We are in the market daily talking to practices that utilize urodynamics. We regularly encounter practices that have a large backlog of urodynamics patients waiting to be tested. Just this week one large urology practice approached us about their problems with a three month backlog of urodynamics patients. Backlogs often occur because of staff and/or equipment issues. We were able to craft a solution to eliminate their backlog quickly and efficiently, and we thought it would be prudent to write about it.
How and why do urodynamic backlogs develop?
A backlog can develop for many reasons. The most common reasons are problems with staff and problems with equipment. When urodynamics equipment breaks down it can often take weeks or months to get it fixed and operating again. Staff problems are even more difficult and can take longer. Training someone in the proper urodynamics protocol typically takes several months (sending them to a 3 day class alone does not work). We often see practices attempt to train someone quickly then turn them loose. In the best case, this quickly trained staff person is only able to test a few patients a day, but at worst, the staff person quits soon thereafter due to frustration and problems. This often exacerbates the backlog.
Another reason we regularly see urodynamics backlogs is due to simple business prioritization. Urology, urogynecology, and OB/GYN practices are often seeing more patients with fewer staff due to reimbursement rate reduction trends. In other words, almost all practices are attempting to do more with less which results in constant re-prioritization of staff tasks. Urodynamics can be prioritized lower, below such things as surgical activities and other crises.
A final reason we see backlogs is due to improper planning. We see the slow build-up of a backlog when insufficient resources are allocated to urodynamics which leads to the build-up of a backlog over a longer period, but there will be a backlog nonetheless.
What is the problem with a urodynamics testing backlog?
Having a large backlog is a major problem. Some practices admit this freely, but others are in denial. The primary problem with a urodynamic backlog is customer/patient satisfaction. Nothing aggravates a patient more than having to wait months for a diagnostic procedure when they are in pain or under undue stress. We often get phone calls from patients due to our extensive online presence. We get calls weekly from patients that are so angry because they have to wait months for their test. I personally took a call from a patient in Florida this week who had been told that he would have to wait 3 months before he could be scheduled for his test. He was so desperate to have the test performed that he was willing to pay out-of-pocket directly to have it done, and did not care about the price.
Another problem with backlogs is the delays they create with patient care. If a critical diagnostic cannot be performed and other care is dependent upon that diagnostic, then you can see how other problems can arise. For example, if the patient may have surgery but will not undergo surgery until the urodynamics test is completed, the surgery is delayed in addition to the urodynamics test. This is a problem for the patient, but is also a problem for the practice because it delays the revenue opportunity of the surgery. If you compare a medical practice to a manufacturing operation, it would be similar to the manufacturing operation having a shortage of a critical component, which shuts down the production line and prevents it from doing what it supposed to do.
There is a final problem with backlogs, and it is not typically acknowledged. It is this effect on company morale. When doctors and internal staff are constantly having to explain to patients why a critical test can't be done, it is demoralizing. As humans, if we constantly have to make excuses for things, it drains our energy and keeps us focused on the negative as opposed to focused on the positive. This is not good for any organization. In my company, I am distracted and demoralized for hours after having to make an excuse for some reason. When a nurse or scheduler has to make an excuse to a patient, they are also drained of the energy they need to do their job well.
How to eliminate a urodynamics backlog
The good news is there are numerous ways to eliminate a backlog and ensure they don't return. The first step is to admit there is a backlog and realize that it is a problem for patients and for the practice. If patients are having to wait more than a month for urodynamics test, then you have a problem and you should be looking for a solution.
The second step is to make it a priority. Every practice is constantly juggling priorities. However, every organization only gets things accomplished when they focused on a few key priorities. Any organization that is trying to do too many things at one time typically is getting very little done. You have to make it a priority and make a critical decision this week – not months from now.
Third, after doing the above, you can deploy one of the options below to resolve your backlog.
- Dedicate staff and equipment – You find a properly trained person and make it their fulltime job for a dedicated period of time until the backlog is cleared. If you don’t have the additional equipment and don’t have trained staff, you may need to look to one of the solutions below.
- Arrange for proper overtime – Bite the bullet and pay a properly trained person overtime for a given period of time to get the backlog cleared. Have them start testing an hour early in the morning and end two to three hours after closing (e.g. 8am to 8pm). A twelve hour day is doable for a limited amount of time.
- Contract with a urodynamics testing service provider – This is the easiest solution. There are firms that specialize in urodynamics testing, and you can contract with them to eliminate your backlog. (Full disclosure, my firm is one of these specialty urodynamics firms).
- Refer out – This is probably your last and least desirable option. If you refer out, your practice could lose the patient. However, it is a viable way to eliminate the backlog.
Once your backlog is clear, we strongly advise putting in pace some processes that will prevent it from arising again. The best way to do this is to contract with a urodynamics service provider (full disclosure again, my company is at urodynamics service provider) to provide your organization “surge capacity”. Surge Capacity is defined by the American College of Emergency Physicians as a measurable representation of ability to manage a sudden influx of patients. Surge Capacity is commonly used in other service organizations and in manufacturing. However, you don't often see this being deployed in healthcare. I am not sure why, because it is very logical. Surge capacity means deploying unique resources and staff for a temporary period of time to help process a temporary or sudden influx of patients. Extending the manufacturer analogy, a manufacture might contract with another subcontracted manufacture to produce certain widgets during certain parts of the year to meet their required production rates during busy seasons. They don't need the capacity all year around, but they do need it for certain seasonal variations. When you contract with a urodynamic service provider, they would come in to your practice on an as-needed basis to pare down your backlog. You might ask how exactly this could be set up. The process is quite simple, and follows the steps below:
- Contract with a urodynamics service provider, with the contract specifying services being performed on an as-needed basis. You might also ask for a “Service Level Agreement” as part of the contract so you are guaranteed not to have a backlog.
- Set a threshold for your backlog, and if this threshold is exceeded, the service provider is automatically notified and scheduled. For example if your backlog exceeds 30 patients, then the urodynamics service provider would be booked to come in for two days to pare down your backlog to 10 patients. The objective here is to make this decision and set a policy in advance so there is no waffling later. It just gets done!
- Monitor your backlog to ensure it stays in check.
- Boom! Your backlog is no more!
As practice staff becomes more and more booked, we expect to increasingly help practices and hospitals clear their urodynamics backlogs. We are happy to do this. We know how much patients despise waiting and our mission is to help patients in any way we can.
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