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Practice Bottlenecks: How to Increase Capacity by Removing Hidden Barriers
Jul 28, 2004

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Managing Capacity in Your Chiropractic Office
Hidden barriers to achieving your goals.

You try and try and try to achieve your goals, but for some reason, you just can reach them. You work hard, your put forth effort, but you just don’t get as far as you should. The reason may be that you are running into unseen bottlenecks, or restraints to increasing your production.

For example: one doctor had a small office of about 1000 square feet. He was seeing about 150 visits week, but wanted to see more. He felt the problem was not enough promotions. I visited his office and noticed that he already had a decent amount of marketing underway, but it was not as effective as it should be. His staff seemed motivated and skilled, and all I could see was that his reception area was very tiny. During peak hours there was no room for patient to sit. The doctor did not want to get a larger office because he had heard of doctors seeing 300 O.V.s in 1000 square feet with very low overhead and he wanted to do the same.

I personally interviewed his patients in a special focus group. The primary complaint was that the reception was too small. With this information, the doctor finally decided to move into a new office with a larger reception room. Shortly thereafter, his office visits shot up to an average of 250 per month.

The theory of capacity management, as developed by Eli Goldratt and explained in his books, including the best selling The Goal, discusses the theory of restraints as applied to a manufacturing environment.

The same principle applies to health care facility. According to Goldratt, "Capacity is the available time for production." A bottleneck is: "what happens if capacity is less than demand placed on resource."

Bottlenecks can be at the front desk, in the therapy area, in the insurance department, poorly organized or inefficient paperwork, or even insufficient doctors. Many well established offices can easily bring on another doctor as the demand is often there.

Other examples include:

  • Peak Periods. Between the 4-6 pm slot, where there is extra traffic, extra staff or increased capacity is not provided.

  • Paperwork. Old systems, too much detail, poor scheduling.

  • Poor scheduling of patients: (not cluster booked, not booking for NP paperwork)

  • Doctors waiting for therapy patients. (No CT or therapy after adjustment)

  • Front Desk doing insurance and scheduling at each visit (no MAP and PIA)

  • Not enough exam rooms

  • Clutter in front desk/insurance area

  • Quitting time. After a long day, all staff and doctors are looking forward to leaving and really don’t want extra patients to call or come in. Patients are inadvertently discouraged to come in extra, bring in friends or family , or call in during the last hour.

  • Backlogs. Undone reports from the two summers ago, partially completed projects, cluttered desks or office space, all discourage more an increase in production. You only have so much mental capacity, and if it gets frittered away on projects that are not completed, you will have "too many irons in the fire" to add any more. Finish what you started, and make room for more.

  • "Difficult people". Some staff, or patients, will seem to drain you of your energy, or consume too much of your time trying to keep them happy.

Warning: Too much capacity can also be a barrier. A) Personnel. A staff that has to make up work can retard production. Happy staff are productive staff, and the opposite is also true. Unhappy staff will not make for happy patients. This will also suck up the doctors time to try to remedy his "staff problems." B) Space. Too large of a space can disconnect the staff from each other and the patients and minimize the synergy.

Exercise – Getting Rid of Capacity Restraints and Bottlenecks.

Make a list of any bottlenecks in your office. Start by considering the flow of patients, of paper, and anything that slows it down or gets in its way. Consider patients waiting, paperwork waiting, any times of the day or days during the week where there is a slow down or back log. You can organize it into four categories:

  1. Physical space

  2. Personnel

  3. Procedures

  4. Difficult people

  5. Incomplete projects

Once you have listed these out, give yourself 30 days to fix all these capacity restraints.

NOTE: Bottlenecks can sometimes be difficult to locate, and even more difficult to remove. For more information on bottlenecks and help on removing them, e-mail us at

© Copyright 2008 by

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