4 Features of an Outstanding Clinic

Helping in new clinical settings over the past year, I find these core features in great clinics and hospital departments.

Outstanding clinics:

1. Remember Their Core Motivation

Most of us run from task to task without asking why. At some point, we chose to do what we are doing right now. Even with years of training, people don’t have to keep providing patient care; they could look elsewhere.

People need help to remember why they do what they do, and why they work in a particular place.

Most people who work in healthcare applied from a desire to help people. They looked for specific jobs that allowed them to help and serve patients.

Outstanding clinical groups never forget that serving patients comes before anything else.

2. Support Their Core Business

Especially in large groups, staff might think the clinic or hospital pays them. In a sense, that’s true, but also very wrong. Every business gets paid for doing something.

Although revenue flows through the clinic before it gets to the staff, employees must know that the clinic stays open if physicians see patients. Anything that slows, or stops physicians seeing patients results in poor patient service and less revenue.

Great clinics keep physicians working at what physicians do best: seeing patients.

3. Think About Governance

Governance refers to how organizations are governed and controlled, how decisions get made, and how decision-making units fit together. A solo physician deals with everything, or delegates to an office manager.

Problems arise as clinics grow. At some point, groups need to think about a formal, simple governance structure. Communication, authority, and accountability must flow in a line through the structure. If structure gets ignored and leaders start talking like customers expecting to be heard like owners, chaos ensues. (Check out: The Imperfect Board Member)

High performing clinics have an explicit governance structure that everyone follows.

4. Manage Performance

Once everyone remembers why they are there, knows how the clinic earns income, and understands how decisions are made, staff needs support to perform well. With clear expectations, most staff members excel; some do not. Even in a small group, staff needs performance reviews, incentives to improve, rewards for excellence, and follow-up on underperformance.

Outstanding clinics measure performance using explicit criteria supported by everyone. When members do not perform well after attempts to help them change, great clinics help low performers find work elsewhere.

Final Thought

Oppressive workplaces leave you emotionally exhausted at the end of a day, fill you with dread at going to work, and require you to tiptoe around icy colleagues. Dennis Bakke wrote bestseller Joy at Work suggesting that we embrace human values as ends in themselves, not just means to business ends.

Outstanding clinics foster uplifting, healing work environments.

How to Fix Medicare: If Publicly Funded, Then Privately Run

Parents guilt children into eating vegetables with, “You should be happy; kids starve in Africa!”

Canadians guilt patients into accepting long waits and no care options with, “You should be happy; medical bills bankrupt Americans!”

Indeed, we should always be grateful. Looking for better ways to do things doesn’t imply ingratitude. It demonstrates commitment to excellence.

Designed to Fail

Great organizations meet customer needs. Great companies offer outstanding products and service at a competitive price… and treat their employees well. In these companies, CEOs support management to help staff serve customers.

Medicare does the opposite; it serves system needs and sees patients as cost centres. In publicly run organizations, CEOs support management to help staff spend as little as possible by providing good enough care to avoid revolution.

Politicians and their bureaucrats create regulations and controls that leave administrators and front-line professionals little room to innovate, or incentive to do so.

Good People

Politicians and bureaucrats are good people. They get loads of criticism no matter what they do well. I’m thankful that quality people still run for office and work in political bureaucracy.

Politicians and bureaucrats are intelligent individuals caught in a poorly designed system with perverse incentives.

Motivation

If we consider a businesswoman operating her own store, she must keep customers happy with great service, selection, and quality, or she will go under. No matter how well she manages everything that goes into running a store, if she stops valuing customers she will shut down.

If our businesswoman worked for Medicare, her most important job would be to keep her superiors happy. More than anything else, she must manage those above her. If she does not, she risks her position and hopes for promotion. This is true for every level of Medicare, from front-line providers up through every level of manager and bureaucrat.

Job security motivates administrators; they have to keep bureaucrats happy.

Job security also motivates bureaucrats; they have to keep politicians happy.

Elections motivate politicians. They have to keep voters happy. Voters respond to marketing and handouts, not tough decisions that might disrupt the status quo. Better to make no decisions than to risk making a poor one that will upset voters.

When politicians, and by proxy, bureaucrats, control Medicare, the focus becomes staying in office – winning elections, keeping their jobs – not serving customers.

Inefficient

We do not need more money; we need less regulation. (See How to Fix Healthcare: Let Leaders Lead) For the same cost, government corporations that go private produce 47% more, and are 27% more efficient, than privately run corps. (Download Fraser Institute 2009 report)

We need to let professional care providers figure out creative ways to meet patients’ needs at a local level.

We need to unleash the creative energies of individual nurses, physicians, and allied care providers. We need to support them and reward them for creative ideas that improve patient service and efficiency.

Our Own Fault

Until we redesign the system so that good people – politicians, bureaucrats, and administrators – get free of having to pursue perverse results, we will never have a great healthcare system.

If system leaders aim for anything before great patient service and outcomes, we will never improve things; we will always suffer from a system governed to produce job security.

Let’s put patients – service, results, and quality – back in the spotlight. Let’s stop thinking about elections, job security, or anything else, before patients.

Photo credit: www.gomomentum.com

Doctors, Incomes, and Fancy Cars

People look at the cars in the doctors’ parking lot to estimate MD income. Most folks still think that doctors are loaded, and doctors generally like to be thought of as rich.

This post looks at physician income, motivation, and public myths about what doctors get paid.

In a private medical system, if doctors don’t drive a Lexus or better, they must not be a good doctor.

In a publicly funded system, doctors should drive a Honda, otherwise we pay them too much!

Physician Income:

1. Physicians who work more, earn more.

Most MDs do not receive a salary; they increase their earning by working longer hours. Like any self-employed business person in a market that needs your services, time and energy are the only limits to earning. No matter what you earn per hour, if you work 100 hour weeks, you will earn $$$$, too.

2. Physician income does not equal take-home pay.

Most physicians hire staff, pay rent, lease equipment, and carry dozens of other expenses related to running a small business that eat up 35% of gross billings.

3. Physicians do not receive benefits.

MDs pay for their own pension, medical, dental, vacation, etc. Benefits typically cost 25% of income.

4. Physicians earn less than other professionals.

With similar training and experience (or much less), professionals in other industries (law, dentistry, finance) earn more.

5. Physicians don’t own all their bling.

Physicians aren’t known for financial prudence or frugal living. Fancy cars are often leased: one more payment to a stack of debt.

Physician Motivation:

1. Delayed gratification.

After 12-15 years of University, many physicians think they’ve earned the right to spend. After watching friends in other professions buy houses and raise families, physicians think they’ve earned the right to go deeper into debt with a fancy car.

2. Societal expectation.

Despite begrudging envy, non-physicians expect doctors to spend. They look askance if MDs drive up in an old vehicle. People need to see extravagance, any extravagance, to justify their firm conviction that physicians are loaded.

3. Peer pressure.

Very few docs resist dressing, spending, and living like their colleagues.

Summary

Physicians do very well and work very hard for it. Anyone who trains for years and works hard can do as well, or better, in North America. What’s holding you back?

(photo credit: asianweek.com)