Urgent message: For owner-operators truly committed to creating “the ideal urgent care experience”—a thriving operating model that benefits patients, employees, and investors alike —a commitment to operational excellence, a perfecting of the patient experience, and the embrace of an empowered, engaged employee culture must form the bedrock principles of their practice.
Alan A. Ayers, MBA, MAcc
Driven largely by millennials and Gen Xer’s who place a premium on convenience, alongside Baby Boomers utilizing their newly acquired Medicare benefits, urgent care centers continue to experience a significant surge in demand. According to the 2018 Urgent Care Association Benchmarking Report, the total number of U.S. urgent care centers grew 8% from 2017 to 2018 alone, with those clinics handling roughly 89 million patient visits per year. Despite this huge expansion in urgent care volume and utilization, though, some markets are already experiencing oversaturation, which has led to fierce competition for local patients’ urgent care spend.
So even with the ready growth and profit potential available in owning-operating a center or chain of urgent cares, merely placing a Grand Opening sign in front of a new clinic or maintaining a mediocre status quo in an established clinic in no way guarantees patients beating down your door, nor a well-oiled, humming operation. Rather, independent of your marketing mix or your high-traffic, high-visibility location, it will require a concerted effort to create the kind of “ideal” urgent care experience that delights patients, provides workplace fulfillment for your staff, and drives the kind of robust revenues that garner your center/chain the kind of high valuation that makes it an attractive asset to potential investors and buyers.
Developing a Modern-Day Urgent Care ‘Playbook’
This approach is all about building a consistent, scalable, repeatable, measurable, and predictable operating model—one that has been refined and tested, can be implemented and replicated easily, and has all the necessary ingredients to create a thriving urgent care experience when executed. It requires the development of a modern-day urgent care “playbook” of sorts that factors in today’s changing healthcare landscape, advances in technology, the growing competition from market disrupters, and the needs and preferences of emerging patient cohorts who are driving demand and innovation. To that end, the modern-day urgent care “experience” playbook should be built upon these three foundational pillars:
- Operational excellence
- Patient experience
- An engaged, empowered employee culture
When the modern-day playbook is executed properly, these three pillars interact and interconnect on every level. They’ll combine in an interdependent fashion to facilitate the smooth functioning of the whole, which is the sort of “big picture” game plan required to develop a truly holistic model that fulfills the promise of the ideal urgent care experience. In the following sections, we’ll briefly examine each of these foundational pillars, along with some basic strategies for their practical execution.
The guiding theme of each of the pillars of the ideal urgent care experience should be one of No wait, no waste, and no hassle, with operational excellence being no exception. For operational excellence, this means the center’s operating philosophy and culture should be centered around improving workflows that boost patient throughput, eliminating unnecessary administrative burdens for providers and staff and identifying and correcting errors, friction points, and bottlenecks at every opportunity—all of which are built upon a set of highly optimized processes. The following are several No wait, no waste, no hassle operational excellence principles upon which urgent care workflows and processes can be built:
- Preventative culture: Staff should be trained to anticipate and recognize potential issues before they arise, and be empowered to take corrective action. An effective preventative culture is best instilled through consistent and repeating messaging, to the point where it becomes a company mantra. One example on the administrative side is first-pass resolution rates on claims submissions; this directly impacts urgent care revenue. The center’s culture must be one that is hypervigilant on ensuring accuracy in coding and documentation to prevent rejected claims, which result in wasteful rework, costing the center valuable time (and money) to go back and correct the error. Similarly, failing to ensure that a patient’s demographics are double-checked and up to date at registration/check-in can result in costly denied claims. Overall, throughout the entire operation, “getting it right the first time” must be the overarching standard that permeates all clinical and administrative activities and processes.
