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Dynamic Chiropractic – January 29, 2008, Vol. 26, Issue 03

A Happy Solution for Unhappy Staff: Technological Integration Is Vital

By Steven Kraus, DC, DIBCN, CCSP, FASA, FICC

Good staff morale - for most chiropractors, it's an important balancing act that has become trickier than it used to be. As paperwork has grown with managed care, both doctors and their teams have felt the squeeze of too much to do with too little time.

Unfortunately, this development means more than just later hours in the office. It means more stress, less-than-satisfied staff and an environment that doesn't nurture happy patients. For some chiropractors, an increased paper workload has become the difference between a surviving practice and a thriving practice. As any business knows, without happy, satisfied staff, it's hard to create and keep satisfied customers. My experience in managing 18 different practices has shown that the front-desk staff can increase or decrease your practice volume by 25 percent. Great staff will increase business, while a poor staff will hold you back. By definition, an unsatisfied staff cannot be great. So what's to be done?

Nowadays, good staff morale demands a more innovative solution than a traditional HR pep talk. A happier staff requires the power of digital integration, a new way of doing clinic. Your staff needs fewer paperwork redundancies and less wasteful clinic management. That means you will need to empower your staff with both horizontal and vertical clinic integration. Let me show you why.

What Does Your Staff Want?

In order for us to understand why the growth of paperwork loads can have a damaging effect on staff morale, we have to understand what our people want in the first place. According to the human-resources gurus, people find job happiness in positions that include personal responsibility, opportunities for upward mobility and recognition for using the abilities that give them satisfaction. Simply put, they want their work to have meaning.

What Do They Complain About?

So, what do we give them beside these things? All health care personnel complain the most about paperwork - too much paperwork. If paperwork is getting you down, think about what it's doing to your staff. Essentially, paperwork increases workload in areas that most staff do not find meaningful. This can become a problem unless the employer reduces the load or finds some way to increase the meaningfulness of another part of the job.

This position is supported by a large study published in the Journal of Allied Health,1 which examined the changing attitudes of nurses and occupational therapists who graduated in the late 1980s and mid-1990s. While many showed a high degree of job satisfaction, most agreed that the health care system was becoming inefficient and burdened by larger workloads and more paperwork. Respondents who were unhappy said workload and paperwork were key elements in their dissatisfaction. The authors draw the conclusion that increased workloads and burnout seem to stop workers from achieving the very things that normally would satisfy them about a job: a sense of achievement and worth.

Let me rephrase these points in a different way: If your staff is unsatisfied due to paperwork overload, you need to find a way to lessen the load. They're not going to find meaningful work in your office if you don't.

Options for Load-Lightening

If you're going to lighten your staff's paperwork load, you've got three options: hire more staff, get rid of most of your patients or find a way to manage your clinic more efficiently. Of course, only the third option is desirable. I believe it's only possible if it involves a paperless-management model. Going digital is the only way you're going to get the electronic integration you need to help your staff find new meaning in their work.

Redundant and Uncoordinated

If you examine what makes paperwork such a burden for staff, two factors are obvious: the mindless repetition and redundancy of tracking the patient's personal health information, and the difficulty in coordinating the patient's plan of care before, during and after a visit. Boiled down to two words, your workload probably is redundant and uncoordinated. From these two factors stem the frustration that robs your personnel of what they actually love about their jobs.

A permanent solution to both of these factors means eliminating redundancy and improving coordination so paperwork becomes second nature. The only solution that can achieve both is digital clinical management with both vertical and horizontal integration.

Horizontal Integration

Horizontal integration is the ability of your departments to talk to each other. It is billing talking to scheduling, which is talking to your rehab department, which is talking to your patient-education database, which is talking to your patient's electronic health record - even as you're in the process of annotating the patient's care plan. It allows you and your staff access to every step of your patient's movement through your practice, from the time they first make an appointment until the time you release them from condition-based care. While it sounds complicated - and you almost have to see this integration in action to believe it - the concept behind this coordination is simple. The concept is called interconnectivity.

