Variance can be defined as the performing the same process, say a tooth extraction, and getting a different result each time. A result can be the outcome of the process, such as a complete or incomplete extraction, happy or unhappy patient, etc. A result can also be an attribute of the process, such as the time it takes to perform the process (some call this Takh time). Variance is waste. If a procedure has a great deal of variance, the front desk will allow for that in the scheduling, setting appointments farther apart. When appointments are set farther apart, the assistants spend more time than necessary on the patients (at their regular hourly rate) and the doctor spends more time in the office than necessary. Usually a practice has an agreed-upon block of time allowed for each procedure. There may be science behind the determination of the block length, or there may not. I was in one practice where they had block times designated for procedures, and the front desk put “time bands” around the blocks because of the variance.
The conclusions are two: variance causes waste, and variance is costing you money.
The question is whether you can do anything about the variance.
I know that many of you will say that variance is caused by the specific circumstances and physiology of the patient. I won’t argue. My experience “standing in a circle” has produced evidence that many practices induce variance into their processes through disorganization, inattention to detail, not taking the patient’s point of view, and so forth. So what did I see?
- I saw assistants going from opertory to opertory searching for needed items. This costs time and adds to variance.
- I saw staff not knowing what was required for the procedure. This costs time and adds to variance.
- I saw staff not planning for contingencies. This costs time and adds to variance.
- I saw staff waiting for the doctor who was on the telephone or computer. This costs time and adds to variance.
- I saw extra time necessary to explain post-procedure instructions to patients because the instructions were not delivered from the patient’s point of view, so the patient did not understand. This costs time and adds to variance.
- I saw assistants moving small inexpensive items from opertory to opertory because not all opertories were setup similarly and the patient was put in the “wrong” opertory. This costs time and adds to variance.
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I saw assistants searching through the drawers in the opertory looking for items, when they were in an opertory that wasn’t “theirs”. This costs time and adds to variance.
Not all variance can be eliminated. But much can be. You will have to involve your staff in the measurement of procedure time, and the identification and elimination of causes of variance.
You can be assured that the reduction of variance will pay long term dividends to your practice, to you and to your staff.