- Continuous improvement: Just because a process has been in place for a while does not mean it can’t be improved. In fact, over time, many organizational processes become “jury-rigged” such that they’ve become little more that inefficient band-aids that basically serve to “plug the dyke” to temporarily stem leakage. This is why it’s essential to cultivate a mindset of always searching for ways to make the operation more efficient, improve quality, remove non─value-added tasks from roles and processes, and upgrade the level of service. Rather than making excuses as to why an established but inefficient process is too difficult to change, a culture of continuous improvement must instead be embraced and reinforced at every touchpoint. In the modern-day urgent care setting, continuous improvement initiatives will rely heavily on the practice management (PM) solution and the electronic medical record (EMR) working in concert to capture and analyze both clinical and administrative data. These systems can track key performance indicators (KPIs), create KPI dashboards, and generate reports, allowing clinics to closely monitor their important metrics. So, when the metrics fall below expected benchmarks, they can be traced back to the processes that underpin them, which then are evaluated for improvement.
Continuous improvement initiatives will also lean heavily on input from front-line staff, as they are the people who execute the processes day in and day out, understand the urgent care operation from the patient’s perspective, and deal firsthand with the interconnectivity of all the clinical and administrative roles, systems, policies, and processes.
- Inventory management systems: For the center’s medical supplies, this service is available either free or at a nominal cost from leading medical supply houses. Inventory management systems allow the center to reduce supply expenses by creating a formulary of pre-approved items, preventing staff and providers from ordering expensive, unnecessary supplies. The inventory management system also enables the center to reduce excess inventory by providing visibility of current inventory levels and setting minimum on-hand and reorder quantities, which prevents hoarding supplies or redundant purchasing. Supply inventory levels will be based on the number of patients seen, which, again, can be closely tracked through the KPIs provided by the PM and EMR systems.
- Maximizing labor and controlling labor expenses: As labor management is critical to controlling expenses, KPIs are a primary factor in helping the center better align staffing numbers with morning, evening, weekend, and seasonal patient volume trends and expectations. Additionally, centers should consolidate redundant tasks (eg, managers of each center in a chain/organization spending valuable time each day processing invoices) into a single, dedicated role towards freeing up providers and managers to focus on coaching staff, patient care, and customer service. There should also be an effort to consolidate roles and cross-train whenever feasible. For example, consider cross-training radiology technicians (RT) as medical assistants (MAs) and/or vice-versa. A $22-$25/hour RT is typically the second highest paid position in the center, after the provider, which means that if the “typical” urgent care sees 35 patients and only 10% to 15% get an x-ray, then the RT is only doing a 20-minute x-ray four times over a 12-hour shift. Alternately, there are states where an MA can be trained to take x-rays, as modern equipment is very easy to use under a “basic machine operator” or “limited scope x-ray” license. Hence, it’s much more cost effective in terms of labor expense to employ an MA who’s trained to do x-rays rather than hiring a more expensive RT whose college training includes MRI, CT, ultrasound, and other modalities that are rarely if ever used in urgent care (and thus not fully utilized).
- Optimized support services: For service level agreements with internal and external support services and vendors such as outsourced billing, accounting, IT, payroll, and janitorial, every contract should be error-free, on schedule, and customized to the needs of the individual center. Expectations, performance level, remediations, termination clauses, and other contract terms should be clearly spelled out and adhered to by the service provider.
- Organizational forward thinking: Businesses fail when they don’t anticipate change or react poorly to it. As such, your center must remain on the cutting edge and prepare today for tomorrow. This might entail staying abreast of market trends and technology, paying attention to shifts across the healthcare landscape, keeping your “fingers on the pulse” of your local community’s patient population (and their evolving wants and needs for becoming their urgent care of choice) and remaining lean and flexible in your organizational model so you can grow and adapt to change—which is inevitable.
