note. She takes it off at 11:30am and 4:30pm to run the batch of messages.

Sometimes you have to get creative to batch in our modern electronic environment and it can be done. Ask your team (see above) if you are having trouble coming up with solutions on your own. (You are never alone in the office. Use your team!)

With your batchable items identified and the discipline to actually address them in batches twice a day, you will shave a minimum of 30 minutes off of each half day at work – barring one of those “days from hell” that come up every other week. This is the best way my clients have found to start getting home earlier and one of the first two tools I recommend.

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • buzzkillerjsmith

    I do twice a day batching and it does make seeing pts much more enjoyable because that’s the only thing I’m doing at that time. But….

    I never ever ever get to leave my office at lunch because I’m debatching. I’m sure I’m not alone in this.

    There is considerable debatching to be done after hours.

    I’m not sure batching saves me an hour a day, but maybe half a hour. It also makes the day more pleasant.

    Your larger point is well taken. Primary care medicine is a death of a thousand cuts and we’re better off if we can fend off even a few of the sabres.

    • http://www.thehappymd.com/ Dike Drummond MD

      Hey BKS … glad to hear you are a regular “batcher”.

      I can say with complete certainty … any practicing physician that is NOT doing these two things
      Batch process
      BID team huddle

      Is wasting at least an hour a day, working way to hard and putting out way to many avoidable fires.

      Not doing these two things adds to the stress and overwhelm that cause physician burnout. I teach them to all my coaching clients.

      Here is a link to the Team Huddle Power Up Training so you can learn how to use that tool with some real power
      http://www.thehappymd.com/physician-leadership-patient-flow-and-team-huddle-power-training/

      Dike

      Dike Drummond MD
      http://www.thehappymd.com

      • http://onhealthtech.blogspot.com Margalit Gur-Arie

        That’s very much like what the PCMH model is advocating… Just one comment regarding the huddle thing: I wouldn’t wait for staff to identify tasks that they can do instead of you. Depending on your staff, you may have to wait a long time… Here are a few ideas on how to identify those little, and not so little, things that you should systematically delegate (ad hoc delegation is a waste of time and a stressor) http://onhealthtech.blogspot.com/2013/05/if-you-want-to-win-you-may-have-to-fight.html

        • http://www.thehappymd.com/ Dike Drummond MD

          Hey Margalit … you never “wait around” for anything. What most doctors don’t do is ask for their staff input. I have never met a doctor who’s staff did not want to help them more. The key is the power structure/culture does not support them speaking up unless the doctor has specifically asked them to point out areas where they might take over a task.

          The best way to identify things to systemize and delegate is what I call the broken record method. Here is an article on that ..
          http://www.thehappymd.com/patient-flow-physician-stress-broken-record-method/

          The is the essence of team centered care is that the doctors are aware of and specifically request everyone’s input. They have to “step down from the throne and become a collaborative leader rather than the choke point in the system.

          Dike

          Dike Drummond MD
          http://www.thehappymd.com

          • http://onhealthtech.blogspot.com Margalit Gur-Arie

            Hi Dr. D., I guess my experience is different, but I am not convinced that we have a power culture where staff is afraid to speak up. Granted I don’t deal much with hospitals and CorpMed, so things may be different there.
            For most practices I walk into, the practice manager is supreme ruler (and often spouse), and I walked into countless situations where other staff (MAs and nurses) were not exactly thrilled (understatement) with added responsibilities, related to EMR data entry in particular, and in some cases pretty vocal about it too.

          • buzzkillerjsmith

            The nurses run things where I work too. That’s fine. They’re very good at telling me where my attention should be focused at any point in time to maximize flow.
            They would laugh at the idea that the docs are on a throne.

          • http://www.thehappymd.com/ Dike Drummond MD

            Staff is often reluctant to speak up to the doctor and say … why don’t you try doing it this way? There is always buzz at the water cooler that never reaches the physician. I call it “being on the throne”.

