Today’s post dives into the world of batching as it relates to a busy clinic day. Not everything is batchable. So read on to learn when it is useful and how to pull it off.
Batching 101
Batching is the practice of grouping similar tasks together and completing them in one sitting instead of scattering them throughout the day. It is a time management technique to try to boost productivity and efficiency.
Batching can be done with any repetitive task, and is generally best suited to tasks that do not require much thought or creativity. (Sounds like physician work, amirite?)
You can batch in many areas of your life: work, fitness, food/diet, chores, and other aspects of your personal life.
In this post, I will share my take on the role of batching in completing clinic work. There are certain things that are batchable and others that don’t lend themselves to batching, as we will explore, and using batching on the correct things can help you optimize your time in clinic.
Bustin’ a Popular Myth: Multitasking
The biggest benefit to batching is that it helps us avoid task-shifting, also known as context switching, which refers to the act of switching our attention and focus to different things we’re working on, often back and forth.
We like to believe we can multitask, but our brains can only focus on one task at a time. Even if we think we’re multitasking, we’re really just switching rapidly between the competing tasks, which is inefficient.
Why? Because of attention residue. Attention residue is a phenomenon where we continue to think about and process a previous task even after we’ve moved onto another task.
To some degree, this is unavoidable even when a prior task has been completed. However, we tend to take this to an impressive degree—rapidly switching between tasks all the time, spreading our attention too thinly, and leaving us unable to give anything our complete attention.
I should note that task-switching includes interruptions, from the small seemingly inconsequential checking of our emails or crossing off the “easy” items on our to-do lists to others vying for our attention to get questions answered, etc.
This can leave us exhausted with little quality work to show for the time we’ve put into all the tasks. Cue the frustration and shame.
There are data to show that multitaskers take longer cumulatively to get their work done, and, additionally, are more prone to making errors.
Now you’re probably thinking, “Hey, hey, hey, I totally can fold laundry while listening to a podcast.” And you’re correct. But that’s not true multitasking because one activity requires mindless and mild physical activity while the other truly holds your attention.
Try writing a clinic note, then taking a call from a colleague, then being paged overhead for some other need, then remembering you should look at your inbasket, and finally coming back to the note because you didn’t finish it.
Think you could do all of that simultaneously? You couldn’t, even if you thought you did. We have learned to context switch rapidly and probably do it very well compared to most, but that does not make it ideal. Far from it.
Batching a Plan
At this point, you may be wondering if there are any opportunities to batch in the clinic setting, and it’s a fair question. After all, a typical clinic day is an exercise in managing frequent (maybe near constant) interruptions, right?
Well, I attempted to divide the tasks we do in clinic into three baskets:
1) Tasks that lend themselves to batching
2) Tasks that sometimes should be batched and other times not so much
3) Tasks that should not be batched
We’ll take a look at each of these categories below.
But before we do, please bear in mind, these are my general thoughts and “guidelines” on clinical tasks and your needs may vary. My hope is that this is at least a starting point for you to evaluate your day to see where batching may come in handy.
Just Batch and Chill
The first category involves those things that are batchable—that is, doing multiple of them in one sitting is possible, helps you get in a flow state, and boosts efficiency by reducing context switching.
As mentioned earlier, interruptions are common in clinic, but do your best to group these things together and you’ll notice improved flow.
Inbasket items. This includes all portal messages, calls, results, refills, cc’d transcriptions, etc. These are best tackled by picking one folder and then tackling as many items in that folder instead of jumping around.
A common mistake is to click on everything once to “triage” it and then 10 minutes later you’ve clicked on everything and addressed none of them. Touch them all once if possible and get ‘em done.
Forms and other paperwork. My least favorite clinical task that somehow makes my handwriting look stereotypically like a doctor’s. I like to group these together as much as I can to decrease time spent and number of touches on this type of task. I’ll do the bulk of mine on a certain day of the week if not urgent—I highly recommend this!
Can I hire this person?
Virtual visits. I find having these interspersed throughout my in-person visits takes me out of my rhythm. I try to consolidate as many of my virtual visits to my “virtual” half-day where I only do these. Alternatively, you can batch a few of these to start your day, before lunch, or at the end of your day.
Huddles and check-ins. At huddles you can look holistically at all your patients coming in for the day and plan accordingly with your team. This is best done all at the beginning of the day or dividing up into morning and afternoon sessions.
Regularly scheduled check-ins with your team where you can address things they need and during which they can ask you questions gives them time when they know they’ll have access to you. This can decrease interruptions.
Panel management. Here I’m thinking population level health tasks, e.g., looking at data around all of your diabetes patients and their needs. Easiest to this during a chunk of dedicated time if this is part of your practice model (like a patient centered medical home).
Mix and Batch
The second category are those tasks that sometimes should be batched and other times not so much. I’ll try to illustrate that as we go.
