Dr John Lockley discusses how streamlining simple everyday tasks can save time in general practice

Everyone in primary care is time-poor. So what can we do about it? Save time by shaving time, that’s what. ‘Shaving time’ (think of Sean Connery saying it!) is about finding ways of doing common tasks a bit more quickly.

There are several ways of doing this:

  • speed up a task by doing it differently, for example, by—
    • cutting out part of the job
    • making it simpler
    • dispensing with it altogether, or
    • making it someone else’s responsibility, such as the patient’s
  • do some or all of the work automatically—this offers a three-fold benefit: it reduces stress, saves time, and eliminates human error.

A surprising example

Twenty years ago our clinicians used a manual buzzer to ask the receptionist to call in their next patient. When the buzzer sounded the receptionist had politely to extricate herself from what she was doing (perhaps booking an appointment over the phone), look at the board to see which clinician’s light was on, find the correct appointment list, see which patient was next, and call them in. Finally she could return to her previous task—which was often around the time the next buzzer sounded.

Installation of an electronic call-in board, linked directly to the clinicians’ computers, saved about 20 seconds per patient. Not a lot, I hear you say. Now do the maths. With 18 patients (at least) in each surgery, that’s a saving of 6 minutes per session. At nine surgeries a week that’s 54 minutes per week, for each doctor and nurse.

Suddenly that insignificant 20 seconds has turned into an hour a week for each of the clinicians (and the receptionists are less stressed, too).

All this happens whenever we shave time—and the more frequent the activity, the more time we save overall. Taking just 1 second off an action done 1000 times each week saves an hour a month. And that’s just one activity! Find a few more and you can reclaim staggering amounts of time for yourself and your staff.

What gets done frequently? Many things—answering the phone, opening letters, ordering blood tests, bagging up samples, annotating laboratory results, reauthorising prescriptions, making routine telephone calls, writing letters, doing home visits, recording medical notes … the list is almost endless.

The golden rules of saving time

The simpler you can make each job, the quicker it usually becomes. This can be done by:

  • reducing the number of steps needed
  • minimising the number of fiddly stages
  • where possible, reducing the number of people involved
  • gathering similar work together so one experienced operative does it for everyone, at double-quick time.

One golden rule: time is money. It may be cheaper to buy apparently expensive equipment if by utilising it you continually save time (and hence money). Take stamping an envelope: how long does it take to prise a stamp off a sheet, align it with the top right hand corner of the letter and press it on to the envelope? How much more quickly could you do the job by using an automatic franking machine? (And postage is cheaper!)

By itself this won’t save much time if most staff members only write one or two letters each a day. But if all the letters to be posted are gathered together, then stacked into the franking machine, you can still save time, effort and stress, gradually and progressively, week by week by week …

Then there’s writing letters: spend money on a voice processor and from then on you can dictate letters and medical notes directly on to the computer. There is less need for secretarial time, and you can check your letters and notes as you dictate them.

What about getting a mobile computer (laptop, tablet, etc) for home visits? This cuts out the time, paper and printer ink used in creating a home visit report; and you don’t have to transcribe your paper notes on returning to the surgery.

Could you even get others to do the job for you—such as using a patient self-check-in screen? It saves hours of receptionists’ time.

What about making ‘downstream’ events simpler: for GPs, how about setting up a completely separate bank account/card to pay your personal tax—deductible expenses, so everything you need to claim against tax—professional fees, travel, car expenses, telephone bills—is gathered together in one account? Now you don’t need to wade through pages of your ‘normal’ home account, in order to exclude payments made to the supermarket, meals out, or the garage bills for your car. All your professional bills appear on the different account: checking them becomes a doddle.

Automation

Automation is great! It saves time, reduces stress (because it stops you having to think about the problem, or even having to carry it out), and reduces or eliminates transcription errors.

The computer is a wonderful place to do this:

  • create a Startup folder for each member of staff, so the programs they personally need each day load automatically when they log into their computer.
  • bookmark web pages you use frequently
  • create standard Word templates for letters and agendas, containing all the routine items, so they don’t have to be re-typed each time
  • pin your commonly used programs to the Task bar at the bottom of your screen: now you can call them up directly.

Where do I start shaving time?

Take a detailed look at what you’re doing: can you automate any of it, or perform it remotely? Or get equipment to do it for you? Or avoid doing it entirely? In the ‘internet of things’, what about wiring the practice fridges so you can measure their temperatures remotely; or open the late-night surgery door remotely (having checked first via a camera who is there)? What about an electric stapler, telephone banking, paying by direct debit…?

If it’s to do with the telephone, can you turn it into a speed-dial? If it’s on the computer, can you create a macro to perform it? (A macro is a sequence of keystrokes, mouse movements and mouse clicks, all collected together and triggered by a key combination such as, say, ALT-CTRL-K.) Using macros you can input three lines of text in a tenth of a second; record a full examination in six keystrokes, load a referral letter template.

It all helps, and it all shaves time—lots of it.

Key points

  • In the time-poor world of primary care, save time by shaving small amounts of time off frequently-performed tasks. It all adds up—sometimes to hours a week
  • Think about the jobs you do frequently:
    • can you do them more simply?
    • can you automate them (saving time, reducing stress, and minimising mistakes)?
  • Every little helps: the more frequently you do a streamlined task, the more time you save—forever!