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One of Your Clinics is Not Like the Others

Originally published March 31, 2009

One of your clinics is not like the others. It is different. It is better. It is a beacon.

One of your clinics is more profitable than the others. Revenue is higher and so are reimbursement rates. Costs are lower. Receivables are turned faster and claims denials are fewer.

One of your clinics is brighter, cleaner, cheerier and more open than the others. Patients are a little happier to be in a place that cares. Doctors want to practice there, and the clinical and administrative staff want to work there. There is a sense of alacrity and ownership across the board. Few seem to have time for or want to engage in political infighting.

One of your clinics gets better quality scores, both in terms of clinical quality and patient satisfaction. And the never-ending stream of compliance demands doesn’t even make them flinch. Irritating? Yes. Disruptive? No.

One of your clinics is better than the others.

Do you know which one? They do, and knowing this is why they are the best.

Knowing which clinic is best on any of these factors isn’t just nice-to-know information or simply emotionally satisfying. It is important for hard-nosed business reasons as well. Knowing which is best is an extremely efficient means of giving the entire organization a vision and a model of success. Donald Berwick, the patient safety and clinical quality champion, tells us to focus on the leaders, and the followers will follow naturally. This is efficiency.

Maybe the beacon you seek is not a clinic at all, but a particular department in one of your hospitals, or maybe the whole hospital. It might be a medical practice, a nursing home, a retail clinic or a lab or a pharmacy. The principle is the same no matter what type of business unit we are talking about. One of them is different.
For the past decade or so, I have been watching, listening and studying these “outliers” in order to find the methods that the best are using to be the best. It turns out there are a surprisingly small number of tools and techniques that differentiate the beacons. Consider this list and see if they apply to your organization.

Tools that Differentiate

In short, the tools that differentiate are:

Vision (shared or otherwise):

At the top of the list is a vision for what the clinic can be and is actively working to be. It may be trendy to have a “shared” vision, meaning it is bought into by everybody in the organization. This would be great, but people today are hungry for any vision and they will to stick with that vision, even if they don’t completely agree with it.

Having a “shared” vision usually means it is bland. It is typically a compromise or expressed in vague generalizations. For instance, one shared vision might be “to be a resource for the community.” This is a good thing and few would disagree. As a matter of fact, your clinic is already a resource for the community just by existing.

Better to have a sharp, powerful vision that stretches the imagination, even if it is not completely “shared” and everybody is not fully convinced that it will work. One example I have come across is “to be able to predict the exact needs of our patients today, tomorrow and every day.” How would we be able to predict the exact needs of our patients? This will take knowing our patients intimately, knowing their life cycles and the probability of key events that they are likely to face.

And if we know this, how will this affect our organization in terms of staffing, expertise, scheduling, supplies and equipment that we will need, our hours of operation, physical access, and so on? A sharper vision focuses everybody.

Ears:

This may actually be the most important of all tools being used by clinics and other departments to rise above the rest. Listening to patients, staff, physicians and other stakeholders, and writing down what is heard is critical for two reasons. First of all, it increases trust in the person who is expressing the thought, even if it never comes true. And second, it provides a base of improvement ideas for the organization. In his book called What Would Google Do? , Jeff Jarvis tells us that to survive in the emerging economy, we need to engage in the conversation with our customers, not just let our customers converse among themselves about us. We need to ask. And we need to write down what we hear.

Relentless service experimentation:

What do we do with these ideas? We experiment with responses to what we heard. For instance, I have heard about ideas such as drive-through vaccinations at a retail clinic in a grocery store, doctors coming out to the waiting room to escort their patients into the examining rooms and RNs coming out to the waiting rooms to take vitals (with permission from the patient). These may seem far-fetched; but if we had a national emergency or an epidemic, they would be almost expected. Plus, at one time even drive-through pharmacies and clinics and optical centers in grocery stores were seen as strange ideas. Experimentation is essential.

Constant exchange of ideas:

This goes hand in hand with experimentation. The beacons in your organization are inviting a continuous stream of peers from other organizations with expertise to share. And they are speaking at conferences to trade what they know for ideas that they don’t yet fully understand. Lunch-and-learn sessions are common.

Comprehensive event-response planning:

Nearly every medical emergency is covered with color-coded event-response cards. But what about other areas of your operations? The best clinic in your organization has extended this type of thinking and planning to administration, finances, process improvement and virtually every area of their operation. For instance, they know what they would do if revenue was cut in half. Or doubled. They also know how they would handle a dramatic shift in patient base (e.g., older to younger or vice versa). They know in advance what to do if every claim from a particular health plan was denied because they thought about this event ahead of time. Response planning is not just for medical situations, or even just for emergencies. If you want to be the best, you need to plan for emerging situations as well (e.g., the gradual drift in patient base from older to younger, or rural to urban, or insured to uninsured).

Many levels of business intelligence:

With all of these ideas and measures being recorded and experiments being conducted, it is essential to analyze this data to look for trends, patterns, outliers and clusters in the data. This is where business intelligence comes in, giving clinic management the ability to slice, dice, sort and sum the information to evaluate the results of responses to events, of experiments, of imported ideas, etc. Plus, this data provides the ability to respond to compliance demands and helps the organization to find improvement opportunities.

There are at least two levels of business intelligence in use at beacon organizations. The first is information about the clinic and operations within the clinic (i.e., executive information). Information at this level is like grades on a report card and leads us to find out where we are strong and where we are weak.

Another important level of business intelligence is information for the clinic. For instance, this might be statistical data on the patient base for use in patient education. One example I have heard that is pretty powerful is when our family doctor or nurse practitioner can quote a percentage of the clinic’s population with a condition like mine and another statistic on the effectiveness of certain interventions.

Next Steps

One of your clinics is not like the others. One of them is different, better. And that clinic is using just a few, powerful tools to accomplish superior performance. Find out which one is your beacon, analyze their actions and results, and spread the knowledge to the rest of your organization. Then you will have a new challenge. You will have to try to keep up as they will push out to once again be the best.

Thanks for reading!

SOURCE: One of Your Clinics is Not Like the Others

  • Scott WanlessScott Wanless

    Scott is the Healthcare Analytics Director for Cipe Consulting Group. He has more than 30 years of experience in business intelligence strategic planning, analytics application development and business analysis across numerous industries including hospitals, physician groups, healthcare payers, laboratory research, insurance, lending, manufacturing, retail and state government. Scott can be reached at scott.wanless@cipeconsulting.com.

    Editor's note: More healthcare articles, resources, news and events are available in the BeyeNETWORK's Healthcare Channel featuring Scott Wanless and Laura Madsen.

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