Improving Inefficiencies in the Office Setting

 

15 Inefficiencies Killing Your Eye Practice — And the Evidence-Based Fixes

By Sandra Lora Cremers, MD, FACS • Board-Certified Ophthalmologist • Visionary Eye Doctors, Rockville, MD

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Like most surgeons, I love efficiency because I think it really provides better care for patients—their time is as valuable or more valuable than my time. A lot of our patients are having severe distress because of loss of vision or a fear of loss of vision or having significant pain or acute loss of vision. When our team has inefficiencies, that can be very dangerous for patients. A colleague was telling me recently that a patient in angle closure—meaning the pressure was more than 60 and the eye's drain was closed off due to the iris pressing against the opening and the patient was in a lot of pain—waited in the office for almost 2 hours before anyone noticed and started eye drops.

I come from a developing world and have done multiple mission trips in my life. This is not something I expect to hear in a world-class United States–based office.

Still, correcting these inefficiencies can be difficult, especially if you are not the one in charge—and especially if you have a reputation for maybe being “bossy,” though multiple women who are surgeons have told me they are really saying the “B…” word behind your back.

Every practice has its own inertia. Unless there’s a new force for good—a surgeon or director with a vision that demands excellence with the authority to do it; a competitor next door who does things better, faster, cheaper; heaven forbid a death of a patient or some significant morbidity; or now AI & robots—many practices are slow to change.

Below are the key ways that efficiencies could improve in every office. Those that are able to adapt to these recommendations are more likely to stay off the takeovers from better providers nearby.

Patients can tell when they’re in a well-run practice: their wait times are reasonable, their calls get returned within a reasonable time range, emergency calls get answered ASAP, and teams return calls. Anything less than this implies inefficiency, which drives everyone crazy—and puts patients at risk.

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Evidence-Based Inefficiencies & Solutions in Eye Surgery Practice

#	Inefficiency	Evidence-Based Solution
1	Excessive patient wait times and prolonged in-clinic time (Median 131 minutes in baseline studies)	Implement Lean Six Sigma workflow optimization; use data-driven scheduling templates based on appointment length (short/medium/long); standardize clinic schedules. Track minutes per patient encounter as a KPI. Sources: BMC Health Serv Res 2021; Retina 2018; Int J Qual Health Care 2022
2	Poor scheduling optimization Leading to gaps, delays, and idle exam rooms	Use EHR timestamp data to create simulation models for optimal scheduling; implement visual web-based calendars instead of text-based systems; schedule patients 1–2 weeks prior to procedure. Measure patients per hour per room as a core productivity metric—most efficient ophthalmology practices target 4–6 patients/hour/provider with 2+ exam rooms running simultaneously. Sources: Ophthalmology; BMC Health Serv Res
3	Physician performing non-clinical tasks Calling patients into rooms, searching for patients, assisting with wheelchairs, transferring patients to exam chairs, restocking supplies, opening tissue boxes, moving containers	Delegate to medical assistants and technicians; standardize division of labor for each team member; create clear role definitions. It is significantly cheaper for the office to have team members do these tasks—moving patients, opening supplies, restocking rooms, doing consent forms—than having the surgeon do it. A surgeon’s time generates revenue only when spent on clinical decision-making and procedures. Source: JAMA
4	Empty exam rooms at start of clinic Causing physician downtime	Pre-room first patient before physician arrival; implement parallel processing with staff preparing rooms while physician sees other patients. The first patient should be dilated and ready by the time the surgeon walks in. Sources: BMC Health Serv Res; JAMA Surg
5	Physician reading through charts without preparation Chart review during patient encounter wastes face-to-face time	Have technicians or scribes present patient summary; use standardized documentation templates; implement pre-visit chart review by staff. A 1-page “patient snapshot” prepared by the tech saves 3–5 minutes per encounter. Sources: BMC Health Serv Res; JAMA Surg
6	Vague patient complaints without quantification Unstructured chief complaints slow triage and diagnosis	Standardize intake questions: “What is your main symptom and on a scale of 0–10 how would you rate it?”; use structured chief complaint templates that prompt for duration, severity, laterality, and associated symptoms. Sources: BMC Health Serv Res; J Eval Clin Pract
7	Inconsistent or duplicated diagnostic workup Repeated testing wastes time and money	Create computerized consultation templates outlining necessary preoperative workup; standardize service agreements between departments so tests are not duplicated across referrals. Source: JAMA
8	Poor communication handoffs Between departments and staff members	Implement swim lane diagrams to clarify responsibilities; use structured handoff protocols (e.g., SBAR: Situation, Background, Assessment, Recommendation); improve interdepartmental communication systems with real-time messaging. Source: JAMA
9	Excessive documentation time Consuming physician productivity	Consider AI ambient scribes for automated clinical note generation from patient conversations; optimize EHR workflows with iterative improvements; use smart phrases/macros. See AI Scribe Considerations below. Sources: Annals of Surgery; J Eval Clin Pract 2026
10	High no-show rates Reducing clinic efficiency and revenue	Implement telephone reminders within one week of appointment; use telehealth for pre-visit screening; standardize no-show policies; consider overbooking algorithms based on historical no-show data by appointment type. Source: JAMA
11	Inefficient patient flow pathways With multiple bottlenecks	Map the five most common patient pathways (e.g., cataract eval, dry eye visit, post-op, injection, emergency); immediately start patients into the appropriate pathway; adjust staffing to high-demand tasks throughout the day. Source: Retina
12	Equipment and supply delays Missing supplies, room not set up, surgeon moving equipment	Create liaison between sterile processing and OR personnel; standardize equipment needs by procedure type. Laser rooms should have two chairs so the surgeon doesn’t waste time repositioning; key drop containers should be stationed on both sides of the room to eliminate unnecessary movement. The surgical team should actively identify and fix these small inefficiencies—they add up fast. It is always cheaper for staff to handle setup, supply restocking, and room turnover than for the surgeon to do it. Source: JAMA
13	Lack of same-day or urgent appointment availability	Reserve flexible block time for high-priority patients; create same-day appointment slots for urgent referrals; have a triage protocol that flags emergencies (acute vision loss, angle closure, retinal detachment) for immediate access. Sources: JAMA +1
14	Insurance authorization delays For procedures and follow-up	Streamline authorization processes; assign dedicated staff to insurance coordination; implement pre-authorization protocols that begin at the time of scheduling, not after the patient visit. Source: JAMA
15	Variability in clinic workflows across providers Different surgeons, different processes	Standardize work across surgical subspecialties; create consistent processes for all providers; use checklists, standard operating procedure (SOP) manuals, and regular team huddles to maintain alignment. Sources: JAMA +1

