Chapter 012

Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc.
Office Environment and Daily
Operations
Chapter 12

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.

This chapter will examine:
 Actions that need to be taken before the office opens
 Patient traffic flow as a consideration in office design
 Expenses involved in the operation of a medical practice
 Price comparisons for office supplies
 Ways to save money in the medical office

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.

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.

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.

 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.

Restock examination rooms
– Cotton balls
– Adhesive bandages
– Gauze pads
– Patient gowns
– Drapes

Restock restrooms
– Toilet paper
– Soap
– Hand towels
– Urine specimen cups

 Make sure that prescription pads are available.
 Keep the pads out of patient sight.

 Turn on equipment.
– lights
– computers
– lab machines
– copy machines
 Run controls on lab equipment, if necessary.
 Fill copy machine with paper.

 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.

 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.

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.

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.

Pharmaceutical Representatives
 Also called “detail persons.”
 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.

Other Office Visitors
 Medical suppliers
 Office suppliers
 Medical equipment suppliers

Physicians
 Take visiting physicians directly to the doctor’s office.
 Notify the doctor at once that a physician is waiting in the
office.

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.

Using the Office Policy Manual
All employees must read the office policy manual and are
responsible for knowing the information contained in the
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

 Manuals should be written in clear, concise language.
 Manuals should be consulted whenever questions
regarding policy arise.
 All employees should sign a document stating that they
have read the manual.
 All office tasks must be detailed in the policy and/or
procedure manual.

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.

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.

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.

Cleaning Services
 Service performs more intensive cleaning chores.
 Service usually cleans in the evenings and on
weekends.

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.

Filing
 Critical job
 Always a stack of filing to be done
 Stay on top of this duty
 Responsibility of every employee

Filing (cont’d)

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.

Budgeting
 Salaries
 Medical supplies
 Business equipment
 Medical equipment
 Utilities
 Rent or mortgage
 Insurance
 Maintenance
 Taxes
 Laboratory fees
 Office supplies
Expenses in operating a medical practice include:

Budgeting
 Expenses are usually planned 1 year in advance.
 Log expenses into specific categories monthly.
 Adjust budget categories, and determine where
overspending has occurred.

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

When Making Purchasing Decisions…
Consider:
 price
 delivery
 shipping
 handling charges
 length of time to use all stock

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.

Internet Shopping
Compare prices on the Internet in addition to using local
suppliers.

Ordering Equipment
 More involved than ordering supplies
 Often considered a capital purchase
 Physicians almost always involved in capital equipment

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.

Outsourcing
Outsourcing could be less expensive than performing
treatments, tests, or procedures in the office
environment.
Compare prices, and determine the best outsourcing
company.

Options for Equipment Purchase
 Local supplier catalogs
 Local supplier sales representatives
 Used equipment
 Purchasing equipment from retiring physicians
 eBay
 Internet

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

Troubleshooting Equipment Failure
 Consult owner’s manuals for troubleshooting
procedures.
 Owner’s manuals are often available online.
 Look for the simplest solutions first.

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.

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.

 Refurbish office equipment.
 Use bulletin boards.
 Change to cloth towel dispensers.
 Reuse printer toner and ribbon cartridges.
 Retrofit exit sign bulbs.
 Convert to high efficiency fluorescent lighting.

 Reuse dishware.
 Use reusable forced air filters.
 Eliminate single-use cups.
 Reuse paper printed only on one side.

Lunch and Break Etiquette
 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

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.

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.

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.

Internet Research
 Look for information from sites that can be trusted.
 Bookmark good sites for future reference.

Internet Research
Various types of information can be found on the
Internet, such as:
 Company reports
 Financial information
 Company profiles
 Conference proceedings
 Seminar announcements

Internet Research (cont.)
 Law, government announcements, and parliamentary
debates
 News and current affairs
 Databases of reference material
 Places to discuss topics and ask for help

Traveling for Business Purposes
Training seminars and workshops allow employees to gain
CEUs, learn new techniques and procedures, and
maintain certifications.

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.

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

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.

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.

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.”

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.

Basic Identifying Markers
 Height
 Weight
 Hair color and length
 Clothing, especially the color
 Race
 Distinctive markings (scars, tattoos, and so on)

Office Security
 Store cash and narcotics in locked cabinets.
 Use an alarm system.
 Limit the employees who know alarm codes.

Smoke Alarms
Two types of smoke alarms:
 Photoelectric
 Ionization
Change batteries twice a year at daylight savings time.

Fire Extinguishers
 Fire extinguishers must be serviced annually by a fire
professional.
 Staff members should be trained in the use of fire
extinguishers.

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

Is the Physician’s Office Safe?
 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?

 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?

 Are all flammable liquids and materials stored away from
heat sources?
 Are all plumbing, mechanical, and electrical systems
functioning properly?

Fire Exits and Escape Routes
 At least two exits must be designated as fire exits in the
medical facility.
 They must be clearly marked and easily accessible.
 Escape plans must be posted in several areas of the
facility.

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.

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.

Ergonomics
Ergonomics is the applied science concerned with
designing and arranging things people use so that the
interaction between them is efficient and safe.

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.

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.

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.

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

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.

Chapter 012

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