Doctor is Complaining to his Staff

Stress can be both good and bad for your individual well-being: it can be that extra shot of adrenaline that helps you give a great presentation or win a race, or it can be the unhelpful, grinding pressure that can undermine your mental and physical health.

Organizations also collectively experience different types of stress — the good kind that enhances performance, and the bad kind that insidiously undermines it.

Start-up teams understand the good kind of stress.  The pressure to perform is intense when you’re putting your career on the line to create something that previously didn’t exist.  But, when you’re working without a net, all progress is exhilarating, and the pursuit of a singular, world-changing vision is an intense bonding experience for team members. Leadership expert Jim Collins coined the term BHAG (‘bee-hag’)  — ‘Big, Hairy, Audacious Goal’ — for the type of driving mission that allows some organizations to thrive — and excel far beyond expectations — under exceptional stress.

Established medical practices, unfortunately, often experience the detrimental kind of organizational stress — the kind that undermines performance and becomes contagious throughout the practice team.  And, far too often, this stress is self-inflicted — caused by organizational decisions and policies that make the fast-paced management of a practice harder than it needs to be.

A key culprit: unnecessary variability in processes and policies.  When a practice aims for flexibility in all ways this can severely and needlessly tax the systems that keep patients flowing through to their doctors.  Does your practice allow rules like payment terms or cancellation fees to apply on a case-by-case basis?  When staff have to seek out a physician to decide how to handle simple administrative issues, patients are kept waiting, the schedule falls behind, the operation experiences more stress, and productivity suffers. Does your practice allow every doctor to set his own policies for basics like scheduling, patient reminders, past-due collections or standard fees?  Failure to standardize — and enforce — practice policies makes everything much harder (and more costly) than it has to be.

Practices may aim for maximum flexibility because they believe they’re offering better service.  But, often they don’t really even know patients’ preferences before deciding that flexibility is the most important goal.  The decision to place flexibility above all involves some suspect assumptions: for example, that patients prefer more flexibility in every respect to less waiting in the reception area, or that patients prefer more flexibility to more timely access to appointments.  Odds are, patients would give up the option to, say, decide whether to pay their copay or be billed, or to walk in any time for a vaccine instead of during a set day/time, if it meant better access and more punctual appointments.

Similarly, practices may offer physicians flexibility without considering the trade-offs.  It’s common to consider staff costs as fixed, and therefore worry less about how people are utilized.  But, more variability means stress to the overall practice operation — and less throughput.  Lower productivity means fewer patients seen, and less income — a trade-off many physicians might reject if they were aware of the hidden choices inherent in practice policies.  Lower productivity may also mean — ironically — less satisfying patient service, as scheduling becomes less predictable and unforeseen delays in the practice more common.  This reflects poorly on individual physicians as well as the practice as a whole.  Of course, the stress on the organization also eventually stresses staff, too — and that can lead to lower morale and turnover, and higher costs.

So, is all flexibility detrimental?  No — but, it’s critical to fully consider the downsides of increasing variability in one area of your practice and not just look at the upside that some patients or physicians will gain when the practice allows more customization on-the-fly.  Often, the gains are severely outweighed by the costs.

(Image credit: © andrewgenn – Fotolia.com)

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