As the urgent care industry has evolved amid a changing landscape dotted with disruptive market entrants that expertly leverage nimbleness and technology, so has the expectations of the patient insofar as the experience they expect. Spurred by the proliferation of high-deductible health plans (HDHPs) that have shifted more of the financial burden of their healthcare onto the patient, patients are increasingly behaving like consumers who demand the same level of access, convenience, price transparency, and frictionless financial transaction that they enjoy from their other service providers. Consumers can order meals and event tickets, check wait times, and get real-time updates on their smartphones from the businesses they patronize; hence, they now expect the same convenience from their preferred urgent care. Couple that with the steady shift of urgent care from a largely walk-in business to an online appointment/reservation culture fueled by technology, and it becomes clear that to create an ideal patient experience, urgent care operators must employ systems, processes, and technology that both elevate the patient financial experience and seamlessly integrate with mobile technology. With that in mind, here are several actionable No wait, no waste, no hassle optimizations urgent care centers can make to meet the demands of patients’ growing consumerism.
- Online reservation/registration: Through any web-enabled device, patients should be able to “reserve their place in line.” While it’s not an actual “appointment,” this feature is a welcome convenience since it allows the patient to “wait” from home, work, or while running errands, reducing their perception of the total wait since most of it does not occur sitting in an urgent care lobby. Patients should also have the option to register their information from their mobile device, further speeding up the actual in-clinic visit time. These online reservation/registration systems also greatly benefit the urgent care staff, as knowing how many patients are waiting in “virtual line” helps pace the flow of patients through the center, versus the often-unpredictable ebb-and-flow that occurs with walk-in traffic. Better pacing of patients leads to more predicable throughput times, better utilization of staff, and more predictability in staff scheduling. It then becomes a matter of simply aligning the number of “slots” in the queuing system with staffing levels, then optimize staffing by the number of patients per hour per staff person seen. A further benefit to shifting registration to mobile and electronic self-serve technology is it reduces the use of paper/tone, and “shifts” a good portion of the basic data entry work from the paid staff to the patient who essentially is working for “free.”
- Two-way patient/clinic texting: After a patient reserves their spot online, the queuing system should be designed to communicate expected wait times via text, as well as when to arrive at the clinic, or changes in wait times. Lab and test results, reminders, and refill requests should be available via text or dedicated online patient portal. Texting should also be used to conduct brief, after-visit surveys shortly after the patient leaves the clinic. This kind of survey is invaluable in gaining a rough idea of what your net promoter score (NPS) is and gives you the opportunity to respond immediately to unhappy patients and negative feedback.
- Patient satisfaction rounding: Patients who reserved their spot online in advance have far less tolerance for in-clinic delays than walk-in patients. The center, therefore, should have a patient satisfaction rounding policy in place, where patients in the lobby or waiting room are given an in-person update on when they will be seen. As a rule of thumb, the amount of time between direct patient updates, even when it’s busy, should never exceed 10 minutes.
- Financial best practices: Consumerism in healthcare has resulted in a discerning and empowered patient population that actively seeks out providers who place an emphasis on elevating the patient financial experience at every touchpoint. From price transparency, the actual financial transaction, clear explanation of insurance deductibles, copays and other financial obligations, financial counseling and advocacy, and consolidated, no-surprise billing, patients now demand a straightforward, frictionless encounter. In fact, the financial experience is so central to patient satisfaction that a negative financial experience—such as receiving a bill for unexpected charges or being sent to collections—sometimes leads patients to post a negative online review even if the clinical outcome was successful. Bottom line, patients don’t want price and billing ambiguity, uncertainty, or surprises after the visit. Especially for self-pay patients, they want clear, flat pricing and simple, straightforward ways to view and pay their bill. To that end, the center can help facilitate clean financial transactions by employing real-time insurance verification to determine patient responsibility, and digital tools such as credit card preauthorization to ensure collection of the patient’s obligation at the time of service.
Engaged, Empowered Employee Culture
No matter how much cutting-edge technology your center can leverage, executing a high level of operational excellence and creating a satisfying patient experience would be difficult, if not impossible, without an engaged, empowered employee culture as a foundational pillar. All successful—and unsuccessful—cultures begin and end with the quality of its people, and their commitment to the success of the organization. After all, it’s the people who execute the processes each day that ultimately determine whether it all adds up to a thriving, successful urgent care business.
