Constant housekeeping is essential to ensure an efficient and resilient business, but many people are unsure where to start. To begin, you should consider something most of us are already familiar with – the clinical audit cycle.1 Although not the most exciting of tasks, or why we entered this field, applying this level of scrutiny and common sense to all aspects of your business can save you significant time and free up your staff to do other important tasks. The four stages of the clinical audit cycle refer to:
1) Finding an area of your practice that could be improved
2) Measuring the performance of that aspect
3) Making the necessary improvements
4) Measuring again to see if the intervention gave the expected changes
This philosophy can be adopted for your business processes and can cover almost anything – for example, ordering and stock management, cleaning, check-in/check-out, staff training/mentoring and complaint handling. An effective way of compiling these outcomes is by creating standard operating procedures (SOPs).
Standard operating procedures
SOPs are a set of step-by-step instructions created by an organisation or business that aim to help workers carry out complex routine operations.2 According to the UK Government, SOPs should also take account of regulatory requirements and security practices.2 It’s not just about efficiency but also quality control – ensuring that all employees are following the same process in order to deliver the same quality of service or product. In the early days, new SOPs are often identified and created regularly as you become aware of the gaps. As your business matures, the focus often moves to improving existing SOPs. Practitioners shouldn’t see this as a chore but rather a valuable opportunity to make your business run more smoothly. In my business, there are two main events that result in reviewing our SOPs:
1) Complaints – every complaint is reviewed carefully to decide if the problem was a missing or poor quality SOP (in which case we need to correct this) or whether the SOP was adequate but was not followed (in which case the solution is staff training).
2) Staff feedback – in every monthly team meeting, the agenda includes time for the staff to report any problems that they have encountered that have made their job more difficult or has affected the customer/patient experience. You don’t need to wait for a complaint – the goal is to improve things before they can become a problem.
When creating or updating your business processes, ensure that you commit them to paper in the same way that you would with a treatment protocol. Have your staff read them and sign that they have understood and promise to follow them. The aim is to create a document detailing how your business works so that all staff understand what is required of them. These documents should be written after careful consideration of how you want each process in your business to be performed. As with all processes, it’s important to be clear what the benefits are and that they are real before implementing them permanently. Ensure that they are simple enough for all grades of staff to understand and remember when they are needed. The more unlikely an event, the more simple the SOP should be. If the event rarely happens, it’s highly unlikely that anyone will remember the SOP for it, let alone a complicated one. Many of my SOPs include asking for help from a senior which helps to cover all eventualities, including those that cannot be planned for. If the member of staff tries to manage a complicated situation that is outside of their capabilities, they can still be held to account for failing to involve a senior staff member. Ensure that your SOPs are reviewed as appropriate in the same way that you would with your clinical SOPs (e.g. consent procedure), especially as your business will change more often and quickly than clinical practice.
In my business, our SOPs are saved in a shared folder that all the staff can access and review at their leisure. As new SOPs are added, they are shared and discussed at the next team meeting.
Below I outline a few examples of how I identified areas of my business to be improved, implemented the changes and then added to my SOPs.
As medical professionals, we operate in a regulated sector and it can be easy to respond to this with bloated paperwork and processes. As a result, procedures need to be implemented that can increase productivity and reduce bureaucracy. For example, at my clinic, all my staff are required to have an hour long one-to-one with their manager each month and I have an hour with each of my managers. Staff performance and expectations are discussed, in addition to training requirements and any problems that they may have. Each month we also have a three-hour team meeting that does much the same but for the business performance and team as a whole. Managers would write the notes for the one-to-ones they performed following the meeting, and a nominated staff member would write the minutes for the team meetings, which a manager will then review. When I first implemented this process, I hadn’t appreciated the amount of time staff spent writing these notes. As important as I thought this task was, realistically there is a limit on the amount of time that can be spent on them before the benefits begin to fall away. I made the decision to have the minutes typed up during the meetings. If necessary, these would be completed afterwards, but with a guide to what information is relevant and how much detail to include. The grand saving? Around four hours of employee time each month, enough time for a member of staff to perform several hundred pounds worth of treatments.
When I opened my clinic, we accepted both cash and card payments. However, I have realised that the time and effort of accepting and processing cash just wasn’t worth it. Whilst I believe it’s important we don’t move to a cashless society just yet as vulnerable groups may be excluded, these groups do not make up a significant part of our patient base. Additionally, with an average transactional value of well over £100 for aesthetic treatments, cash is not a significant method of payment so there was only a small number of cash payments. Alongside this, following COVID-19, few people want to handle cash that has passed through many hands. We therefore introduced a clinic management system with integrated payments which means that patients can enter their card details and pay a deposit when booking online. When it comes to paying, they can choose to pay with that saved card. Staff click a button on the computer or device to take payment and the patient leaves without having to interact with anyone or anything. This will be done in the treatment room in future, leaving the patient to leave the premises without having to interact with the reception team again, leaving them clear to manage incoming patients. Changing well-established behaviour is always a challenge but in the case of payments, many people are used to having card details saved for quicker payment processes through e-retailers like Amazon. We’ve had a few people not wanting their details saved, so they simply use their card as normal. However, once they understand that our staff have no access to their card details other than the last four digits and expiry date, they often change their minds.
When faced with improving profitability, most consider the obvious areas – what supplies can I buy at a better price and which services can I charge more for? Buying low and selling high is business 101 and a strategy that most of us attempt to implement. However, improving efficiency and saving time will also improve your profit. If your team spends an extra five minutes on a process or wastes five minutes of your doctor’s time, there is a cost to that. Multiply this across the days and weeks that this problem occurs and it could be hours each month. The cost of this is easily calculated by how much they are paid per hour. Of course, this is the minimum cost as there may well be knock-on costs such as lost sales or complaints. We had a problem with clinicians not always letting the staff know when consent forms were running low – on occasion, this would be overlooked until in the middle of a busy clinic, when there would be no consent forms. The knock-on effect on the clinic and business was extremely damaging for such a small issue with a simple solution. Until that time, there had been no formal SOP. I would simply let the staff know when I noticed that the forms were running low and I had asked other clinicians to do the same. The new SOP made my full-time staff responsible for checking forms and printing more if they were running low. There was a rota that ensured that management would know which member of staff had checked the room on each day and so there was a record of who would be accountable if there was a problem.
Improving the team
Organisations are complex and whether they are documented or not, there are many processes to learn and remember. Aesthetic clinics are particularly difficult due to their specialist nature and level of regulation. SOPs are an important addition to an employee’s contract and job description. They ensure that a new member of staff is aware of what is expected of them and provide a source of information for when they forgot what to do or how to do it. It also enables employers to review staff performance and create training plans when SOPs have been forgotten. Ultimately, staff can be held to account when SOPs have been ignored. Ask your staff for their comments and include them in the process of drafting or signing off SOPs that affect them. If they feel included in the process, they will be more likely to remember and adhere to them.
Actioning and updating SOPs
Scrutinising business processes with the same vigour that we give to clinical processes is important to ensure a smooth running, productive and efficient business. This is an ongoing task where SOPs should be reviewed, improved and updated on a regular basis, especially as your business grows and faces new challenges. Ultimately, well written and adhered to SPOs will result in a better service for your patients, happier staff and more profit. All these are more important than ever at a time when business conditions are unpredictable.
1. NICE, Principles for best practice in clinical audit, 2002. <https://www.nice.org.uk/media/default/About/what-we-do/Into-practice/principles-for-best-practice-in-clinical-audit.pdf>
2. Gov.UK, Standard operating procedure guidelines, 2007. <https://www.gov.uk/government/publications/standardoperating- procedure-guidelines>