Office Environment and Daily
Operations
Chapter 12
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
1
Introduction
The physician’s office is a busy place where the
medical assistant encounters new challenges
every day.
When adaptation skills are learned and refined,
office efficiency increases and the schedule can
handle interruptions and emergencies.
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
2
This chapter will examine:





Actions that need to be taken before the office
opens
Emergency preparedness for the physician’s
office
Expenses involved in the operation of a medical
practice
Price comparisons for office supplies
Ways to save money in the medical office
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3
Using the Office Policy Manual
All employees must read the office policy manual and
are responsible for knowing the information contained
in the manual.
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
4
THE OFFICE POLICY/PROCDEDURE
MANUAL






Virtually all businesses have some type of policy and/or
procedure manual.
The manual should be easy to read, detailed, and logically
organized.
The manual should be constantly updated as technology and
regulations change.
The manual must be reviewed annually for corrections and
additions.
One of the most common citations in OSHA compliance is
for having a policy manual, but not following the stated policy
in various areas.
The medical assistant must form a habit of going to the office
manual whenever in doubt about any procedure.
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5
Using the Office Policy Manual
Sections include:
 Expected
performance of
employees
 Tardiness and
absenteeism
policies
 Sexual harassment
issues
 Confidentiality





Vacations, sick time,
paid time off
Employee
evaluation
Continuing
education
Chain of command
How to deal with
certain patients and
visitors
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6
The office policy manual should include
sections that deal with several topics
Expected performance of the employee
 Tardy/absentee policy
 Sexual harassment
 Confidentiality
 Vacations, sick time, paid time off
 Employee evaluation
 Continuing education
 Chain of command
 How to deal with certain patients and vistors

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7
Policy or Procedure Manual?
Often, a procedure manual is combined with
policy manuals. Between the policy manual
and procedure manual, there should be no
office tasks that are not detailed on one of the
two documents.
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8
Opening the Office



Arrive early to prepare the office for the day
ahead.
Allow only a certain number of employees to
have keys and alarm codes.
Numerous keys distributed gives more
employees access to the office after hours.
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9
Preparing for the Day Ahead



Each employee is responsible for his or her own
work space preparations.
Work together as a team.
Complete work quickly and efficiently.
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10
Duties before Patient Arrival




Call the answering service to collect messages.
Write the messages on the message pad to
ensure that a copy is kept.
Make copies of the day’s appointments.
Provide a copy to each physician.
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11
Duties before Patient Arrival



Prepare medical records for patients that are to
be seen.
Make certain that there are enough progress
notes in each medical record.
Glance over notes from the previous visit to be
sure that laboratory results are in the record and
available to the physician.
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12
Duties before Patient Arrival
Restock examination rooms

Cotton balls
 Adhesive bandages
 Gauze pads
 Patient gowns
 Drapes
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13
Duties before Patient Arrival
Restock restrooms

Toilet paper
 Soap
 Hand towels
 Urine specimen cups
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14
Duties before Patient Arrival


Make sure that prescription pads are available.
Keep the pads out of patient sight.
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15
Duties before Patient Arrival

Turn on equipment.

lights
 computers
 lab machines
 copy machines


Run controls on lab equipment, if necessary.
Fill copy machine with paper.
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16
Duties before Patient Arrival


Check specimens and laboratory tests that
need to be viewed, and record results in the
patient medical record.
Make certain the physician sees all test results
according to office policy.
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17
Duties before Patient Arrival



Most abnormal results are emphasized in a
separate column or a different color of ink.
This makes directing the abnormal results to
the physician’s attention easy.
The medical assistant does not interpret test
results or decide what is or is not normal, but
can visually judge if the results are printed in
such a way that abnormal results are
highlighted or emphasized in some way.
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18
Duties before Patient Arrival



Prepare the accounting software or manual day
sheet.
Gather enough encounter forms for the day.
Stock the patient check-in and checkout areas
with business and appointment cards.
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19
Patient Traffic Flow


Room design is generally out of the medical
assistant’s control.
Physical design and room layout can usually be
changed and adapted for patient traffic flow.
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20
Patient Traffic Flow


The fewer steps that patients have to walk as
they work their way through the office, the
better.
Move patients from room to room only when no
other options exist.
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21
Pharmaceutical Representatives