Key Evidence-Based Findings

Studies in ophthalmology practices using Lean Six Sigma methodology demonstrated an 18% reduction in patient flow time and a 9% increase in clinic volume without additional resources.^[1][2]

The most impactful interventions focused on eliminating non-value-added time, which decreased from 17 to 8 minutes (51% reduction) in surgical clinics.^[3]

Patients per hour per room is one of the most important metrics a practice can track. Efficient ophthalmology practices with two or more exam lanes running per provider can see 4–6 patients per hour. This requires excellent tech support, pre-rooming, and a team that anticipates the surgeon’s next move.

⚠️ AI Scribe Considerations

Current AI ambient documentation tools can reduce documentation burden and cognitive load, but present important considerations:^[4][5]

HIPAA compliance requires: Business Associate Agreements with AI vendors, patient consent for recording/data use, secure encrypted data transmission, and clear data ownership policies.^[6][7][8]

Limitations: Frequent errors requiring editing, excessive note length, poor EHR integration, and variable accuracy in complex visits.^[4]

Consent requirements: Patients must be informed about AI recording, data storage, potential privacy risks, and given the option to decline.^[8]

The evidence suggests that task delegation to trained staff (rather than AI) for patient presentation and chart review carries lower HIPAA risk while achieving similar efficiency gains.^[1][2][9]

The Bottom Line

The practices that thrive are the ones that treat efficiency as a patient safety issue, not just a business metric. Every minute a patient waits unnecessarily, every time a surgeon hunts for a drop bottle, every chart that isn’t pre-reviewed—these are failures that compound. The good news is that most of these fixes cost nothing except the willingness to change. Track your patients per hour per room. Empower your team. And never forget: a well-run clinic is the best advertisement you’ll ever have.

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References

1. Kam AW, Collins S, Park T, et al. Using Lean Six Sigma Techniques to Improve Efficiency in Outpatient Ophthalmology Clinics. BMC Health Services Research. 2021;21(1):38. doi:10.1186/s12913-020-06034-3.
2. Ciulla TA, Tatikonda MV, ElMaraghi YA, et al. Lean Six Sigma Techniques to Improve Ophthalmology Clinic Efficiency. Retina. 2018;38(9):1688-1698. doi:10.1097/IAE.0000000000001761.
3. Sullivan K, Topper L, Rajwani A. Redesigning Patient Flow in Orthopedics and Radiology Clinics via a Three-Phase ‘Kaizen’ Improvement Approach and Interrupted Time Series Analysis. Int J Qual Health Care. 2022;34(3):mzac061. doi:10.1093/intqhc/mzac061.
4. Atiku S, Olakotan O, Owolanke K. Usability-Related Barriers and Facilitators Influencing the Adoption and Use of AI Scribes in Healthcare: A Scoping Review. J Eval Clin Pract. 2026;32(1):e70365. doi:10.1111/jep.70365.
5. Angus DC, Khera R, Lieu T, et al. AI, Health, and Health Care Today and Tomorrow. JAMA. 2025;334(18):1650-1664. doi:10.1001/jama.2025.18490.
6. American Academy of Dermatology. Position Statement: Augmented Artificial Intelligence. 2023.
7. Wang C, Liu S, Yang H, et al. Ethical Considerations of Using ChatGPT in Health Care. J Med Internet Res. 2023;25:e48009. doi:10.2196/48009.
8. Lawrence K, Kuram VS, Levine DL, et al. Informed Consent for Ambient Documentation Using Generative AI in Ambulatory Care. JAMA Netw Open. 2025;8(7):e2522400. doi:10.1001/jamanetworkopen.2025.22400.
9. Valsangkar NP, Eppstein AC, Lawson RA, Taylor AN. Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center. JAMA Surgery. 2017;152(1):42-47. doi:10.1001/jamasurg.2016.2808.

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Sandra Lora Cremers, MD, FACS, is a board-certified ophthalmologist and Fellow of the American College of Surgeons at Visionary Eye Doctors in Rockville, MD, affiliated with Johns Hopkins Medicine. She hosts The Eye Show podcast and blogs at EyeDoc2020.blogspot.com.