Paperwork involves redundancy and discord because it lacks interconnectivity. Take for example, the simple task of double-checking a patient record. Let's say it is to see if your rehab exercise instructor spoke with a patient about modifying their ADLs or therapeutic activities, and if billing actually filed a claim for the service. Without horizontal integration, this single task is extremely time-costly.

First, your office manager retrieves the patient's file from storage and then finds the date of the record in question and the therapeutic modifications involved. Next, the manager will find the staff trainer and ask them if a printout of take-home exercises was given to the patient. The next stop is in the patient's financial file to see if the billings department coded and filed a claim that included services rendered in therapeutic modifications. Rather than consulting with one integrated source, the manager has to consult with three sources. Each time, it involves re-filing paper records, opening and closing separate software programs, and manually coordinating the information within.

Now imagine what would happen if the task was to double-check not one patient, but 20 different patients. And not just for one patient visit, but for a series of patient visits spanning three weeks. The time invested in this task by multiple personnel probably would outweigh any positive benefits. The workload would be a drain on staff time and take away from tasks that need more immediate attention.

A practice working with true horizontal integration, on the other hand, should achieve this kind of task in a few seconds. If it involves multiple patients over multiple visits, it should only take minutes longer. That's because horizontal integration allows a central source of clinic data that is easily accessed and grouped according to multiple search parameters. One staff from one computer could accomplish this task efficiently and effectively - completely coordinated and without redundancy.

With horizontal integration, more meaningful work is possible because staff actually work in unison and anticipate the needs of the doctor's treatment plan. They are not isolated responders three steps behind the doctor, always playing catch-up.

The staff has more time to focus on other tasks that improve the practice bottom-line, such as improving patient care and achieving better patient outcomes. Now, that's work with meaning.

Vertical Integration

The concept of interconnectivity also guides vertical integration. Vertical integration is the ability of all the practice's departments to communicate with outside data sources. One example is communicating between devices like digital inclinometers, surface EMGs and the doctor's SOAP notes. Another example is the storage of digital X-rays, radiology reports and outside laboratory studies as attachments to the patient's electronic health record. Imagine the kind of efficiency that would be possible if your billings department knew which tests were run for which patients as soon as those tests and exams were complete. Vertical integration is just another way digital clinic management reduces redundancy and improves coordination.

The Integrated Difference

The difference between a redundant and uncoordinated workload and one with digital integration is like night and day. In the paper practice, your staff does a set of never-ending repetitive tasks. In the digital practice, your staff is aware of your treatment plan, updated on what services are expected for the day, and plays an important role in patient management. In the paper practice, your staff is a cog in a machine that needs tuning. In the digital practice, it consists of vital, fully informed, empowered people who don't have to deal with a growing volume of paperwork. They are freed by the interconnectivity and the automation of management tasks, such as insurance authorizations of the doctor's plan of care.

When a workload isn't uncoordinated and redundant, staff can do what they do best. If they're organizers, you've given them the ultimate tool to manage your office. That will make them happy. If they're into assisting in direct patient care, they can join in where they feel most helpful; where they'll be recognized for their abilities.

If they are problem workers, your new efficiency may have just made their jobs unnecessary. As a CEO of an EHR company, the first thing I notice about customers is that the doctor often discovers how much their team can get done with fewer members, due to the increased efficiency.

The Happy Practice

Do want to end your staff's frustrations and increase the meaningfulness of their work? Then you need to find a way to reduce redundancy and improve coordination. As quality and size of workload are critical to job satisfaction, digital management will improve your staff's outlook. As the attitude of your support can make all the difference in how patients experience and perceive your practice, you'd better believe that their sense of satisfaction can affect your own satisfaction as well. It takes deep integration of the digital clinic to conquer our increasing mountains of paperwork; to transform the monotony of paper into an opportunity for a new kind of satisfaction that comes with meaningful work.


Lyons KJ, Lapin J, Young B. A study of job satisfaction of nursing and allied health graduates from a mid-Atlantic university. Journal of Allied Health, 2003;32(1):10-7.

Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.

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