Also called “detail persons” or “drug reps.”
Do not always see the physician.
Restocks the sample drugs.
Answer questions about the drugs they
represent.
Goal is to get the physician to prescribe their
company’s drugs more often.
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22
Pharmaceutical Representatives



Pharmaceutical representatives were allowed
to leave memo pads, pens and other gift
items.
State laws now dictate if these gifts may be
given.
Lawmakers are more concerned about perks
such as honorariums for guest speakers.
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23
Other Office Visitors



Medical suppliers
Office suppliers
Medical equipment suppliers
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24
Other Office Visitors
Physicians
 Take visiting physicians directly to the doctor’s
office.
 Notify the doctor at once that a physician is
waiting in the office.
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25
Other Office Visitors
Physician’s Family Members or Friends
 Follow the physician’s directions as to family
visits.
 Never send family members or friends away
without notifying the doctor of their presence in
the office.
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26
Daily, Weekly, and Monthly Duties



Use checklists to ensure that all duties are
completed.
Checklists help divide duties among staff
members.
Include even the smallest tasks on the
checklists.
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27
Daily, Weekly, and Monthly Duties

Take initiative and work as a team: the effort
may be important when supervisors choose
the employees to promote or terminate.
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28
Constant Cleaning


Nothing should appear dirty in the physician’s
office.
Countertops, sinks, door handles, and
restrooms should be checked frequently and
cleaned whenever needed.
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29
Constant Cleaning



Look for items that need cleaning in the office.
Be conscientious about cleaning duties.
Supervisors will notice productivity, and this will
reflect positively during employee evaluations.
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30
Cleaning Services


Service performs more intensive cleaning
chores.
Service usually cleans in the evenings and on
weekends.
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31
Cleaning Services


Communicate with the service, and immediately
contact them when cleaning is not done as
expected.
Keep a log of tasks, and mark off those that are
completed.
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32
Filing




Filing is a critical job, although repetitious.
The medical assistant can always find a stack of
filing to be done.
Stay on top of this duty.
Filing is a responsibility of every employee.
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33
Filing (cont’d)
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34
Identifying the Need for Specific
Supplies



Consult the policy manual to determine the way
that supplies should be ordered.
Take an inventory at least monthly.
Communication is the key to keeping supplies in
stock.
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35
Budgeting
Expenses in operating a medical practice include:






Salaries
Medical supplies
Business equipment
Medical equipment
Utilities
Rent or mortgage





Insurance
Maintenance
Taxes
Laboratory fees
Office supplies
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36
Budgeting



Expenses are usually planned a year in
advance.
Log expenses into specific categories monthly.
Adjust budget categories, and determine where
overspending has occurred.
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37
Budgeting and the Medical Assistant
Remember that salaries are directly related to
the budget. If the office is struggling financially,
salaries may be less than ideal. The office is a
business and exists not only to serve the
patients but also to provide the physician …
and the medical assistant…
an income!
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38
Comparing Prices


Compare prices when shopping for supplies
and equipment
Price may not be the only consideration when
making a purchase. Also consider:



warranties
bulk purchase discounts
maintenance agreements
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39
When Making Purchasing Decisions…
Consider:
 price
 delivery
 shipping
 handling charges
 length of time to use all stock
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40
Ordering Supplies




Responsibility should be assigned to one
person.
Determine a method for tracking usage and
ordering.
Ensure that staff members note when supplies
are taken from stock.
Use the system that works best in the office.
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41
Internet Shopping
Compare prices on the Internet in addition to
using local suppliers.
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42
Ordering Equipment



More involved than ordering supplies
Often considered a capital purchase
Physicians almost always involved in capital
equipment
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43
Capital Purchases
Different businesses use different monetary
amounts to classify capital purchases.
At least three estimates should be obtained before
a capital purchase is made.
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44
Outsourcing
Outsourcing could be less expensive than
performing treatments, tests, or procedures in the
office environment.
Compare prices, and determine the best
outsourcing company.
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45
Options for Equipment Purchase






Local supplier catalogs
Local supplier sales representatives
Used equipment
Purchasing equipment from retiring physicians
eBay
Internet
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46
Receiving an Order
Packing slips
 List of items ordered and items shipped
Invoice
 Itemized list of goods shipped that specifies
price and terms of sale
Statement
 Summary of a financial account that shows the
balance due and transactions that affect the
account
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47
Receiving an Order

