The Power of Protocols

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Neil Baum, MD, and Neeraj Kohli, MD, MBA

Neil Baum, MD, is Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, LA, and author of Marketing Your Clinical Practice-Ethically, Effectively, and Economically, Jones Bartlett Publishers.

Neeraj Kohli, MD, MBA, is Director, Division of Urogynecology, Brigham and Women’s Hospital, and Assistant Professor, Department of Ob/Gyn, Harvard Medical School, Boston, MA.


As physicians, we are creatures of habit. We all recognize that a routine often has the power to improve our performance. Surgeons have long recognized that a routine in the operating room is absolutely necessary. Routine steps taken before the surgical procedure, such as the preoperative evaluation, anesthesia induction, preparation of the instrument card, and making certain that the operating room staff is comfortable with the procedure, can improve your performance and the outcomes. It is no wonder that those procedures that we do most often are the easiest, the most efficient, and have the most favorable outcomes. Perhaps this is the reason why surgeons who have a large volume of similar cases have better outcomes than those surgeons who only infrequently or rarely perform a procedure. By performing a large number of cases, surgery becomes routine and standard.

So, how can we translate what happens in the operating room to our office practices? We believe that developing protocols for day-to-day activities in your office and your clinic will improve the efficiency and productivity of your practice.
Begin by looking at those procedures that are performed multiple times throughout the day or multiple times each week. You will find that most of the processes in your office practice are repetitive. Examples of these activities include answering the telephone, making appointments, moving patients from the reception area to the exam room, in-office procedures, and obtaining studies in the office setting. You might consider looking at a few areas that present problems within your practice. For example, are the patient’s X-ray reports and laboratory tests ready when a patient is placed into the exam room? If those reports are not available, there can be significant delays that can result in a patient’s increased anxiety. You may also want to consider developing a protocol for procedures frequently performed in the office. You want to be sure that all of the instruments and equipment that are needed for the procedure are available in the room so that no delays occur when you enter the room to begin the procedure.
Next, create a routine. Develop a written step-by-step protocol for procedures that you want to streamline. If you are trying to develop protocols for meaningful use of your electronic medical record keeping, there is a program sponsored by the government that can provide doctors up to $44,000 to each doctor who documents meaningful use in his or her practice. Consider assigning one staff member to weigh the patient, take the vital signs, and update the medications and allergies in the electronic medical record. This process should be streamlined so that there is no downtime between when the patient is placed in the exam room and when he or she is seen by the physician. If the patient is to have blood drawn, this can also be added to the protocol and can be accomplished before the physician sees the patient.
Once the protocols are developed, it is time to implement the routine. This requires adding the protocol to your office staff manual. Then, the new protocol should be discussed with all members of your staff. This can often be done at your weekly staff meeting. You want to get the staff’s input on the new protocol and listen to their comments and suggestions before implementation.
Finally, you want to follow-up and analyze your results. This means tracking the performance of your protocol and determining that the process results in improvement of patient care. In order to make this process effective, you need to inspect what you expect. You might also consider rewarding the staff in some small manner, such as a party for the office staff, movie tickets, or even a bonus for goals achieved and accomplished.
Bottom line: Properly instituted protocols get everyone—patients, staff, and doctors—on the same page. Protocols have the potential to increase the effectiveness and productivity of your practice.