As a young business management student, I was intrigued by the research of Frank and Lillian Gilbreth, two early industrial engineers. I enjoyed reading about their efforts to help employees accomplish work faster and easier, which benefited the employers and the employees. They broke processes into their smallest component parts (which they named “therbligs” – Gilbreth spelled backward) and analyzed the need, role, timing and position of each therblig in the process. They experimented with each process, diligently measuring the outcomes, in pursuit of the “one best way” to accomplish each task and the process as a whole. The concept of improving methods to find “the one best way” to accomplish a process seemed to fit my personality and my view of the world. The search for and application of correct principles, processes and practices, as demonstrated by measurable outcomes, seemed like a rewarding pursuit – benefiting organizations, their employees, and those they serve. Such has proven to be the case.
Employee turnover is costly – especially when that employee is your senior medical practice group executive. There are the direct costs of recruiting someone new. There are also the fairly well-documented indirect costs including lost organizational history and experience, lost relationships, lost investment in training, and the lost productivity that accompanies organizational change. Even more significant is the strategic disruption that will occur if a new executive comes into the organization with his or her own strategy, based on past successes in other settings. So often, we have witnessed a change in strategic direction in a medical practice group with a perfectly sound strategy simply because “there’s a new sheriff in town.” There are times when infusing a medical practice with “new blood” and a fresh perspective can be valuable. Nevertheless, change for the sake of change can damage physician trust and engagement, dampen productivity, increase costs, and lead to further turnover.
This post originally appeared on the MedCity News website on December 6, 2015.
On a recent assignment, we encountered a hospital client who had built up a bureaucratic maze of medical directors and executives tasked with steering both the business and clinical sides of the hospital’s owned medical practice network. Unfortunately, rather than facilitating smooth operations, the additional layers of management slowed the decision-making process, created confusion for providers and support staff, and produced inconsistent operating performance from clinic to clinic.
At the client’s request, we provided training on operational governance and introduced our council model to the physician network. As they began to implement our training, the physicians and other providers became engaged as peers and as partners, providing the positive peer pressure and clinical direction necessary for day-to-day operations within each individual practice and across the entire medical group.
In implementing this new system of operational governance, our hospital client noted that many of their traditional medical director roles had become superfluous. As a consequence, they asked for our help in creating a streamlined and effective implementation management infrastructure that would support the new operational governance model and perhaps even allow for the elimination of these unnecessary director roles.
Such a request is not uncommon; we have interim managers out in the field who are seeing similar situations on a regular basis. What we’ve learned from being on the ground is that, as we mentioned in the previous article, hospital-owned physician networks can benefit greatly from studying successful independent practices and applying what they learn to their own infrastructure.
Let’s take a look at some of the principles of management that work well for independent practices and examine how those principles can apply in a medical practice network setting.
In Part I of our post on engaging employed physicians in your hospital's success, we discussed engaging with physicians as business partners. In this post, we explore a successful model for decision-making, performance improvement and accountability.
A few years ago, a client engaged us to conduct an evaluation of their multi-specialty, multi-site group practice, which was organized as an integrated component of a local health system. This multi-site network suffered from high physician turnover and annual financial losses in the millions. As we began to delve into the everyday workings of the practices, we found that the physician CEO who managed this network had an autocratic leadership style, and the providers had little input into decisions that affected their daily lives. The practice management team gave inadequate attention to clinical or service quality. Performance expectations were unclear. Provider productivity varied dramatically, and no one was held accountable for performance improvement. As a consequence, the individual providers felt no concern for practice or enterprise performance.
We’d seen this scenario many times, and we quickly zeroed in on the fact that the providers’ indifference to the success of the organization was hindering performance improvement for the entire network.
In fact, this lack of physician engagement had become one of the most critical barriers keeping the practices from reaching individual, network, and organizational goals.