Medical Practice Projects Require Staging, Less Physician Involvement

One of the things I like best about doctors is their action orientation. (What does M.D. stand for? Make a decision!) They gather data points, evaluate options, reach a conclusion, and issue instructions very quickly. The pattern is so consistent that I must assume it is a combination of self-selection (indecisive people are not likely to choose to become physicians) and training (rapid synthesis and certainty are de rigueur).

As valuable as this quick decision making must be in the practice of their art, I believe it explains at least some of the difficulty physicians encounter in running the business of their practices. Rather than eating an elephant one bite at a time, there is a tendency not to begin a project unless the whole elephant can be swallowed in one gulp. Open access scheduling is an excellent example.

The difference in the requirements of a traditional scheduling system and those of open access are significant. Successfully making the shift to a completely open schedule requires an examination of every front- and back-office procedure, and making modifications to most of them.

Open access scheduling requires changing physician and staff scheduling, and it is no small feat to accurately anticipate patient demand and schedule practice resources appropriately. Communicating with patients to identify what's important to them and to manage their expectations is critical.

The bottom line is that this is too big a transition to make in one bold leap. Even if the practice can correctly anticipate and plan for all the changes, the implementation is likely to bring the practice to its knees, at least temporarily. In addition, the change is so fundamental that there is no way all of the implications can be fully understood before implementation begins.

The obvious temptation is to maintain the status quo. Don't do it. Not only does open access, to one degree or another, have a lot of appeal for patients, it also has the potential to significantly decrease operating expenses and increase practice productivity.

The trick is to identify the most beneficial, least disruptive ways to begin to move toward open access, and to learn as you go. This approach is not appealing to most physicians. In the first place, in addition to gathering a lot of information about preferences and processes, it requires careful analysis of interactions and the effects of proposed changes.

Good decisions for this type of problem require mulling, rethinking, and refining before implementing changes. For truly action-oriented people, it is torture.

In the second place, even when the first stage of the project has been fully implemented the project is not complete. All of the same steps must be repeated for the various stages.

An additional benefit of approaching the project in stages is that the practice can stop at the end of any stage, either because it is satisfied with the new status quo or because it must focus on something else at the current point in time. This is very different from a single huge project where there are no benefits until everything is done.

The best advice I can offer physicians is to consciously insulate themselves from the process of a major, multi-faceted project. Participate in the high-level decisions regarding objectives, and have someone else do the work of analysis and planning in service of those goals. You should not have to be concerned with the plan until it has been fully developed and cleared by the staff. Then you can do what you do best: Evaluate what is presented and make a decision, which can surely include modifications to the plan.

Most practices do not, and should not, have people on staff with both the skills and time to do the analysis, planning, and implementation of a major change like open access scheduling. That's why God made consultants. They are an additional but temporary and time-bounded expense. A properly drawn contract will be very specific about deliverables so there is no question when the practice has gotten the benefits it contracted for.

A fundamental principle of effective management is to play to each person's strengths and avoid putting him in a situation for which he is not suited. Another principle is to utilize all resources in their highest and best (and most profitable) capacity. Both of these argue for keeping physicians out of the nitty-gritty of operational transformation, and maintaining their function as goal-setter and leader.