Following are several practical considerations on how to keep your staff motivated, engaged, and empowered within the ideal urgent care operation.
- Create a bottoms-up culture: Millennials are now the most prevalent age group making up the workforce. And unlike the Gen Xer’s and Baby Boomers that came before them, they work best not within a top-down management style, but rather a more empowering bottoms-up workplace culture. In a bottoms-up workplace culture, employees have a voice and feel free to share opinions, insights, and ideas on how to improve the operation. Of course, a medical business like urgent care requires strict compliance to set regulations, policies, and procedures, but empowered employees feel free to offer suggestions for improvement without fear of negative repercussions from management. Ultimately, a bottoms-up culture engenders a level of ownership where people at every level see the big picture, are vested in the long-term success of the business, and understand how their specific role, actions and decisions drive the bottom line.
- Employee engagement through KPIs: One of the single biggest drivers of employee engagement is cultivating understanding and then “ownership” of the center’s KPIs. When team members understand the KPIs, how they affect the business, how their individual roles impact them, and how they can influence them, they become motivated by the feedback they provide. This leads to discussion, brainstorming, and teamwork on how to improve patient care and service delivery. In fact, many successful urgent care teams write their main KPIs on a white board daily, which they then review in their team huddles. Such teams also utilize “mini-games” to set goals and challenge themselves to move the metrics. Unsurprisingly, these methods drive great motivation and enthusiasm in tracking and driving the key numbers.
- Employee rewards: Consider rewarding employees for exemplary performance whenever feasible. Rewards can be a simple as a gift card in acknowledgement of an accomplishment or buying the team lunch when a targeted milestone has been achieved. Salary increases and yearly bonuses tied to performance should also be implemented where it’s financially feasible. This can help team members become more fully invested in the business and feel that their efforts will be financially compensated.
- Gratitude and recognition: Probably the most powerful drivers of employee engagement in the workplace, studies have shown that many employees value gratitude and recognition over financial compensation. Those same studies show that companies that practice gratitude and recognition outperform their competitors in metrics such as revenue growth and stock price, given that happy and appreciated employees are decidedly more productive. When employees feel that their work, their presence, and their contributions matter, they become ambassadors and cheerleaders for your center and its culture. And the way an urgent care operation treats it employees has a direct trickle-down effect to the way those employees treat patients. You can recognize a culture of gratitude and recognition when you see employees’ pictures framed on the wall; when managers and providers seek out opportunities to “catch” someone doing the right thing; when management brings in coffee and donuts for the team; when management gives a team member a hand-written note or card thanking them for a job well done; when management spotlights and celebrates an employee on the company’s social media channels; when management shares with the team an anecdote of a patient praising an employee’s service and professionalism; and when management holds meetings for the sole purpose of saying thank you and acknowledging team member contributions.
Though the urgent care business as a whole is booming, owner-operators who want to stand apart in their individual markets must take a hard look at the changing landscape and ensure that their urgent care operation—no matter its size—is fully optimized for today’s consumerism-focused, technological savvy patient. This entails developing a modern-day urgent care playbook that places a renewed focus on leveraging technology and systems to achieve operational excellence and elevating the patient experience at all the relevant touchpoints—particularly the financial experience. And above all, a keen recognition that peak potential will never be achieved without the buy-in of an engaged, empowered culture of employees who are truly committed to fine-tuning and executing the processes necessary to create a successful operation. Hence, by committing to all three foundational pillars, you, your staff and your patients can truly achieve the “ideal urgent care experience.”
Alan A. Ayers, MBA, MAcc is Chief Executive Officer of Velocity Urgent Care and is Practice Management Editor of The Journal of Urgent Care Medicine. The author has no relevant financial relationships with any commercial interests.