Chapter 012

Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.

Office Environment and Daily Operations

Chapter 12


Introduction

The physician’s office is a busy place where the medical assistant encounters new challenges every day.

When adaptation skills are learned and refined, office efficiency increases and the schedule can handle interruptions and emergencies.


This chapter will examine:

Actions that need to be taken before the office opens

Patient traffic flow as a consideration in office design

Expenses involved in the operation of a medical practice

Price comparisons for office supplies

Ways to save money in the medical office


Opening the Office

Arrive early to prepare the office for the day ahead.

Allow only a certain number of employees to have keys and alarm codes.

Numerous keys distributed gives more employees access to the office after hours.


Preparing for the Day Ahead

Each employee is responsible for his or her own work space preparations.

Work together as a team.

Complete work quickly and efficiently.


Duties before Patient Arrival

Call the answering service to collect messages.

Write the messages on the message pad to ensure that a copy is kept.

Make copies of the day’s appointments

Provide a copy to each physician.



Prepare medical records for patients that are to be seen.

Make certain that there are enough progress notes in each medical record.

Glance over notes from the previous visit to be sure that laboratory results are in the record and available to the physician.



Restock examination rooms– Cotton balls

– Adhesive bandages

– Gauze pads

– Patient gowns

– Drapes



Restock restrooms– Toilet paper

– Soap

– Hand towels

– Urine specimen cups



Make sure that prescription pads are available.

Keep the pads out of patient sight.



Turn on equipment.– lights

– computers

– lab machines

– copy machines

Run controls on lab equipment, if necessary.

Fill copy machine with paper.



Check specimens and laboratory tests that need to be viewed, and record results in the patient medical record.

Make certain the physician sees all test results according to office policy.



Prepare the accounting software or manual day sheet.

Gather enough encounter forms for the day.

Stock the patient check-in and checkout areas with business and appointment cards.


Patient Traffic Flow

Room design is generally out of the medical assistant’s control.

Physical design and room layout can usually be changed and adapted for patient traffic flow.


Patient Traffic Flow

The fewer steps that patients have to walk as they work their way through the office, the better.

Move patients from room to room only when no other options exist.


Pharmaceutical Representatives

Also called “detail persons.”

Do not always see the physician.

Restocks the sample drugs.

Answer questions about the drugs they represent.

Goal is to get the physician to prescribe their company’s drugs more often.


Other Office Visitors

Medical suppliers

Office suppliers

Medical equipment suppliers



Physicians

Take visiting physicians directly to the doctor’s office.

Notify the doctor at once that a physician is waiting in the office.



Physician’s Family Members or Friends

Follow the physician’s directions as to family visits.

Never send family members or friends away without notifying the doctor of their presence in the office.


Using the Office Policy Manual

All employees must read the office policy manual and are responsible for knowing the information contained in the manual.



Sections include:

Expected performance of employees

Tardiness and absenteeism policies

Sexual harassment issues

Confidentiality

Vacations, sick time, paid time off

Employee evaluation

Continuing education

Chain of command

How to deal with certain patients and visitors



Manuals should be written in clear, concise language.

Manuals should be consulted whenever questions regarding policy arise.

All employees should sign a document stating that they have read the manual.

All office tasks must be detailed in the policy and/or procedure manual.


Daily, Weekly, and Monthly Duties

Use checklists to ensure that all duties are completed.

Checklists help divide duties among staff members.

Include even the smallest tasks on the checklists.


Constant Cleaning

Nothing should appear dirty in the physician’s office.

Countertops, sinks, door handles, and restrooms should be checked frequently and cleaned whenever needed.


Constant Cleaning

Look for items that need cleaning in the office.

Be conscientious about cleaning duties.

Supervisors will notice productivity, and this will reflect positively during employee evaluations.


Cleaning Services

Service performs more intensive cleaning chores.

Service usually cleans in the evenings and on weekends.


Cleaning Services

Communicate with the service, and immediately contact them when cleaning is not done as expected.

Keep a log of tasks, and mark off those that are completed.


