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By: Robert G. Chalmers
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Life has been tough for private practices and will likely get tougher over time. Rising operating costs, disappointing reimbursement and stressors from every direction, combine to keep todays practice under tremendous pressure to manage costs and reduce malpractice risks while providing quality care. What a balancing act!
Practices are forced to respond to these pressures, or risk going out of business.
Believe it or not, you can help assure quality care in a cost effective manner by employing the simple methodology outlined in this article. The methodology presented here is applied to Medical Assistants (MAs). However, the process can be used with any other staff function.
For the average primary care office, the MA is likely the staff member who spends the most time with a patient. From greeting to departure, this person most represents your practice to your patient/customer. How well do you evaluate, train and monitor this employee?
How well are MAs trained?
Some of the more seasoned MAs may not have attended a structured program (MA “school”). There are currently no curriculum or content standards in place for the education and training of MAs. In 2007, The National Council of State Boards of Nursing proposed a model curriculum for MA-C’s (Certified MAs). So far, nothing has happened.
A friend who is a risk management expert has visited and lectured at a number of MA schools. This expert reported an absence of consistency in curricula among the schools. MA education and training programs have, in some cases, come down to as little as six weeks! Practice administrators report interviewing MA candidates who could not take vital signs except by using a vitals station. Is this the competency level to which you will entrust your patients and the future of your practice?
In short, the leaders of the practice should set a list of duties they expect their MAs to perform, evaluate initial skills against each duty or task, and monitor for ongoing competency. Leaders should also decide how they want these duties carried out. When I was a practice administrator, I had each MA write up a detailed description of how they performed certain duties. For example, when we focused on lab related procedures, each MA picked one procedure and wrote it up in detail. Involving your staff is a great way to help them feel invested in the process and contributing to the practice.
Clinical leadership then reviewed these procedures, making changes if needed. This creates practice specific standards - “We expect you to be able to perform these tasks and this is the way we want them performed.” You make your expectations clear and have them documented in a personnel or clinical services manual. These policies should also be reviewed with all prospective MA hires. Whenever possible these candidates should demonstrate their proficiency at the interview. The practice leaders observing the candidate’s proficiency in each task must also document the proficiency, or lack thereof. If, the candidate cannot be checked out prior to hire, they should be evaluated as soon as possible after hire. Results of the monitoring should be documented. This only takes a check mark in a “Yes” or “No” box on a form with any deviations documented.
Deficiencies need to be addressed immediately. Once they past this “test” you should periodically “re-test” them to ensure they haven’t made any changes in the prescribed care. If they do, they are counseled. As the MA continues to “pass,” the frequency of retest can be reduced.
While physicians should be directly involved in this monitoring, these duties can be shared by all licensed providers at the practice, so the ongoing time investment is indeed minimal.
To summarize: Tell them what you want them to do. Tell them how you want it done, and assess competency and periodically reassure yourself (and any potential reviewing agencies) that they are still complying with the protocols you established. By following this process your risk of MA performance problems are reduced, your quality of care and efficiency are increased, and your medical malpracitce liability and staff turnover will likely be reduced.
Robert G. Chalmers is the Executive Director of Physicians’ Alliance, Inc.