            It is definitely a result of the pecking order inherent in the practice. In order to be a collaborative team you have to break down that pecking order. The doctor has to say …”Hey team, let’s put our heads together and figure out the best way to work as a team … and there is no rank in the room as we figure this out.”

            Having a doctors spouse running the practice puts a king and queen in the building with their whole relationship on public display … hugely challenging to say the least.

            If nurses run things … that is because the doctor has abdicated that role. Everything we are talking about is not taught in residency. We are doing post, post graduate, remedial leadership and productivity training here.

            Dike
            Dike Drummond MD
            117 ways to prevent Burnout In the MATRIX report here
            http://www.tinyurl.com/bpmatrix

          • buzzkillerjsmith

            I hear ya. Some of the nurses/MAs have been at my location longer than I have and are very good. One lady remembers being at work and seeing the ash come down in the streets when St. Helens blew.

  • Dr. Drake Ramoray

    I batch refills, tasks, labs, and often notes. That being said that often means I’m working through most of lunch (I take 30 min of the 60 min for lunch), work at least an hour or so after patients are finished at the end of the day, and often come in 30-60 min before patients the next morning. I could probably work faster if I template my notes but I prefer to use Dragon so that my referring docs can see what I’m thinking and don’t get 5 pages of gobbledygook, icd-9 codes and CPT codes for a consult.

    I’m not certain it saves much time, but at least that means I very rarely have to make my patients wait for their appointment. My MA also knows my heavy task list will come after lunch and first thing in the morning. I’m usually ready for the next patient before they are ready to be seen (which is when I do the note if I can.). We are small enough that there isn’t much use for a team huddle (especially since all of the docs do things a little differently).

    • http://www.thehappymd.com/ Dike Drummond MD

      Hey Dr. D … templates in your EMR are massive time saving tool that you ignore at your own peril. You are overcharting … and working too hard plain and simple. I know I am not the only person who has ever told you that.

      If you create a unique note for each and every patient encounter .. and expect to get home at a reasonable time … well .. .all I can say is good luck with that. The key is to become a power user of whatever EMR system you are using. That involves tricking it out with your own personal templates that “eliminate gobbledygook” and allow you to automate 50% of what you are dictating word for word right now.

      And ideally batching is not done in addition to a full half day of patients. It is done as part of that half day. It is a part of the structure of your day NOT something you do instead of eat lunch or between 6 and 7 at night when you are done with patients.

      There is no such thing as a practice where a team huddle does not help … especially if you are a small practice and especially if the docs all do things a little differently.

      My two cents,

      Dike
      Dike Drummond MD
      http://www.thehappymd.com

      • Dr. Drake Ramoray

        Hi Dike,

        Thanks for the reply. I’m sure you know there are very few people more reluctant to change than doctors who do things a certain way!

        I have moved back to templating on some cases. I have been at my current practice less than two years because my previous places of employment were outright malignant.

        Unfortunately, I didn’t pick our EMR and so we can’t import labs in the body of a note. Sayin labs are normal just doesn’t cut it for an Endo.

        The second problem is meaningful use. I can’t change the insulin dosing on the med list every visit because then unless I write a script for the insulin at that encounter I get dinged for meaningful use. As such, our med list is fairly generic and our medications have to be listed specifically in the note. It took me a few months to even figure out how I would want to template them. The fact that I can’t change an insulin dose from 16 to 18 units without writing a script to avoid getting dinged by the government is depressing.

        If my EMR allowed me to import labs and there was no meaningful e use for electronic prescriptions then I would be home at 4:30 every night.

        I have templates for some easier things (thyroid cases) but those notes didn’t take very long anyway.
        I hear you on the team hurdle though. Its tough to be the new guy, and Im by far the first one to go home. (Yay, my practice is the least bad!? /s). It’s something I will bring up in the future.

    • swatdoc

      We too are doing the same things no lunch on a busy Monday because patients come first. Most workdays are 11-12 hours and then often an hour at home reviewing charts of the 40-60 patients seen that day