Filing

Critical job

Always a stack of filing to be done

Stay on top of this duty

Responsibility of every employee


Filing (cont’d)


Identifying the Need for Specific Supplies

Consult the policy manual to determine the way that supplies should be ordered.

Take an inventory at least monthly.

Communication is the key to keeping supplies in stock.


Budgeting

Salaries

Medical supplies

Business equipment

Medical equipment

Utilities

Rent or mortgage

Insurance

Maintenance

Taxes

Laboratory fees

Office supplies

Expenses in operating a medical practice include:


Budgeting

Expenses are usually planned 1 year in advance.

Log expenses into specific categories monthly.

Adjust budget categories, and determine where overspending has occurred.


Comparing Prices

Compare prices when shopping for supplies and equipment

Price may not be the only consideration when making a purchase. Also consider:– warranties

– bulk purchase discounts

– maintenance agreements


When Making Purchasing Decisions…

Consider:

price

delivery

shipping

handling charges

length of time to use all stock


Ordering Supplies

Responsibility should be assigned to one person.

Determine a method for tracking usage and ordering.

Ensure that staff members note when supplies are taken from stock.

Use the system that works best in the office.


Internet Shopping

Compare prices on the Internet in addition to using local suppliers.


Ordering Equipment

More involved than ordering supplies

Often considered a capital purchase

Physicians almost always involved in capital equipment


Capital Purchases

Different businesses use different monetary amounts to classify capital purchases.

At least three estimates should be obtained before a capital purchase is made.


Outsourcing

Outsourcing could be less expensive than performing treatments, tests, or procedures in the office environment.

Compare prices, and determine the best outsourcing company.


Options for Equipment Purchase

Local supplier catalogs

Local supplier sales representatives

Used equipment

Purchasing equipment from retiring physicians

eBay

Internet


Receiving an Order

Packing slips

List of items ordered and items shipped

Invoice

Itemized list of goods shipped that specifies price and terms of sale

Statement

Summary of a financial account that shows the balance due and transactions that affect the account


Troubleshooting Equipment Failure

Consult owner’s manuals for troubleshooting procedures.

Owner’s manuals are often available online.

Look for the simplest solutions first.


Equipment Maintenance

Many machines must receive scheduled maintenance.

Records must be kept of all maintenance procedures.

Maintenance guidelines are usually found in owner’s manuals.


Preventing Waste while Saving Money

Use solar-powered calculators and battery rechargers.

Use refillable pens, pencils, and tape dispensers.

Use refillable calendars.

Use two-way envelopes.

Reuse file folders and binders.



Refurbish office equipment.

Use bulletin boards.

Change to cloth towel dispensers.

Reuse printer toner and ribbon cartridges.

Retrofit exit sign bulbs.

Convert to high efficiency fluorescent lighting.



Reuse dishware.

Use reusable forced air filters.

Eliminate single-use cups.

Reuse paper printed only on one side.


Lunch and Break Etiquette

Take a morning and afternoon break

Stagger breaks with those of other employees

Alternate lunch hours

Use the lunch hour to rest and refresh

Eat a nutritious lunch


Lunch and Break Etiquette

Be respectful of break and lunch time restrictions.

Clean dishes used and put them away.

Do not store food and medical supplies that need refrigeration together.

Clean the refrigerator at least once a week.

Keep lunch and break areas clean.


Sending and Receiving Email

Always project a professional tone.

Use office systems for work-related email only.

Never forward comics or sexually explicit email using the office system.

Treat email as confidential if it relates to a patient.


Sending and Receiving Email

Email and all computer activity can be monitored in real time.

Files are not completely gone even when deleted.

Do not participate in any email activity that you would not want your supervisor to read.


Internet Research

Look for information from sites that can be trusted.

Bookmark good sites for future reference.


Internet Research

Various types of information can be found on the Internet, such as:

Company reports

Financial information

Company profiles

Conference proceedings

Seminar announcements


Internet Research (cont.)

Law, government announcements, and parliamentary debates

News and current affairs

Databases of reference material

Places to discuss topics and ask for help


Traveling for Business Purposes

Training seminars and workshops allow employees to gain CEUs, learn new techniques and procedures, and maintain certifications.


