Zap Your Gaps: Closing the Gaps in Your Practice

A gap analysis can be used by a medical practice to determine what steps need to be taken to move from its current state to the desired, future state. Gap analysis consists of the following steps:

1. Listing characteristic factors (e.g., attributes, competencies, performance levels) of the present situation (i.e., “what is”);

2. Listing factors needed to achieve future objectives (i.e., “what should be”); and

3. Highlighting the gaps that exist and need to be filled.

Gap analysis forces a practice to reflect on the current situation and what can be done in the future to bridge the identified gap.

Medical practices are different from other services or products. Doctors and hospitals are in charge of far more serious aspects of our patients’ needs and wants than any other profession or occupation, with the possible exception of an airline pilot! Often there are gaps between what patients request and what we deliver in the services we provide.

Benefits of Conducting a Gap Analysis

A gap analysis can help you understand and prioritize problems and deficiencies by identifying gaps that need to be overcome. Once you uncover the gaps, it becomes easier to quantify them and identify the work effort that will be required to address them. Certainly, you are likely to identify several gaps that need to be bridged, but once discovered, you can prioritize them so that the largest gaps or the ones that are affecting patients the most can be addressed first.

Gaps usually appear in one of three categories: people, processes, and technology:

• People gaps, for example, might be that the staff or an employee lacks the right skill set, or that their job descriptions aren’t clearly defined.

• Processes gaps might include redundancies or unclear handoffs between steps in a process. One example is asking patients to fill out insurance forms and health questionnaires each time they have an appointment. This irritates patients and results in inefficiency in patient flow.

• Technology gaps would include situations such as incompatibility between the computer system at the practice and the one used by the hospital.

Each type of gap requires a similar approach: identify the gap; find the cause; and then provide the solution. A thorough gap analysis can help identify the gaps, their root cause, and the solutions that can overcome them.

A gap analysis can either give decision-makers a comprehensive overview of the entire practice or focus on a particular function, such as billing, accuracy of coding to prevent denials, information technology, or operations. This allows doctors and office managers to determine whether the practice has the resources needed to meet their goals and objectives. The gap analysis helps the practice focus its efforts and make informed decisions. After the gaps are identified, the gaps are categorized as high, medium, and low priority.

The larger gaps between expectations and experiences or between “what is” and “what should be” generally lead to patient dissatisfaction. Therefore, measuring these gaps is the first step to patient satisfaction. Having the realistic ability to reach identified strategic goals and targets puts your practice at a distinct advantage. This inevitably leads to better patient care, enhanced reputations both on- and off-line, more new patients, and greater productivity.

If you conduct patient surveys of your practice, you will also find unmet needs in your practice. Certainly, all the unmet needs or gaps can’t be solved, but the ones that appear over and over again should be given a high priority.

Gap analysis also applies to your internal customers—that is, your staff. Gaps between their expectations and their work experiences can lead to low morale and poor productivity as well as increased and costly turnover of your employees.

Identifying the Gaps

A gap often reveals itself when a patient or staff member expresses a need that is not being met. Such gaps often are identified by listening to our patients and our staff. Think about your patients and which of their needs are not being met. For example, if patients are having to wait weeks or months to obtain an appointment, this is a gap that should be bridged or repaired. Yes, it may fuel the doctors’ egos to feel that they are in demand by having a long wait-time, but this is not meeting patients’ expectations or their needs. Another example is seen when patients call the office or e-mail the doctors with a question and do not have the call returned or e-mail answered in a timely fashion . . . currently a reasonable response time is 24 hours.

Gaps also can be identified by conducting a survey of your patients. This survey can be a formal one, such as those that can be created at no cost on SurveyMonkey.com , or informal, as when you look at online reviews of your practice. Another type of informal survey that will identify gaps is merely to ask patients about their experience with your practice. The key here is to speak to the patients and your staff and identify what are their pain points or what are their needs.

Other gaps in your practice might include revenue and productivity, profit, market share, patient complaints, or staff issues such as absenteeism or frequent turnover.

For example, if surveys show that patients are complaining about waiting four to six weeks to have access to the practice and then waiting nearly 60 minutes after their appointed time to be seen by the physician, you have identified a significant gap that needs fixing.