Make certain that stock is rotated, with new
items placed at the back, while older items or
those with sooner expiration dates are placed
at the front, so that they will be used first.
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48
Troubleshooting Equipment Failure



Consult owner’s manuals for troubleshooting
procedures.
Owner’s manuals are often available online.
Look for the simplest solutions first.
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49
Equipment Maintenance



Many machines must receive scheduled
maintenance.
Records must be kept of all maintenance
procedures.
Maintenance guidelines are usually found in
owner’s manuals.
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50
Equipment Maintenance

Remember that the maintenance must be
performed by an authorized user of the
equipment; if an employee is authorized to
use the equipment, he or she can take care
of maintenance issues as well.
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51
Equipment Maintenance

Routine maintenance is importance in
keeping equipment in top working order so
that patient care is not affected by the
availability of equipment. Some machines
may require proof of maintenance records to
honor warranties.
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52
Preventing Waste while Saving Money





Use solar-powered calculators and battery
rechargers.
Use refillable pens, pencils, and tape
dispensers.
Use refillable calendars.
Use two-way envelopes.
Reuse file folders and binders.
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53
Preventing Waste While Saving Money





Refurbish office equipment.
Use bulletin boards.
Reuse printer toner and ribbon cartridges.
Retrofit exit sign bulbs.
Convert to high efficiency fluorescent lighting.
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54
Preventing Waste While Saving Money




Reuse dishware.
Use reusable forced air filters.
Eliminate single-use cups.
Reuse paper printed only on one side.
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55
Lunch and Break Times





Take a morning and afternoon break
Stagger breaks with those of other employees
Alternate lunch hours
Use the lunch hour to rest and refresh
Eat a nutritious lunch
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56
Lunch and Break Etiquette





Be respectful of break and lunch time
restrictions.
Clean dishes used and put them away.
Do not store food and medical supplies that
need refrigeration together.
Clean the refrigerator at least once a week.
Keep lunch and break areas clean.
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57
Lunch and Break


Many people run errands and try to complete
personal tasks during lunch.
Healthcare workers should make every effort
to actually use breaks for their intended
purpose – to serve the patients to the best of
their ability.
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58
Sending and Receiving email




Always project a professional tone.
Use office systems for work-related email only.
Never forward comics or sexually explicit email
using the office system.
Treat email as confidential if it relates to a
patient.
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59
Sending and Receiving email



Email and all computer activity can be
monitored in real time.
Files are not completely gone even when
deleted.
Do not participate in any email activity that you
would not want your supervisor to read.
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60
Internet Research


Look for information from sites that can be
trusted.
Bookmark good sites for future reference.
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61
Internet Research
Various types of information can be found on the
Internet, such as:
 Company reports
 Financial information
 Company profiles
 Conference proceedings
 Seminar announcements
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62
Internet Research (cont’d)




Law, government announcements, and
parliamentary debates
News and current affairs
Databases of reference material
Places to discuss topics and ask for help
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63
Traveling for Business Purposes
Training seminars and workshops allow
employees to gain CEUs, learn new techniques
and procedures, and maintain certifications.
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64
Seminars and Workshops


Physicians are required to earn a certain
number of continuing education units each year.
Depending on what type of certification the
medical assistant holds, he or she may be
required to earn continuing education units as
well.
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65
Seminars and Workshops
When considering the cost of seminars and
workshops, don’t forget to include:
 Cost of workshop itself
 Travel costs
 Hotel
 Gas
 Food
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66
Scheduling Travel, Hotel Rooms,
and Car Rentals



Location of event dictates the type of travel
arrangements that should be made.
The Internet is often used to book travel
arrangements.
Staff members should expect reimbursement for
reasonable business expenses.
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67
TRAVEL RECEIPTS




Keep all receipts.
Complete a Travel Expense Report.
Account for each expense on the report and
attach the receipts.
Make a copy for personal records.
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68
Suspicious Persons



Keep a distance if a suspicious person enters
the office.
Stay behind counters and desks.
Lock doors that lead to the reception area, if
possible.
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69
Suspicious Persons