Seminars and Workshops

Physicians are required to earn a certain number of continuing education units each year.

Depending on what type of certification the medical assistant holds, he or she may be required to earn continuing education units as well.


Seminars and Workshops

When considering the cost of seminars and workshops, don’t forget to include:

Cost of workshop itself

Travel costs

Hotel

Gas

Food


Scheduling Travel, Hotel Rooms, and Car Rentals

Location of event dictates the type of travel arrangements that should be made.

The Internet is often used to book travel arrangements.

Staff members should expect reimbursement for reasonable business expenses.


Suspicious Persons

Keep a distance if a suspicious person enters the office.

Stay behind counters and desks.

Lock doors that lead to the reception area, if possible.


Suspicious Persons

Attempt to notify another employee as soon as possible.

Plan codes for different types of emergency situations.

“Norman is here to see you.”


Robbery

Thieves may assume that the physician’s office has cash or, more likely, narcotics on hand.

Never argue or fight with such persons.

Attempt to get them out of the office as soon as possible.


Basic Identifying Markers

Height

Weight

Hair color and length

Clothing, especially the color

Race

Distinctive markings (scars, tattoos, and so on)


Office Security

Store cash and narcotics in locked cabinets.

Use an alarm system.

Limit the employees who know alarm codes.


Smoke Alarms

Two types of smoke alarms:

Photoelectric

Ionization

Change batteries twice a year at daylight savings time.


Fire Extinguishers

Fire extinguishers must be serviced annually by a fire professional.

Staff members should be trained in the use of fire extinguishers.


Fire Extinguishers

Multipurpose ABC extinguishers are suitable for small businesses.

Basic Use:

P—Pull the pin

A—Aim the hose

S—Squeeze the handle

S—Sweep the nozzle


Is the Physician’s Office Safe?

Are all exit ways accessible and unobstructed?

Are all of the fire extinguishers operational and properly locatable?

Are all of the emergency lighting units and exit signs operational?

Are any extension cords or multiplug adaptors in use?



Is there an escape plan with two ways out, and do employees know how to use it?

Is the fire alarm and sprinkler system functioning correctly and easily accessible?

Is all storage neat and orderly and not obstructing sprinkler heads?



Are all flammable liquids and materials stored away from heat sources?

Are all plumbing, mechanical, and electrical systems functioning properly?


Fire Exits and Escape Routes

At least two exits must be designated as fire exits in the medical facility.

They must be clearly marked and easily accessible.

Escape plans must be posted in several areas of the facility.


Locked Storage Areas

Narcotic and other drugs should be kept in locked cabinets.

Limited access should be granted to employees.

Prescription pads should be kept in a locked cabinet and never left out in plain sight.


Waste Storage and Destruction

Medical waste and regular waste are found in the physician’s office.

Medical waste must be disposed of according to OSHA guidelines.– Records must prove that medical waste was collected

and destroyed.

Regular trash is collected two or three times a week.


Ergonomics

Ergonomics is the applied science concerned with designing and arranging things people use so that the interaction between them is efficient and safe.


Acoustics

Acoustics is the science that deals with the production, control, transmission, reception, and effects of sound.

Acoustics can affect confidentiality in the physician’s office, so office acoustics must be designed to guard the patient’s right to privacy.


White Noise

White noise masks undesirable noises, such as multiple conversations in interior spaces.

Most people have no idea that white noise is being generated.

Sometimes white noise sounds like a soft static.


Identifying and Sharing Community Resources

Get to know people and organizations in the community.

Use contacts as referral sources for patients who need assistance.

Create a community resource list.

Stay in touch with contacts to make certain patients are given correct, up-to-date information.


Emergency Phone Numbers

Keep a list of frequently called and emergency phone numbers.

Include: Local hospitals Local pharmacies All physicians associated with the practice All employees Nonemergency police services On-call physicians


Closing the Office

Check to see that all patients have left the office.

Straighten examination rooms.

Lock file cabinets, drawers, and doors that must be kept locked.

Perform general housekeeping duties.

Send phone lines to the answering service, if applicable.

Lock the facility.