Organisational Systems and Standard Operating Procedures for Business and Practice Management

Original Editor - Jacquie Kieck

Top Contributors - Wanda van Niekerk, Jess Bell and Tarina van der Stockt  

Introduction

Organisational systems and standard operating procedures (SOPs) are important for all rehabilitation professionals in their work environments and businesses to establish consistent and high-quality client / patient care. These detailed instructions provide a roadmap for staff for specific tasks, from appointment booking procedures and therapy sessions to the use of social media and practising within the legal and regulatory requirements of their country and professional body. This page explores organisational systems and standard operating procedures for rehabilitation professionals and clinics.

Standard Operating Procedures

Definition: "Established or prescribed methods to be followed routinely for the performance of designated operations or in designated situations".

Standardised operating procedures (SOPs) have many advantages. They can be a guide to ensure tasks are performed consistently and efficiently, minimising errors and misunderstandings. They allow for seamless onboarding and training of new employees, as well as preserving a business’s organisational collective knowledge. SOPs contribute to quality assurance and adherence to regulatory requirements. Implementing SOPs helps business owners optimise their operations, improve employee performance and reduce risk.

Your operating procedures manual is not a static set of documents that you draw up, put somewhere and leave. These procedures need to be constantly reviewed and updated as your business develops or things change; they must be relevant to what is happening in your business now.

Processes and Procedures

Clinical policies, payments, business plans and marketing strategies are key areas clinicians should consider when establishing a business. Some areas that require processes and procedures are summarised below.

TOP TIP: As you develop these procedures, create templates of documents related to the procedures (e.g. employment contracts or interview schedules) and link to them.

Billing and Income Generation

Have regular financial reviews in place and ensure that fees reflect the cost of providing services and allow for a profitable business.

Billing procedures must align with:

• country-specific laws
• regulatory body requirements
• business type (e.g. physiotherapy, multidisciplinary, prosthetics, etc.)
• arrangements and contracts with funders

Billing structure:

• determine the billing structure of your clinic. Examples include:
  • cash-based or direct (client-business contract) / self-pay clients
  • third-party funder (business-funder contract)
  • hybrid model or mixed funding (partial third-party funding with client co-payments)
  • worker's compensation

Billing operations:

• determine billing frequency (per appointment or bulk billing)
• have a procedure in place for issuing accounts and consider the timing of this in relation to cash flow and payment of expenses
• determine who is responsible for billing
• consider the potential ethical implications of coding and billing tasks
• staff need to be properly trained to handle billing codes
• clinical documentation should support the level of billing
• set up compliant invoicing systems

Billing for products and consumables:

• understand your contracts and what services, consumables and products can be billed
• determine how to charge for physical products (e.g. exercise bands) and consumables (e.g. splinting material) alongside service fees
• stipulate if funders or clients will cover costs
• have a system for calculating the costs of materials to ensure accurate billing
• adhere to regulations regarding the billing and sale of products within your profession
• all billed items should be clearly reflected in the documented treatments in the patient's clinical notes

Invoicing requirements:

• familiarise yourself with legal and regulatory requirements for invoices
• include all necessary information, such as tax numbers, invoice numbers, banking details, professional registration number or practice number
• select practice management systems that can accommodate all of this

Payment processing:

• define accepted payment methods (e.g. cash, card, electronic financial transactions)
• establish payment collection procedures
• consider payment processing costs
• implement petty cash management systems

Account rendering:

• in your SOP, ensure the following:
  • assign responsibility for account rendering
  • define the frequency of issuing accounts and consider cash flow with the timing of accounts
  • include timelines and dates for sending accounts

Month-end procedures:

• set aside time at the end of each week / fortnight / month to review your key business metrics
• audit monthly billing procedures and track trends related to income, expenses and billing:
  • identify any gaps or issues and address these
  • billing should accurately reflect the amount of work done
  • check that every session is billed for
  • update your SOPs and train staff based on the findings of the audit

Debt collection processes:

• these should be stipulated in compliance with legal and professional guidelines of your country
• design a standardised approach to recovering outstanding payments
• set time frames for sending accounts, expecting payments and following up on outstanding accounts
• have clear guidelines on when to hand over accounts for collection
• consider the legal aspects and potential costs before taking further legal action

Fee declaration policies:

• it is good practice to declare your fees to clients before treatments
• employees should know this and be trained on the clinic's billing policies

Expense tracking:

• keep a record of deductible business expenses
• maintain the proper documentation for such expenses
• be familiar with what expenses are deductible or have a professional help you with this

Administrative Procedures

Record keeping and appointment administration:

• have procedures for record retention and disposal for each type of record in your clinic according to legal and regulatory requirements
• it is necessary to have a procedure for archiving records
• it is very helpful to have a calendar for these procedures

Clinical records:

• policies on clinical notes should be clear, accurate and comply with legal and regulatory requirements
  • medical documentation can be electronic, handwritten or dictated and transcribed - it is the rehabilitation professional's responsibility to have accurate and complete documentation for every client
• these records include all aspects of patient care, such as investigations, medical communication and laboratory results
• special considerations are necessary when providing services outside your clinic (e.g. hospital, care facilities, etc.) - it is necessary to understand the facility’s documentation requirements and whether additional notes need to be kept in the clinic’s records

Examples of other types of records that a rehabilitation clinic may have:

• billing records (for patients and funders)
• financial records (annual statements, income and expenses, etc.)
• human resources records (staffing, contracts, leave, etc.)
• plaster casts (specific to prosthetics and ortotics clinics or occupational therapy clinics) – there needs to be a space to store positive casts

Appointment scheduling:

