Using SOAP Notes for Business Problems

Every business, including a medical practice, regularly encounters challenges.  Enterprise survival requires solving critical problems.  Profitability and job satisfaction require effective solutions, defined and implemented efficiently.  Physicians can improve the quality of business-problem solutions by applying a model that serves them well in the clinical part of their practice:  A SOAP note.

The SOAP Note as a Model

SOAP notes are second nature to current practitioners and their staffs. Utilizing the format in non-clinical diagnoses requires learning no new techniques and leverages the thinking process already understood and employed.

A SOAP note can cover all the elements of standard business problem solving:  Identification (Subjective), Data Collection (Objective), Analysis (Assessment), and Plan.

In a clinical setting, the SOAP note seldom proceeds from S to P without some jumping around.  That experience gives a valuable insight into business problem solving.  While the novice (and most EHRs) want to believe the process is linear, the truth is that some jumping around between steps is almost inevitable.

Subjective

How is the problem being experienced?  What are the symptoms?  As with evaluating a patient, there is no requirement at this point to know why revenues are down, staff turnover is up, or patients are complaining. You simply need to clearly describe the sub-optimal situation.

Objective

This is the step for gathering data, both objective and subjective.

Why is income down?  Are billings down?  If so, are fewer patients being seen?  If not, which delinquencies or write-downs are growing?  All of this data is objective and can be retrieved from financial and activity records.

Why are patients complaining more?  Do they not understand that they have more financial responsibility?  Are they frustrated that the office schedule is unreliable or inconvenient?  This data is subjective and is best gathered in interviews.  If the practice is reluctant to ask patients directly, the front-office staff can be an excellent proxy.  Physicians rarely have good insight into the reason for disgruntled patients.

Assessment

It takes analysis or assessment to turn data into actionable information. This element of the process tends to be a linear series of questions and their answers.

What is the fundamental cause of the problem?

In business, as in medicine, this is the most important question to ask and to answer correctly.  Developing a solution for the wrong problem can do more harm than good.

Is the problem time-limited?

If a drop in income has come from fewer physician hours in the office and it corresponds to a maternity leave that is about to end, that resource issue will resolve itself with time.

Is the problem systemic or random variation?

This is an especially important distinction to make when dealing with unhappy patients.  If one patient in a hundred complains about the examining room gowns, her complaint must be addressed respectfully but there is no need to start a search for a more palatable alternative.

If sixty patients complain, the problem is systemic and needs a more complex solution than an apology.

What are potential solutions to a systemic problem?

Any potential solution deserves to be listed.  This is not the time to eliminate options out of concern that they will be too expensive or complicated.  There is not enough information at this point to reliably estimate expense or complexity.

What is the highest value option?

Value is the ratio between benefit and cost, and cost is the total cost of ownership and use.  Something that costs little but fails often is never a good option.  Something that costs a lot but makes staff more productive can be a very good option.

What is the lowest risk option?

There are many different kinds of risk.  Financial is only one.  Time to implement is a risk, as are reputation and patient satisfaction.

Which option offers the best combination of value and risk?

This is almost always a subjective decision and it is a mistake to force it based upon objective data.

Plan

This will look like any treatment plan, although there will be more interim checkpoints and deadlines.

• Identify the steps necessary to move from the status quo to the desired outcome.
• Construct a timeline.
• Due date
• Measure of successful completion
• Responsible party
• Monitor progress.
• Modify plan as necessary.

Using a proven methodology which the practice understands and trusts is a better way to approach non-clinical challenges that adopting a B-school protocol that is unfamiliar.