Precharting. I love me a nice chunk of time to prechart (a.k.a. chart prep) a few upcoming visits together. Then after closing one encounter, I can jump right into the next one without skipping a beat.
However, I can only realistically do that for three, maybe four consecutive visits before I’ve forgotten enough details to have to re-review before I go see the next patient, at which point the benefit of precharting diminishes.
Me walking into that fifth patient’s room if I precharted too far in advance.
I can also prechart before each visit if necessary, so batching isn’t necessary.
Furthermore, even within precharting a single encounter, I try to batch the tasks involved like formatting/setting up the note, then putting in diagnoses and relevant orders, and finally starting the after visit paperwork.
Outside record review. Here I’m not talking about precharting before a visit which can include reviewing recent appointments and such. Instead this refers to a ream of outside records you will need to go through.
Sometimes this can be so time consuming for a single patient that you simply can’t batch and just getting through one is a success. (You used to be able to bill for this time if over 31 minutes using a 99358, but CMS stopped paying for this as of 1/1/23, though other payers may yet still reimburse).
At other times, you can knock out a few of them in short order. It depends.
Scheduling certain visit types. Think new patient versus established patient visits. Maybe it makes sense to batch the more time-consuming new patient visits together.
Or a common practice during the earlier days of COVID-19 was to do physicals/well checks in the mornings for “well” patients and then switch to “sick” acute visits in the afternoons. This helped with patient flow, separating healthy versus ill, and PPE use when it was in short supply.
Then again, depending on how your team works, this may bog down your staff with vision/hearing screenings and/or vaccines that are back to back and slow them down rooming your subsequent patients.
Depending on your situation, it may make more sense to use wave scheduling where you have two different appointments that start at the same time and are scheduled for double the time—like an acute visit and a physical that are normally 20 minutes each if sequential but for wave scheduling are both 40 minutes starting at the same time.
Then ideally you’re knocking out that acute visit while your staff is rooming and doing all the additional tasks for the physical before you move into that room for that visit. This is a powerful way to pair different visit types (so, not batching) for better efficiency.
Scheduling similar procedures. Similar to the last one, this allows you/your team to collect and set up the necessary supplies once to streamline the prep for each procedure.
Mohs surgeons, for example, do this very well taking the next layer of tissue and then sending it for pathology review for one case before moving to the next case. They repeat this several times over and have several cases going simultaneously.
But this also works if you do steroid injections, for example. You can have a procedure half-day to knock these out. I’ve seen Rheumatology and Sports Med do this quite successfully.
You may not have enough volume to pull this off, in which case, you have no need to batch per se.
Phone calls. If you can set aside time to get them done in one fell swoop, then more power to you. But chances are that you’ll have to pencil them in at various times when you have…time.
Put It on the Batch Burner
The third and final basket are the tasks I recommend you not batch.
Note writing. I’ve written elsewhere about the importance of charting as you go, and this is usually the largest component of it. Saving all your notes to work on at the end of the day, for example, means you’ll spend way longer on them. Don’t believe me? Then you need to read this.
I get that notes seem like a single task, but they vary so drastically from one to the other (especially for primary care, maybe not as true for certain hyper-specialized folks—I’m looking at you Endocrinologists who only deal with disease involving the isthmus of the thyroid!).
That’s not a real hyper-specialization. I made it up.
Plus carrying around all of that information in your head all day is one giant pile of attention residue that slows everything else down, whether you notice it or not.
Order entry. If you didn’t capture it during precharting (like for a physical), then do it on the fly during an encounter because you’ll forget later. And if you forget later, that will likely cause more interruptions later, like lab or radiology hunting you down for orders after you sent the patient there or being interrupted by a call from a pharmacy for a prescription you forgot to send in.
Miscellaneous. Any workflow optimizations like making or editing note templates, order preference list entries, patient education, and the like should be done on the fly as well when they’re fresh in your mind. If you don’t do them at that time, they’ll never get done because you won’t remember them until you need them again.
A Batch Made in Heaven
So there you have it: my take on batching. I’m sure I left some things out, so feel free to let me know in the comments below.
As we end this post, I do want to give you a little framework for how to approach batching.
First, you have to look at your day and workflows to determine what may benefit from batching.
Then prioritize those tasks in order of importance.
Finally, do your best to plan out when you’ll try to do them (starting with the most important and moving down your prioritized list) and even schedule time to get them done.
Game, Set, Batch
Wrapping up, batching is a time management strategy that can help you manage your time more efficiently during a hectic clinic day.
By grouping certain similar tasks together and completing them all at once, you can streamline your work, complete it more efficiently with fewer interruptions, and even improve patient care and satisfaction.
I sound like a Mentos commercial…
… or worse yet: administration 
.
However, you have to be intentional and tactical in your deployment of batching given the nature of your clinical day.
So experiment with different batching strategies and find the techniques that work best for you and your patients.
Do you batch? Where do you find it useful? Where do you find it less useful? Let me know in the comments section below.
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