American Association for Physician Leadership

Time Management in the Healthcare Practice and Delegation Strategies

John Guiliana, DPM, MS

Hal Ornstein, DPM, FASPS

June 8, 2023

Volume 1, Issue 2, Pages 75-77


Many challenges arise in healthcare practices. Inadequate time management does not have to be one of them. Get off the gerbil wheel and control your life and practice. This article offers 13 practical strategies for time management and delegation. In addition it also offers an Action Step that will assist you in identifying areas that can be optimized to make more efficient use of your time.

Are you busy? Of course, you are. For years, we’ve run full-time practices as well as acted as medical practice management consultants and speakers. Over the years, we’ve learned a few things—hopefully—about managing our time. Here are 13 tips we’ve found helpful.

  1. Master Schedule. Having one schedule for the practice that indicates your schedule, the employees’ schedules, patients’ schedules, and everything else on it helps significantly. Everyone on staff needs to feed into the master schedule so that all relevant professional activities, as well as special occasions (birthdays, holidays, etc.) are available at a glance. Professional activities can include normal office hours, nursing home visits, surgical appointments, house calls, teaching and workshop dates, conferences, and educational seminars. But it’s not enough to just make the schedule—you have to look at it. Make sure you look at the next day’s schedule prior to the end of your work day so you won’t be surprised by anything on the schedule. Oops! I’m giving a talk tomorrow and I haven’t made the PowerPoint slides yet!

  2. Ask for Help. If you’re really having problems being organized, discuss it with your staff. Set up a mutually convenient time when you won’t be interrupted (like a Saturday morning, perhaps) and brainstorm about how to avoid wasting time and increase efficiency.

  3. Analyze Appointment Patterns. This can be surprisingly effective. Are there some patients that you know suck up your time? Are there certain types of exams that require more time (like physicals)? What are your busiest days? What are your slowest days? Perhaps there are certain days when certain types of appointments would be better (e.g., scheduling physicals for Fridays, if they’re your slowest days). If you’re traveling between practice locations, are you scheduling travel time? Identify problem areas and adjust your scheduling patterns accordingly.

  4. Block Out Times. Sometimes our days seem horribly fragmented, going from one type of task to another to another. This is terribly inefficient and can be energy draining as well. Increase efficiency by scheduling blocks of time for things that are similar—surgical assistance or minor office procedures, or physicals all on one day, or nursing home visits all scheduled at once, or one day that is devoted to immunizations or allergy shots.

  5. Interrupt the Interruptions. How much time do you spend getting interrupted? Hundreds of times a day? Are you interrupted by your staff? Interrupted by patients? By sales people? By family and friends? By email, Facebook, Twitter, and dozens of other so-called social media? This happens to everybody, but it can be a huge time sink. Patients need to make appointments, and so do pharmaceutical reps and, yes, even family members. If necessary, schedule time in for interruptions and appointments when you deal with non–patient-related business.

  6. Multitask. Most physicians do this, but take a harder look at how and when you’re doing it. Can you keep multiple examining rooms running simultaneously? Are all your examining rooms properly stocked so everything you need is in every room? Are they all organized appropriately so things are easy to find?

  7. Dictation or a Scribe. There are a number of charting possibilities, thanks to current technology. Some physicians prefer to write their own charts. Others dictate and pay someone to type them up. Others hire scribes, who follow them around from room to room and take notes. There is quite a bit of practice management software that allows you to program certain levels of regular responses into your notes, which can save an enormous amount of time. Although some cost more than others, they often pay for themselves quickly through increased efficiency.

  8. Stay Ahead of the Paperwork. Although everybody’s work style varies, in general, it’s far more efficient to stay ahead of your paperwork by working on it daily rather than letting it pile up until you can’t find your desk beneath all the dead tree stuff. One recommendation is to touch paper only once—file it, shred it, or give it to someone to do something about it. Don’t touch it to move it to another pile when you’ll get around to it later. Also, when you work out your billing fees, take into consideration the time you need to spend finishing paperwork not covered by insurers.

  9. Schedule an Extra Day. If you’re traveling, whether on business or on vacation, consider scheduling an extra day in the office to catch up on paperwork and miscellaneous catch-up before seeing patients. There’s nothing worse than coming back from a vacation and immediately feeling overwhelmed and behind.

  10. Prepare Advice Sheets. If you regularly give out the same advice to patients for specific illnesses, prepare pamphlets or handouts that you can give to the patients. Patients typically glaze over at extensive verbal directions, but preprinted materials, particularly with relevant areas highlighted or circled, can give the patient more time to go over them and save you the time of explaining the same thing 50 times a week.

  11. Get Away. One thing about self-employment—it can take over your life. And the Internet, smartphones, laptop computers, and iPads have made it all too easy to take your work with you. Try to disconnect from work. When you’re home, you’re home; when you’re on vacation, you’re on vacation. Even if you have to schedule time away, do it. Not only will this help you be more efficient when you are at work, it’ll help keep burnout at bay.

