Overcome Practice Challenges: A 4-Step Structured Tool for Dermatologists

Every dermatology practice hits roadblocks. The appointment scheduling system that worked perfectly with 20 patients a day becomes a nightmare at 50. The patient intake process that felt smooth suddenly creates bottlenecks that have people waiting in your lobby for an hour. 

We call these challenges hurdles. They're an inevitable part of growing your practice, and honestly, they're good news—hitting hurdles means you're doing something right and your practice is expanding. 

Still, you need to get over those hurdles efficiently. Our CESI tool gives you a structured approach: Clarify, Explore, Solve, and Implement. It's a framework that gets to the core of what's actually wrong and designs meaningful solutions that work. 

A structured approach beats throwing random fixes at problems to see what sticks. 

Start with Clarity 

A hurdle is anything that holds your practice back—it impedes growth, hurts profitability, or drives your patients crazy. The key is stating the hurdle clearly so everyone on your team understands exactly what you're solving. 

People want to jump straight to solutions, but if you don't pause to ensure you're solving the right problem, you end up in the endless cycle of fixing symptoms instead of causes. 

There's a quote attributed to Einstein: "If I had an hour to save the world, I'd spend the first 55 minutes defining the problem and then the last five minutes coming up with the solution." 

Start with observation—without judgment. Look at what's actually happening in your practice. Don't assume why patients are frustrated or why staff seems stressed. Just observe the facts. 

• How long are patients actually waiting? 
• At what point in the process do delays occur? 
• What do patients say when they're upset? 
• When do staff members look overwhelmed? 
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The best way to get clear about the real problem is by asking "why" repeatedly until you reach a core, solvable issue. 

Example: Let's say you have a patient flow problem. Patients complain about long waits. 

Why are patients waiting so long? Appointments are running behind schedule. 

Why are appointments running behind? Each patient visit takes longer than scheduled. 

Why does each visit take longer? Patients have questions that weren't addressed during intake. 

Why weren't questions addressed during intake? The intake process doesn't identify what patients want to discuss. 

Now you have a solvable problem: How might we improve our intake process to identify patient concerns upfront? 

Through clarification, you might: 

• Add detail and specificity to the hurdle 
• Realize one hurdle is actually several different issues 
• Discover what you thought was the problem isn't the real issue 

We once worked with a clinic that had a problem with no-show patients. Doctors thought the patients were ignoring their appointments and wanted to find a way to send extra reminders. Patients were just frustrated.   

Through observation and clarification, we discovered the real issue was appointment type and length. They had three appointment types in the system, and everyone was booked in one of those three types. The problem was that in reality they had five appointment types and one of those was significantly longer (40 minutes instead of 15). 

A couple of type five appointments threw off the whole day, creating long delays for patients who had to return to work. 

The solution wasn’t reminders, it was aligning the system to reality.

Explore Your Hurdle 

The next step is exploring what you've clarified. Often, the problem you see is just a symptom of something deeper. The goal is understanding the core hurdle and turning it into something you can actually solve. 

Look for patterns in your observations. What trends do you notice? When do problems happen most? Who's involved when things go wrong versus when they go right? 

Consider these questions: 

• What processes are working well? 
• What consistently breaks down? 
• What assumptions might be wrong? 
• What constraints are we operating under? 
• What causes this issue to happen? 

Example: Returning to our patient flow issue, exploration might reveal: 

• Morning appointments run on time, but afternoon appointments fall behind 
• Certain types of visits (like skin cancer screenings) consistently run long 
• New patients take longer than the schedule allows 
• The scheduling system doesn't differentiate between visit types 

End your exploration with "How might we..." questions: 

• How might we build realistic time buffers into our schedule? 
• How might we standardize screening procedures to be more efficient? 
• How might we prepare new patients better before their visit? 

These questions set you up for solution brainstorming. 

Solve Your Hurdle 

Now you answer those "How might we..." questions. Sometimes the solution is obvious. Other times, you need to brainstorm multiple options and evaluate what makes the most sense for your practice. 

For the scheduling hurdle, possible solutions might include: 

• Implement different appointment lengths for different visit types 
• Create a pre-visit questionnaire for new patients 
• Block schedule certain procedures to specific time slots 
• Train staff on more efficient intake procedures 
• Invest in practice management software with better scheduling features 

For patient communication issues, solutions might be: 

• Develop a standard consultation format that includes eye contact 
• Create patient education materials to address common questions 
• Train all providers on patient communication best practices 
• Implement a follow-up system for patient questions 

The key is generating multiple options, then choosing the ones that fit your practice culture, budget, and patient needs. 

Implement the Solution 

Ideas don't fix problems—implementation does. This is where you create a specific, measurable plan with clear ownership and deadlines. 

Make your implementation steps: 

• Specific: Exactly what needs to happen 
• Measurable: How you'll know it's working 
• Achievable: Realistic given your resources 
• Assigned: Someone owns each step 
• Time-bound: Clear deadlines 

Example implementation plan for scheduling improvements: 

Dr. Smith will review current appointment templates and create new time blocks by March 15 

Practice manager will update scheduling software with new appointment types by March 20 

Front desk staff will complete training on new scheduling protocols by March 25 

Team will measure average wait times and patient satisfaction for two weeks starting April 1 

Review results and adjust process by April 15 

Your implementation plan might be much more detailed and live in your practice management system rather than on a simple template. The important thing is moving from "good idea" to "actual change."

 

Why This Works in Your Practice 

The CESI framework works because it forces you to slow down and understand problems before trying to fix them. In busy dermatology practices, there's pressure to implement quick fixes, but those often create new problems or fail to address root causes. 

When you observe without judgment, explore patterns thoughtfully, and implement solutions systematically, you solve problems once instead of repeatedly. Your staff becomes more confident because they understand not just what to do, but why they're doing it. Your patients have better experiences because you've addressed the real issues affecting their care. 

Most importantly, you build a practice culture that tackles challenges strategically rather than reactively. That's how excellent dermatology practices stay excellent as they grow.