Don’t forget to ask your employees for gaps in what they are experiencing in the workplace.

Also, look at your online reviews. Anything less than a score of 3.5 out of 4.0 should be cause for concern, because that indicates that there is a gap between patients’ expectations and the experience they received.

Don’t forget to ask your employees for gaps in what they are experiencing in the workplace. If you notice increased employee turnover and see that employees are leaving after a short period of employment and not even giving two weeks’ notice that they are leaving, you have identified a gap that needs fixing. An efficiently conducted gap analysis is designed to improve the entire practice, including deficiencies in the staff. If your employees are better motivated and enjoying more satisfaction at work, there will be less turnover, enhanced productivity, and, ultimately, happier patients and happier doctors.

Key Elements of Effective Gap Analysis

In gap analysis, you typically list elements in the practice’s current state, then list its desired state, and formulate a comprehensive plan to fill in the gap between these two states, i.e., the current situation or the “is” and the future or improved state or “should be” (Figure 1). The first step in gap analysis is identifying your current state and your future desired state.

Figure 1. A gap analysis designed to reach the goal of attracting new patients.

Every gap analysis starts with taking an honest look at existing situation or your current state.

Every gap analysis starts with taking an honest look at existing situation or your current state. Then you list the areas you’d like to see improved. Your focus can be as wide (e.g., the whole practice) or narrow (e.g., staff morale in the collections department). The analysis can be quantitative (e.g., currently see 25 patients per day); qualitative (e.g., patients are not taking their medications properly); or both. The key thing is to be specific and factual with an emphasis on identifying weaknesses or shortcomings.

Other examples of gaps to be filled might include the practice’s revenue—for example, increasing revenue of your practice from $1.25 million to $1.75 million in 18 months, or increasing annual profit from $.5 million to $.75 million over the same time period. An orthopedic surgeon might consider a gap to fill as increasing your market share for hip replacement surgery in the three zip codes around your office from 5% to 8.5%. Finally, if you have patients waiting to obtain an appointment, then consider goals of decreasing wait times for a new appointment from four to six weeks to no more than two weeks and decrease the time waiting to be seen by the doctor once they arrive in your office from the “is” of 60 minutes to less than 15 minutes.

Next, consider the future state or the ideal condition you’d want your practice to be in or the “should be.” This state can be highly specific (e.g., increase by three new patients a day, decrease no-shows from three to five to one, or better yet, zero), or generic (e.g., enhance morale in the workplace). Your gap analysis template should record all the changes you would like to make as they correspond to the current state (Figure 2).

Figure 2. Template for gap analysis.

Look for Causes Before Providing Solutions

Start looking for causes or gaps. This is where the rubber hits the road and you identify the factors responsible for the difference between your current and future desired state. Only after identifying the causes of any problems can you then use this template to come up with a remedies and action plans to zap the gaps.(1)

The next part of your gap analysis template should list all the factors responsible for the gap identified in the previous column. This list should be specific, objective, and relevant. For example, poor prescreening of employees can be responsible for increased workplace absenteeism, or patients having to wait four to six weeks for an appointment can result in an increase in no-shows.

The last step in the gap analysis is to list out all the possible solutions or remedies for bridging the gap between the current and ideal state. These remedies should directly address the factors or causes that you have identified as producing the gap. For example, having patients complete their demographic information and health questionnaire online before coming to the office will reduce their wait time in the reception area. The remedies must be action-oriented and specific, such as arranging automatic prescription refills in order to enhance patient compliance with their medications. You might consider hiring a physician assistant in order to shorten the time a patient needs to wait to gain access to the practice.

Bottom Line: American healthcare is becoming fragmented, and patients are left with a less than optimal experience during their interactions with doctors, hospitals, and payers. Most physicians are experiencing time constraints, making it difficult for them to enhance the doctor–patient relationship. Also, spending more time with patients has the additional detractor that additional time spent with patients typically is not reimbursed. As a result of such barriers, gaps are generated in the doctor–patient relationship. Conducting a gap analysis is the first step to identifying the problem, finding the cause of the problem, and then proceeding to the solution of “zapping the gap.”

Reference

1. Blanchard K, Robinson D, Robinson J. Zap the Gaps—Target Higher Performance and Achieve It! William Morrow, 2002.