When Judy, Joe, and I begin consulting engagements with practices around the country, we’re almost always asked, “Do you think our practice could be overstaffed?” Usually, the administrator or physician leader who asks seems to assume that overstaffing is a terrible mistake, one that will surely undermine the organization’s profitability. Oddly enough, I don’t think I can name a single occasion when a physician owner or manager wondered anxiously if there were too few people employed in their organization. When it comes to staffing in healthcare, the worrying seems pretty tilted towards overstaffing.

It’s easy to see why. Staffing is typically one of the biggest expenses in any healthcare organization. Employees are easy to see, and if they’re not fully utilized at all times, that’s easy to see, too. Cutting staff (or expenses related to staff) may not be simple or painless, but it’s much easier than trying to reduce other overheads like rent or other building costs. In fact, most other large expenses are fixed, or nearly so; staffing may be the only area where cuts can readily be made. And if you can see that there’s slack in the system, isn’t it smart to try to tighten it up?

Perhaps—but it depends. For example, are you sure you’d have no trouble accommodating an unexpected surge in demand with fewer staff? Would you still be able to maintain your service standards with a smaller team, even if some members unexpectedly needed to miss work? And are you sure that every important task is already being done?

It’s easy to overreact to idle time because it’s so easy to spot. But a little bit of idle time may simply reflect the occasional unpredictability of clinic workload. If you overreact to it, you can end up with bigger problems than a bit of staff under-utilization.

When our clients are concerned about staff sometimes seeming unproductive, we suggest they consider whether any important tasks were dropped off the priority list in recent years. In many healthcare organizations, tasks related to patient collections have crowded out valuable non-essentials. For example, receptionists probably spend more time explaining and collecting patient payments than they do welcoming patients or describing how the clinic works. Yet those first few moments a new patient spends at the front desk are an opportunity to establish a caring relationship. A little extra attention from a receptionist could make all the difference to an anxious patient. When a receptionist is slightly less busy and a bit more empowered to offer that personal touch, it could be the first step towards more engaged patients. As patients become more engaged, they may gain more from the healthcare services they receive, and they might be more inclined to recommend them to someone else.

As technology makes some tasks easier, practices that automate may find that instances of idle time increase. But immediately responding by reducing headcount can mean missed opportunities to provide better service—whether in small, simple ways, like a little extra attention to arriving patients, or more complicated ones, like putting more time into recalling patients for follow-up.

Employees often have wonderful ideas of their own for how to restructure their jobs to serve patients better; when it’s clear you welcome those contributions, the quality of the suggestions  and effort that results may surprise you. When a bit of slack in your workflow presents the opportunity, consider letting the entire team contribute their observations about what else could be done to add to the patient experience. Asking patients for their opinions helps keep them engaged—and allows you to benefit from the expertise of the people who know most about what works and what doesn’t in your workflow.

Focusing on avoiding over-staffing causes many practices and healthcare organizations to miss out on the possibilities and advantages that a bit of “extra” capacity can bring to improve productivity and patient service.  My new book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business takes a fresh look at staffing in medical practices, and how it can make all the difference in productivity. To be notified when it’s available, and receive a special price, join our book club mailing list with the form below:



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