Improving practice organisation: four workflows every practice has
Practices differ in almost everything, but four workflows occur everywhere — and stall everywhere at the same points. What blocks them and what helps.
Anyone wanting to improve how a practice is organised finds plenty of general advice: analyse processes, digitise, train staff. The catch is that a practice does not have "processes" but four or five concrete workflows that shape the day. Everything else is decided there.
The following four occur in almost every practice, regardless of speciality and size. For each, where it usually gets stuck.
1. Appointments
The bottleneck is rarely the calendar but the question of how urgent something is. Whoever has to decide on the phone whether someone comes today or in three weeks is making a clinical judgement — under time pressure, with somebody standing in the waiting room.
What helps is not a better calendar system but a written rule: which complaints belong the same day, which within the week, and which can be planned. Three categories are enough. Once they are on paper, reception can apply them instead of weighing up or asking back every time.
2. Incoming post
Lab reports, hospital letters, insurer queries, referrals: they arrive by fax, post, email and portals and all have to be matched to the same patient . That matching is the real effort, not the reading.
The most effective step is to reduce the number of inbound channels before improving how they are handled. Four channels for the same kind of document mean the same manual work four times and four places where something can sit unnoticed.
3. Releasing results
A result is in, somebody has to see it, and in between there is usually a signature. The workflow does not hang on the passing on but on the availability of the person who releases it.
Two changes reliably work here. First, a fixed time of day for going through results rather than in between — nominally that costs more time and really saves the constant switching. Second, a channel through which the patient receives the result without anyone printing and enveloping it.
4. Repeat prescriptions
The least conspicuous and often largest item by volume. A renewal is a clinical decision, but the route to it — take the call, pass on a note, call back, print, collect — is pure organisation.
Counting pays off here in particular: in practices with many chronic patients this single workflow accounts for a considerable share of call volume, and almost none of it needs a conversation.
The pattern behind all four
Three times out of four the bottleneck is not the work itself but the waiting: reception waits for an assessment, the report waits for a signature, the prescription waits for a call back. The work takes seconds, the waiting hours.
In a practice, it is rarely the activity that costs the time, but the handover from one person to the next.
From that follows a test applicable to any improvement proposal: does this change remove a handover, or does it merely speed up one step between two handovers? Only the former changes the day noticeably.
Where to start
With the workflow that occurs most often , not the one that annoys most. The most annoying is usually the rare exception — it is remembered because it disrupts, and over a year costs less than the quiet item that runs thirty times a day.