Attempt to notify another employee as soon as
possible.
Plan codes for different types of emergency
situations.
“Norman is here to see you.”
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70
Robbery



Thieves may assume that the physician’s office
has cash or, more likely, narcotics on hand.
Never argue or fight with such persons.
Attempt to get them out of the office as soon as
possible.
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71
Basic Identifying Markers






Height
Weight
Hair color and length
Clothing, especially the color
Race
Distinctive markings (scars, tattoos, and so on)
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72
Office Security



Store cash and narcotics in locked cabinets.
Use an alarm system.
Limit the employees who know alarm codes.
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73
Office Security
A thief does not know whether the office has
narcotics or cash, but may assume that those
items are available. Even if the office has
neither, the staff must be prepared for office
crime and be proactive in avoiding such
situations.
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74
Office Security



The office manager should make daily bank
deposits.
Only keep the minimum amount of petty cash
on hand.
Daily bank deposits will reduce monies lost in
case of robbery.
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75
Smoke Alarms
Two types of smoke alarms:
 Photoelectric
 Ionization
Change batteries twice a year at daylight saving
time.
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76
Fire Extinguishers





Fire extinguishers must be serviced annually by
a fire professional.
Staff members should be trained in the use of
fire extinguishers.
At least two exits should be designated as fire
exits.
An exit route and alternate exit route should be
posted in each room.
Fire drills help employees evacuate quickly
when necessary.
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77
Fire Extinguishers
Multipurpose ABC extinguishers are suitable for
small businesses.
Basic Use:
P—Pull the pin
A—Aim the hose
S—Squeeze the handle
S—Sweep the nozzle
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78
Emergency Preparedness

According to the Federal Emergency
Management Agency (FEMA) an emergency
is any




Unplanned event that can cause deaths or
significant injuries to employees,
patients,
or the public.
Emergencies can shut down a business,
disrupt operations, cause physical or
environmental damage.
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79
Emergency Preparedness
The following events would be considered an
emergency:






Fire
Hazardous material
spills
Flood
Hurricane
Tornado
Winter storm






Earthquake
Communications
failure
Terrorist act or attack
Bioterrorism
Civil Disturbance
Explosion
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80
Emergency Preparedness
Emergency management is the process of
preparing for mitigating, responding to, and
recovering from an emergency.
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81
Emergency Preparedness

Three major misconceptions about
emergency preparedness:
1.
2.
3.
It will not happen here
It will not happen to me
Someone else will be there to take care of the
problem
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82
Emergency Preparedness

Objectives of the emergency operations plan
should include:
1.
2.
3.
4.
5.
Protecting patients, visitors, and staff safety
Providing prompt and efficient medical care
Establishing a clear chain of command
Maintaining and restoring essential services.
Protecting clinic property, facilities, and
equipment
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83
Emergency Preparedness
The first critical step in emergency
preparedness planning is to determining what
emergencies or disasters might happen in a
single medical facility or in a general area.
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84
Emergency Preparedness
Outline a EOP (Emergency Operations Plan)
that addresses each of the hazards that might
affect the physician’s office. Once those
hazards are identified, determine what steps
must be taken so that the facility can respond
properly to each hazard.
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85
Emergency Preparedness



How would the office staff handle a mass
influx of emergency patients, if need be, while
still treating the patients scheduled on a
particular day?
What type of documentation would be
necessary when caring for mass emergency
patients?
What medications are necessary to treat
patients in an emergency?
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Emergency Preparedness
Remember, the medical assistant can only
perform duties for which he or she has been
trained, but can certainly assist a physician
and take his or her direction as emergency
care is given to a patient.
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87
Emergency Preparedness


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After the EOP has been written, employees
must be trained how the plan should be
followed.
Written copies must be accessible.
Employees should hold emergency drills to
know their role and responsibilities.
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88
Emergency Preparedness
One person should be designated as the
Safety Officer for the facility. Make certain
that the chain of command is clear and that
all employees know who they should report to
for assignments during activation of the EOP.
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
89
Emergency Preparedness
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The medical assistant plays an important role
in an emergency.
Medical assistants must have current CPR
and first aid training.
Be able to perform the procedures for which
they were trained.
Be willing to help wherever help is needed.
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90
Emergency Preparedness

