Saturday, March 29, 2008

The Physician Success Strategies Conference: What Can Doctors Learn From Consultants?

Many doctors, in their daily practice, have the nagging suspicion that there must be a better way to do things.

The blog focuses on strategies and ideas that doctors can use to stay organized, increase productivity, and take better care of patients. Many of my colleagues and I have experienced our desks disappearing under a pile of papers and charts, suddenly realizing that we’re an hour and a half behind schedule in the office, or finishing our workday to discover that we still have a stack of urgent messages that need answering. And physicians, almost universally, have been forced to see more patients, more quickly, yet are reimbursed less for their efforts.

Plenty of patients have the same feeling — that there must be a better way of doing things. They feel this when they're been trapped in a waiting room for over an hour. Or when they’re unable to reach their physician on the phone. Or when they’re rushed through a 10 minute visit without expressing the real reason they came to the doctor in the first place.

Just as doctors devote their careers to caring for patients, other professionals devote their careers to improving the productivity of individuals and organizations. I’ve highlighted some of them previously — like David Allen, author of Getting Things Done, and Marshall Zaslove, author of The Successful Physician. For doctors, there’s an entire landscape of consulting organizations that offer to improve the practice of medicine. In my initial review of consulting groups for this blog, one organization that stood out is the International Council for Quality Care (ICQC). Headed by Greg Korneluk, a healthcare consultant with 30 years experience, ICQC offers an impressively thorough approach to analyzing and improving medical practices. ICQC provides detailed physician benchmarking, clinical practice redesign, staff education, and conferences on improving performance. These services are aimed at both small practices and large organizations, at practices that accept insurance as well as “concierge” or “boutique” practices.

I was curious about what consulting services like ICQC might have to offer physicians. So last week, I accepted an invitation to write about a two-day conference hosted by ICQC called “Physician Success Strategies.” And let me be frank: I usually dislike conferences. As I listen to lectures, these are the questions in my mind: “Why am I here? Is this a good use of my time? Why couldn’t I get this information from a podcast, journal, or book?” As this was the first conference of its kind that I’d attended, I was admittedly skeptical: we’re in the trenches with patients every day, shouldn’t we be able to solve our own practice problems? What can physicians actually learn from consultants?

Quite a lot, it turns out. I left the conference with a notebook filled with ideas and the sense that this was definitely time well spent.

The Physicians Success Strategies conference is held monthly at the Boca Raton Resort and Club, a vast tourist destination and meeting-place in southern Florida. The 20 person group who attended included doctors, nurse practitioners, office managers, pharmacists, and the CFO and CEOs of medical systems. They came from all over the United States. Some had attended multiple times. In the words of one physician I spoke with, “I learn new things every time I’m here.”

And these professionals have real problems with their practices. Some of the multi-provider groups were receiving more than 100 phone messages from patients per hour. And some doctors who attended saw more than 50 - 60 patients a day.

Brita Hess, the president of ICQC, highlighted the problem of information overload in an initial presentation. One of the most striking diagrams of the day — and there were many — was an animation of the flow of people, objects, and information in a typical doctor’s office. Streaks of lines representing the movement of charts, messages, and doctors obscured the screen in a tangle of intersections. Most physician’s offices, it made you realize, were organizational disasters.

Greg Korneluk, ICQC’s founder and the main speaker, asked the audience a simple question: “What’s preventing you from having a perfect day?”

As they brainstormed, Greg sketched a mindmap of the answers. “Patients think my office is a factory.” “I’m not getting my phone calls.” “Patients wait for too long.” “I have to see too many patients in too little time.” “I’m not reimbursed enough.” “I don’t have time to actually listen to patients.”

Faced with the pressure of declining reimbursement on the bottom line, many practices would sacrifice quality of care to reduce costs. ICQC advises a different and perhaps controversial approach: increase the quality of care, and the bottom line will follow. Throughout the conference, videos were played of doctors who’ve successfully followed this model of putting quality first.

ICQC advocates a 360-degree approach to analyzing and improving the quality of care, encapsulated in the mnemonic “CARES+”:
Core Service: Quality Improvement, Clinical Documentation, Patient Education, Outcomes Management, Interpersonal Impact
Access: Facilities & Technology, Records Management, Patient Flow, Time Management, Scheduling Systems
Representation: Practice Positioning, Marketing & Public Relations, Ambiance & Decor, Patient Relations, Collegial Relations
Economics: Optimal Utilization, Third Party Payments, Collections Management, Overhead Management, Financial Controls
Staff & Support: Organizational Structure, Personal Policies, Performance Reviews, Hiring & maintenance, Productive Morale
Attitude+: Pride in Profession, Taking Responsibility, Positive Expectations, Clear Vision, Action Orientation
Each of the obstacles to a “perfect day” were positioned in the CARES+ theoretical framework, and using this model, Greg Korneluk provided advice to solving problems commonly encountered in clinical practice. Some of the many strategies discussed in the two-day conference included organizing office staff into care teams, identifying and opening up bottlenecks in practice, strategies for complete documentation, optimal strategies for scheduling patients, and how to choreograph the ideal patient visit. The level of granularity was impressive. The discussion on patient interactions, for example, even included advice on how to knock, how to shake hands, and the importance of the right facial expressions.

ICQC’s ideas are widely applicable to different types of practices. Parts of the presentation were geared specifically towards “concierge” practices — where patients pay out of pocket for services and typically insurance is not accepted. But more broadly, ICQC focuses on the idea of adding value to medical practices, whether or not they fit the “concierge” model. If there are certain services that patients want — improved access to their physicians, specific procedures, or amenities — patient are willing to pay more. The final presentation outlined strategies for marketing and providing these “value-added” services to patients.

I surveyed the doctors at the concluding lunch. Their consensus was that the conference left them with a wealth of new strategies and ideas to improve their medical practices. And I agreed with them. While conferences like Physician Success Strategies are not for everyone, I believe that a majority of physicians would benefit from this kind of intensive focus on new ways of improving efficiency, productivity, and the quality of patient care.

For more information on the International Council for Quality Care, please see www.bestpractice.com and “Physician Success Secrets” by Greg Korneluk.

2 comments:

Novi said...

A specific consultant service I have been assigned as a project by my group is practice marketing. You mentioned this briefly in the post--was this topic addressed during your conference to any great extent?

You have created a valuable resource with your blog for us docs who are GTD fans. Thanks.

Joshua Schwimmer, MD, FACP, FASN said...

Thanks. They briefly touched upon marketing at the conference. The best book I've read on the subject is "Marketing Your Clinical Practice."

Thanks for the kind words. Please email me at efficientmd@gmail.com -- I'm interested in speaking with other physicians who use GTD.