• booking methods
  • booking options include walk-ins, phone, online, etc.
  • if you are using an online booking system, make sure that it integrates with practice management software to prevent double-booking

• information gathering
  • have a set list of essential information (client's name, contact number, etc.) and preferred clinic location (if multiple sites exist) to be gathered when booking an appointment

• appointment reminders
  • have a procedure or system on how to remind clients of upcoming appointments, to reduce the chance of no-shows

• no-show procedure
  • a follow-up process should be in place for clients who miss appointments to check in on their well-being and maintain client relationships
  • missed appointments have been shown to lead to:
    • loss or wasteful use of resources, such as staff time and equipment
    • loss of income
    • disruption of the continuity of care
    • scheduling overlap
    • increased costs
    • delayed access to healthcare services
    • negative patient outcomes

• additional considerations:
  • make sure clients are instructed on the appropriate attire for their appointments (e.g. clothing that allows for easy examination of the affected area)
• discharge procedure:
  • reporting requirements:
    • procedures should be in place upon discharging a client to ensure all necessary reports are completed in accordance with legal and regulatory requirements (e.g. a formal discharge report summarising the client’s progress and treatment outcomes)

Privacy and Data Protection Procedures

Confidentiality and security:

• have a procedure that outlines how to treat all client information as confidential
• implement measures to protect records from loss, damage or unauthorised access
  • with electronic health records: there are various legal requirements that must be respected:
    • encryption techniques
    • access control
    • audit controls
    • emergency access
    • consent
    • secure transmission
    • authentication
    • automatic log-off

Access control to clinical records:

• clearly define who has access to different types of records (e.g. clinical, financial, etc.)
• store records securely to restrict access to authorised personnel only

Release of information:

• develop procedures outlining the circumstances under which client information can be shared with third parties
• ensure staff are familiar with these guidelines and procedures and the relevant privacy legislation of the county and regulatory body

Staff training:

• all staff should have comprehensive training on the clinic’s privacy policy and procedures and be educated on potential ethical dilemmas related to privacy and how to handle these situations

Legal compliance:

• privacy procedures should be based on the laws and regulations of your country and the guidelines of your regulatory body
• have a list of relevant resources for reference in uncertain situations
• examples of these documents:
  • Health Professions Council of South Africa: Guidelines for good practice in the healthcare professions. Booklet 6. Confidentiality: Protecting and providing information
  • American Physical Therapy Association: Health insurance portability and accountability act (HIPAA)

Informed consent:

• informed consent refers to the client's right to be informed about their condition, treatment options and the risks and benefits associated with them
• rules and regulations regarding informed consent vary by country
• implement the standard operating procedure for informed consent according to your country’s rules and regulations
• consider that there are challenges to obtaining informed consent, such as the availability of resources, cultural factors and the client’s capacity to make decisions
• make it clear in your procedure that informed consent is an ongoing process that should be integrated into all interactions with the client, not a one-time event

Logistics and Security Procedures

Opening and closing procedures:

• specify who is responsible for opening and closing the clinic

• detail the steps involved in opening and closing, including:
  • security access (keys, key cards, access codes, etc.)
  • checking windows and doors, equipment and air conditioning
  • setting alarms (if applicable)

Security measures:

• define who has access to the premises and how access is granted
• outline procedures for when a staff member permanently leaves the clinic (e.g. returning keys, deactivating access codes, etc.)
• describe any restricted access measures (e.g. for clients with appointments only)
• specify if staff have access to emergency buttons or other security devices
• identify the security needs of your clinic and have appropriate measures in place to ensure safety

Professional Conduct

Social media use:

• clear procedures should be in place for staff and clients regarding social media use
• define what is and isn’t allowed in terms of photography and recording during sessions
• staff should be aware of the potential implications of their social media posts in relation to client confidentiality and the clinic’s reputation
• clear guidelines should be in place to protect both the client and the business
• you can find some guidance for social media use for physiotherapists here

Clinic etiquette:

• have a procedure outlining expected staff behaviour in the clinic:
  • examples:
    • no open discussions about clients in the reception area
    • no eating or drinking in the reception area

• ensure professional and consistent behaviour from all staff
• SOPs about clinic etiquette provide a reference point for all staff regarding expected conduct
• other considerations that could be included in the SOP:
  • dress code
  • personal hygiene
  • noise levels
  • personal phone use
  • interactions with colleagues
  • punctuality
  • general courtesy

Internal communication:

• outline clear lines of communication
• define who to contact in specific circumstances and how
• include communication procedures for other scenarios as needed
• include specific contact information for key personnel, such as phone numbers and e-mail addresses to ensure efficient communication in various scenarios

Regulatory compliance:

• types of insurance to consider:
  • professional insurance for staff
  • public liability insurance
  • equipment insurance
  • property insurance
  • contents insurance

• consider the specific needs of the business and the type of service provided

Business continuity planning:

• have a procedure which outlines what steps should be taken in the case of something happening to key staff members

Legislation requirements:

• outline the necessary registrations and qualifications that staff need to practise their profession legally

Resources

• PhysioFirst. Private Physiotherapy Practice - The Essential Guide
• Business.govt.nz. Business structure overview
• Gonzaba, W. Cash-based physical therapy - The ultimate guide
• Health Professions Council of South Africa. Guidelines for good practices in the healthcare professions. Booklet 9. Guidelines on the keeping of patient health records
• Australian health practitioner regulation agency. Managing health records
• Health & care professions council. Record keeping
• Health & care professions council. Confidentiality
• Privacy Commissioner (New Zealand)
• Protection of Personal Information Act (POPI Act)
• Information Commisioner's Office
• Informed Consent