Patients are not the only people prone to
stress during an emergency. You should be
aware of:



The need to step away for a few moments to
collect thoughts.
Take a few moments to breathe in and out slowly.
Volunteer and put the valuable medical skills
learned in class.
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91
Emergency Preparedness

All healthcare facilities need backup plans for:





Communications
Emergency power
Information systems support
Electronic medical records
Human resource information
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92
Emergency Preparedness

Identify the employees with special skills:



Different languages
Organizational skills
Those able to find and follow the EOP (leadership
skills)
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93
Emergency Preparedness
Remember that in a serious regional
emergency, community emergency workers,
such as fire, police, and paramedic personnel
will focus their efforts where the need is
greatest. Be prepared to support their efforts
and make a contribution to the emergency
response.
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
94
Emergency Preparedness
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Are all exit ways accessible and unobstructed?
Are all of the fire extinguishers operational and
properly locatable?
Are all of the emergency lighting units and exit
signs operational?
Are any extension cords or multiplug adaptors
in use?
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95
Is the Physician’s Office Safe?



Is there an escape plan with two ways out, and
do employees know how to use it?
Is the fire alarm and sprinkler system
functioning correctly and easily accessible?
Is all storage neat and orderly and not
obstructing sprinkler heads?
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96
Is the Physician’s Office Safe?


Are all flammable liquids and materials stored
away from heat sources?
Are all plumbing, mechanical, and electrical
systems functioning properly?
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97
Locked Storage Areas



Narcotic and other drugs should be kept in
locked cabinets.
Limited access should be granted to
employees.
Prescription pads should be kept in a locked
cabinet and never left out in plain sight.
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98
Waste Storage and Destruction


Medical waste and regular waste are found in
the physician’s office.
Medical waste must be disposed of according to
OSHA guidelines.


Records must prove that medical waste was
collected and destroyed.
Regular trash is collected two or three times a
week.
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99
Waste Storage and Destruction



Everything that originates in the human body
is not considered medical waste.
The place where it is encountered makes the
difference.
Use common sense when working with any
bodily substance and use standard
precautions.
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100
Ergonomics
Ergonomics is the applied science concerned with
designing and arranging things people use so that the
interaction between them is efficient and safe. Most
office injuries are caused by:
Falls
 Repetitive
movements
 Awkward postures
 Reaching




Bending over
Lifting heavy objects
Applying pressure or
force
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101
Ergonomics
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

Most workplace injuries can be avoided
OSHA guidelines have significantly improved
musculoskeletal disorders.
Information is available from general online
searching and from the OSHA website.
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102
Acoustics
Acoustics is the science that deals with the
production, control, transmission, reception, and
effects of sound.
Acoustics can affect confidentiality in the
physician’s office, so office acoustics must be
designed to guard the patient’s right to privacy.
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103
White Noise



White noise masks undesirable noises, such as
multiple conversations in interior spaces.
Most people have no idea that white noise is
being generated.
Sometimes white noise sounds like a soft static.
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104
Identifying and Sharing Community
Resources




Get to know people and organizations in the
community.
Use contacts as referral sources for patients
who need assistance.
Create a community resource list.
Stay in touch with contacts to make certain
patients are given correct, up-to-date
information.
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105
Emergency Phone Numbers
Keep a list of frequently called and emergency
phone numbers.
Include:
 Local hospitals
 Local pharmacies
 All physicians associated with the practice
 All employees
 Nonemergency police services
 On-call physicians
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106
Closing the Office






Check to see that all patients have left the
office.
Straighten examination rooms.
Lock file cabinets, drawers, and doors that must
be kept locked.
Perform general housekeeping duties.
Send phone lines to the answering service, if
applicable.
Lock the facility.
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107
Summary of Scenario





Kayla learned much more on her externship
than she expected.
Develop a sense of caring about patients.
Be willing to help patients with referrals.
Treat patients as individuals who deserve
dignity.
Show and express compassion to all patients.
Copyright © 2011, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.
108
Closing Comments



A multitude of tasks are completed by the
staff of the physician’s office throughout the
course of a day.
Skilled, dependable workers are usually
promoted accordingly.
Remember that the patient is the primary
concern regardless of the number of tasks
that need to be completed.
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109