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| Dear Friend,
Government, hospitals, and physicians.
That's the subject of this Monday's blog post, Two Wolves and a Lamb. You can follow the link to read the post online, or just keep reading for the rest of the story.
Benjamin Franklin wrote that democracy is like two wolves and a lamb voting on what to have for lunch; liberty is a well armed lamb contesting the vote.
Hospitals and the government believe that the best way to improve the quality of healthcare is to have more collaboration between physicians and hospitals. But, of course, they're not simply talking about working collaboration, they're talking about financial collaboration. And of course, the hospitals want to be in charge of the purse.
So we have our two wolves and we have physicians, the lambs, deciding on the best way to allocate scarce resources.
Of course there's a bit of a jump in logic here and that's because there's no reason why greater collaboration between physicians and hospitals requires economic collaboration at all.
After all, one of the sentinel events in our business lifetimes has been the change brought about by the invention of the microchip and the ensuing technological advances, all of which have served in our economy in general to break down bureaucratic structures due to the increased ability of individuals and small enterprises to compete and for entrepreneurial activity to coordinate across the membranes of separate business organizations as the results of computerization and related technology.
But to believe the government and hospitals, closer financial integration and closer business integration is what is required in order to deliver quality healthcare.
Of course this is a lie, an attractive lie to be sure. What it's really about is power and control.
Physicians should be all for collaboration in terms of patient care, collaboration with other providers and collaboration with facilities.
But hospitals should play a very small role in that they are, to a large extent, dinosaurs of an earlier era in which close physical proximity and bureaucratic structures were required to compete.
If there are to be collaborative care structures, they should be physician-centric, but this will only happen if the lambs are well armed with knowledge and with political organization and expert assistance.
The two wolves have voted to have lamb for lunch. You are on the menu.
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| | | Tuesday - What You Need to Know About Keeping Your Strategy Fresh - Success in Motion
Watch the video here, or just keep reading below for a slightly polished transcript:
Let’s talk today about keeping your strategy fresh.
I spoke with a friend from Colorado (you know who you are!). The discussion was about strategy, our favorite topic, and we’re both big John Boyd buffs.
Boyd was the Air Force fighter pilot who developed the strategy tool called the OODA loop, Observe, Orient, Decide and Act, which he gleaned from his success as a fighter pilot before he became a pure military strategist. That was the system, the strategy, that he used when flying planes in training to get behind the student (the "enemy") to be able to metaphorically shoot him down.
Boyd realized that the same process worked in military strategy in general, and I maintain it works in business strategy as well.
So the object here is to observe what’s going on, observe the environment to orient yourself in terms of where you are and where the target is, and to then make a decision based on that information, and then to act on that decision.
However, it's not just 1, 2, 3, 4, OODA; it’s the notion that it is a loop and that as the loop keeps iterating, you keep gathering more information and acting quicker and quicker. The faster you can move through that loop, the stronger your position is vis-a-vis your enemy, your target, your goal in the business setting.
OOOD involves the concept of maneuverability, the ability to not only go in a direction toward a goal, but to quickly change direction because the goal has changed or moved (which information you’ve gathered from moving through the loop). We see this in business, not just warfare, especially as we see environments change.
For example, in the hospital business, it was once extremely important for hospitals to capture as many primary care physicians as possible to serve as “feeders” into the hospital system. We saw hospital systems grow, almost in hub and spoke fashion, with a figurative “mother hospital” and “children hospitals” out in the community to act as “feeders” back to the mother facility.
But, over time the environment changed.
As a result, we see an increasing number of hospital bankruptcies and of hospital systems merging "to become stronger" (which is a euphemism for survive).
So what does that tell us about your strategy? For example, your strategy as a medical group leader.
It's that when you develop strategy, you can’t just allow that strategy to be your only strategy, your "forever strategy". You must keep observing, orienting, deciding, and acting in order to keep that strategy fresh as the environment changes. Either that or end up with a perfect strategy for a time that no longer exists.
If you want to talk about an analysis of your current strategy, or of ways to go far beyond what the normal notions of what strategies are, get in touch.
See what we can do to help you
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| | Wednesday - Artists, Patient Satisfaction, and the Creation of Something Out of Nothing - Medical Group Minute
Watch the video here, or just keep reading below for a slightly polished transcript: It's Friday night. After leaving the restaurant you turn onto the sidewalk and walk down the street. Ah, an art gallery! You wander inside.
And there you see it on the wall: an original Pablo Kaplunsky! Four slashes of red paint over an inverted crocodile. You've got to have it; it's only $14,000!
The patron who wandered in right behind you is staring at it, too. You hear him exclaim, sotto voce, "What crap!"
They say that beauty is in the eye of the beholder. So, too, is patient satisfaction.
But knowing this means that, first, you have to have a strategy behind satisfying patients and, second, that you have to maximize the touch points (in other words, adopt consistent tactics) that might (because you never know for sure) impact it.
What is satisfaction? How do we measure it? What's the scale? And how, like a sneaky butcher, can we put our finger on it, adding a bit more weight to the pound?
As to strategy, who are you trying to please? Everyone? (Good luck...) A certain type of patient, perhaps one who values your services and pays on time?
As to tactics, they are only of real value if they are synced with your strategy.