  12. Study Your Workflow. Every process, whether it’s building a car or seeing patients, becomes engrained: “We’ve always done it this way!” The entire LEAN and Six-Sigma analysis in manufacturing came about because there are numerous inefficiencies built into most systems, and people don’t want to change and don’t realize things might be faster and easier a different way. Several years ago, a major hospital brought in a LEAN expert to see if he could increase efficiency on one of the patient floors. The first thing he did was have the nurses wear pedometers. He found rather quickly that nurses on the patient floor were walking an average of 5 miles a day just because the drug cabinet was located on a different hallway! It was an easy fix and dramatically increased efficiency. Study what’s going on in your own practice. Are there things you do that don’t make sense or inadvertently waste time? Change them!

  13. Our 13th recommendation requires some more time to discuss. It is: Delegate. We define delegation as “the art of assigning responsibility and authority to key staff of an organization in order to improve productivity.” We have typically found that there are 5 common reasons that physicians don’t delegate. They are:

    1. You haven’t taken the time to really look at what you do and how you do it, so you’re not sure what you could delegate successfully.

    2. You’re a micromanager and think you need to do everything yourself. Yes, control freak, you!

    3. You don’t have confidence (trust) in your staff.

    4. You like the stress of doing it yourself.

    5. You might feel guilty about giving work to other people in order to free up time for yourself.

Because delegation is something of a skill in itself, or perhaps it’s even an art, we have come up with eight considerations to assist in making you a better delegator.

  1. Analyze everything you do. Make lists of big projects and break down the small details. Those can include phone calls, applications, and writing notes. Make the list very detailed. Then, check off the ones that can be done by someone else or that you would like to get rid of. Then, underline the ones that you think only you can do or those that you want to keep for yourself.

  2. Who can do the ones you checked off? Now that you have a list of things you can delegate or want to delegate, identify the person on your staff that you think would be best suited to do it. You need to determine not only if this person is capable of performing these tasks, but whether he or she has the time to do it. This may require you to analyze what skills are required to perform these tasks. It’s important that you either match up the person with the appropriate skills to do the job, or the person who is most willing and able to learn how to do it.

  3. Request versus order. Not all staff members are necessarily eager to take on a new job. Sometimes it’s because they feel they’re already too busy (and they might be), or there’s something about the task they don’t like. They may also be concerned that the task is beyond them and they might screw it up; if that’s the case, some encouragement on your part is in order. You want to empower your employees whenever possible. So, request that the person take on this task or ask them if they would be interested in it. Use respect and show your appreciation.

  4. Communicate. Like most areas of being a physician or managing people, communication is key. You need to have a clear picture of what you want achieved when you delegate a task and then need to communicate that to the person you’re delegating it to. Don’t assume the person you’re asking to do something understands why you’re asking them or exactly why you want the task done. Also, to further empower an employee, if it isn’t essential that the task be performed in a precise way, allow them the chance to use their initiative and creativity to approach the project differently than you would. This can result is spectacular new ways of accomplishing things.

  5. Break it down. If a task is complicated, break it down into a step-by-step action plan.

  6. Why. As mentioned in #4, include why you want the task performed, as well as why you’re asking them to do it. People function better when they understand the motivation for doing something. You also need to make it clear that you’re asking them to do it because they’re capable of it and you trust them to do it, not that you’re assigning them extra work as punishment or because you think they’re not busy enough.

  7. Equilibrate the oversight. Most people don’t like having a supervisor breathing down their neck. Some people can barely function with a micromanager hovering, and others require some line-of-sight supervision. Adjust your level of oversight based on the skill levels and experience of the person you’re delegating to, and to the type of task you’re delegating. With time, an empowered employee won’t require much supervision.

  8. Provide feedback. Most people do not do things perfectly the first time. Feedback is required, and it’s your job to provide appropriate feedback when you delegate tasks to people. Tell them what they did well and tell them what they need to improve on. Again, if you have negative feedback to provide, placing it into a context of why the job wasn’t up to standards gives the employee an understanding not only of what they need to do, but why they need to do it in a specific way. And remember, positive feedback is important. If you only provide feedback when you’re unhappy with the way things are going, you won’t get the results you’re hoping for.

And one final tip: Prioritize. None of us can accomplish everything, and trying to is a surefire way to burn out early and fast. Decide what’s most important and concentrate on accomplishing those things. The less important things can be delegated or can wait for time to open up.

Action Step: Create an activity log to assess how you spend your time over a 14-day period. List three things over a one-month period that you can do in order to optimize your time. Then, one month later, do the same exercise. Keep a daily log of one thing you do for yourself that is important to you. It can be simple.

John Guiliana, DPM, MS

John Guiliana, DPM, MS, is the managing partner of a four-doctor podiatry practice in Hackettstown, NJ. He holds a master’s degree in healthcare management and is a nationally recognized professional speaker and author on medical practice management. He is a frequent contributor to Podiatry Management, Podiatry Today, and is author of Talking Practice Enhancement, an American Podiatric Medical Association news column.

Hal Ornstein, DPM, FASPS

Hal Ornstein, DPM, FASPS, serves as Chairman and Director of Corporate Development of the American Academy of Podiatric Practice Management and Consulting Editor for Podiatry Management Magazine. He has given over 200 presentations internationally and has written and been interviewed for over 250 articles on topics pertinent to practice management, patient satisfaction and efficiency in a medical practice. Dr. Ornstein has been in private practice for 18 years and serves as Medical Director of Affiliated Foot and Ankle Center, LLP with their main office in Howell, NJ.

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