Take, for example, the story of Paddy Lund, the dentist from Australia famous for turning his "best practices" dental practice with its normal reception area, high flow of patients, and so on, that all combined returned good dentist-level income and was at the same time driving him crazy, into an incredible boutique practice: No signage, locked entry doors and a whittled down patient list. He kept only those patients who valued his services, who paid on time, and who referred other similar patients. They were was his target audience and he designed a strategy to satisfy them while at the same time satisfying himself.
Lund assigned a permanent "care nurse" to each patient who greets them at the door, serves them tea and a pastry, leads them to a private treatment room, assists with the procedure, presents the bill and collects payment, and then sees the patient on his or her way with a goodbye bag of pastries. Result: Lund works half the time, earns a huge multiple over his prior "high" level, and is, gasp!, happy. And, from all accounts, so too are his patients.
It may well be that because of your specialty, you've got to take all comers -- a primary care clinic affiliated with a university teaching program, for example. But the minimum you can do (and you should do more, far more) is to demand that your staff and the university create an atmosphere designed to exhibit caring and concern and respect to, at least, the standards of nearly all comers. If they refuse, their holding you to meet certain levels of patient satisfaction (as surveyed by them) is a cruel joke.
So, instead of walking into the art gallery you've walked into your physician's office lobby.
No one greets you at the reception window. Rows of mismatched chairs give the impression that the place was decorated with the leftovers after an IKEA sale. There are three or four magazines for the 37 patient seats. A very large computer monitor on a table displays a static screen of text describing some procedure the doctor performs -- the monitor also bears a 4 x 6 sticker, placed askew, warning you not to change the channel.
How does sitting in that lobby for 40 minutes impact patient satisfaction?
What does any of that have to do with the expertise of the medical treatment? Maybe nothing.
But people don't separate the elements of an experience in weighing their levels of satisfaction. It's all related. Understand that and play to it.
It's not actually cheating.
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| | | Listen to the podcast here, or just keep reading for the transcript.
Most medical groups have a two-level physician engagement/compensation structure: owners and non-owners. They also tend to have a ladder to ownership status along which physicians advance to the top rank. In some groups, all it takes is time; unless someone goes off the deep end, his or her partnership status is just a few years away. But it doesn’t have to be this way. In other professional firm settings, practices have outgrown that type of model. Instead, they've adopted multi-level variants. For example: - An initial level of “contract providers,” professionals who are specifically designated as not being on the ladder to ownership.
- Other professionals begin on the ladder as salaried or production-based employees.
- If, and as, they advance through the ranks, their compensation increases. However, inherent in this system is the fact that a significant percentage of individuals will be culled from the ranks.
- Even after advancing on that basis, not all of the senior employees will be invited to become actual owners. Many will be given titles that indicate senior status but which have no, and perhaps no hopes of, ownership interest, for example, the somewhat humorous law firm title “non-equity partner." Non-equity “partners” receive more compensation than other non-owners.
- Last, there are true equity partners or shareholders who in addition to draws or other distributions, whether set up as salary or as production-based payments, are also entitled to a share of the entity's profits.
Just because every other medical group in your community or even your specialty is structured using a two-level model doesn’t mean that you are prohibited from exploring another design. In fact, compensation plans must be matched to a medical group’s culture and to its overall business strategy. An updated compensation plan can be merged with a redesign of your practice’s advancement track and with its strategic goals. Let’s talk about it. |
| | | Calibrate Your Compass
Read our exclusive RedPaper to guide you through this evolving situation.
The coronavirus crisis caused a short-term economic crisis for many medical groups. Our RedPaper shows you the way out. Plus, many of the concepts discussed are applicable during both good times and bad.
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| | Help Us Help You With Helpful Content
What tailored content would you most like to see during this
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| | | | We all hear, and most of us say, that the pace of change in healthcare is quickening. That means that the pace of required decision-making is increasing, too. Unless, that is, you want to take the “default” route. That’s the one is which you let someone else make the decisions that impact you; you’re just along for the ride. Of course, playing a bit part in scripting your own future isn’t the smart route to stardom. But despite your own best intentions, perhaps it’s your medical group’s governance structure that’s holding you back.
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| In fact, it’s very likely that the problem is systemic. The Medical Group Governance Matrix introduces a simple four-quadrant diagnostic tool to help you find out. It then shows you how to use that tool to build your better, more profitable future. Get your free copy Free.
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| | | | Whenever you're ready, here are 4 ways I can help you and your business:
1. Download a copy of The Success Prescription. My book, The Success Prescription provides you with a framework for thinking about your success. Download a copy of The Success Prescription here.
2. Be a guest on “Wisdom. Applied. Podcast.” Although most of my podcasts involve me addressing an important point for your success, I’m always looking for guests who’d like to be interviewed about their personal and professional achievements and the lessons learned. Email me if you’re interested in participating.
3. Book me to speak to your group or organization. I’ve spoken at dozens of medical group, healthcare organization, university-sponsored, and private events on many topics such as The Impending Death of Hospitals, the strategic use of OIG Advisory Opinions, medical group governance, and succeeding at negotiations. For more information about a custom presentation for you, drop us a line.
4. If You’re Not Yet a Client, Engage Me to Represent You. If you’re interested in increasing your profit and managing your risk of loss, email me to connect directly. |
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