Since when has a solution to one of our most difficult challenges been as simple as a trip to Wal-Mart? Ask and I will tell you a fascinating story about the Patient Communication Board and how it improved the customer service comments and made the concept of informing patients a teamwork process.
The problem we were facing was not new to ED or the culture of medicine. Our patient satisfaction was great except our survey tool highlighted that our patients felt uninformed and that the physicians and nurse didn’t spend enough time in the room. We decided to put a dry erase board and a marker in each of our patient rooms and call the process a “Patient Communication Board”. Each shift the nurse who has been assigned that room writes his or her name and the physicians name on the board. Throughout the course of the visit, the patient is updated by writing information about pending lab studies, test results, expected time of admission or disposition. This process takes about an extra 3-5 minutes of nursing, doctor or ED tech time. The cost of a board and markers is about eleven dollars per room.
The initial ED physician and nurse complaint phase about the new process lasted several months. We continued to stress a culture change around the importance of patient communication. After the process became second nature, we found that our patients were writing in the survey comment section that they felt they understood their diagnosis and the physicians and nurses were working together to keep them in the loop. Our surveys were being returned with compliments that identified the physician and nurse. This allowed us to reward specific individuals for their exceptional patient care.
Another unexpected benefit was a decrease in communication stress between the physicians and nurses. The updated Patient Communication board allows our doctor to walk into the room get information without having to locate the chart or the nurse. This increased foot traffic into the patient’s room improved the patient’s sense of well being. Overall this program was a success for our staff and the patients.
Low cost problem solving, culture change, and better patient care can start during a simple trip to Wal-Mart!
Wednesday, February 6, 2008
Monday, February 4, 2008
Physicians Practice Articles : Should You Outsource?
An interesting article about outsourcing by Physicians Practice-
Should You Outsource?
Getting Help Out of HouseBy Gregory Mertz
Few family physicians would argue that managing the business of medicine is more challenging now than ever before. Practice revenue is flat, or in some markets, declining; practice expenses, such as staff salaries and malpractice premiums, continue to grow; and the burden of government regulations, such as HIPAA, CLIA, and OSHA, are more onerous than ever.
Most physicians have a team of trusted advisers, such as an attorney, an accountant, and an investment counselor, who regularly assist them with personal and business issues. Yet when it comes to running the day-to-day aspects of their medical practices, physicians depend heavily on their own skills to make key decisions. But increasing business demands may well exceed the desire, available time, or the ability of many physicians in their part-time role as owner/manager of their practice, even with the assistance of an office manager or administrator.
To respond to this gap, more practices are electing to contract for management services with outside organizations, such as management services organizations (MSOs) and local consulting firms. How can you decide if such an arrangement can benefit your practice?
What to outsource
Contracting for management and support services is not a new concept for the healthcare industry; hospitals have been doing it for years, for services that range from placement of the CEO to food service and janitorial management. Medical practices now have a growing menu of service options as well.
Not all practices can benefit from outsourcing, and not all services need to be outsourced. The first step is to decide what aspects of your practice, if any, are good candidates for outsourcing. The services mentioned below are not the only ones available for outsourcing, but they are the most common for physician practices. Use the following questions to help focus your thinking. If you answer "yes" to most of the questions, it will be worth considering outsourcing.
Billing• Is your overall collection rate declining? • Are your accounts receivable (A/R) too high?• Are you experiencing an increased number of denied claims?• Are you facing a major investment in new hardware or software?• Are you finding that the number of staff needed to get the job done is growing?• Is turnover requiring too much time and attention?
Payroll• Are you concerned that payroll information will be shared with staff members who don't need to know? • Are you unable or unwilling to spend the time, or add the staff, to manage payroll internally?• Are you routinely paying penalties associated with late tax deposits or periodic reports?• Would you like to have access to more advanced payroll services, such as direct deposit?
Management• Are you unable to find the right person to help manage the business?• Do practice demands keep you from monitoring your manager's performance?• Do you have the sense that the staff is running the practice - not you?• Do you periodically need access to higher level advice than your current management can provide?• Are you planning to expand or contract the practice?• Do you have multiple people performing tasks that could be handled by a single, more experienced manager?• Do you feel that your practice's cost structure is too high, but you can't determine what to do to resolve those concerns?
Information technology (IT)• Have your data needs exceeded your capabilities?• Are you unaware of solutions that may improve practice performance?• Are the growing costs and hassles associated with routine upgrades a growing concern?• Are hardware problems causing disruption in practice operations?
How outsourced services work
Once you have decided to outsource part of your business, it's important to find the best possible contract. Costs and terms vary widely based on what you want done, but here are some general guidelines.
Billing — While some billing firms provide a "one-size-fits-all" approach, many are offering options that allow practice staff to perform some of the tasks and permit physicians to access data and reports online. This flexibility can be an important feature for more sophisticated practices.
Most billing service companies charge a percentage of the funds that they collect on behalf of the client practice. Fees are affected by the size of each claim, the number of monthly claims, the scope of tasks provided, and the payer mix.
Be sure to talk about performance standards in your contract with a billing service. Fees should be tied to collection percentages and days in accounts receivable. Processing electronic claims or providing patient statements may cost more. Some firms may offer additional services such as coding education, or provide you with access to their software for appointments and reporting.
Payroll — Many firms provide routine payroll services that include generating paychecks, direct deposit, preparing routine payroll tax filings, and annual employee statements (W-2s and 1099s). Many now accept direct downloads from practice accounting systems such as Peachtree, QuickBooks, and others.
Larger practices can also get time clocks that are directly integrated with the payroll system.
For smaller practices, outsourcing payroll can help you address privacy concerns. You don't want staff members to know what others (or the physicians) earn. It usually costs more to outsource payroll than to handle it internally, but the hassle factor is lower. Pricing typically includes a minimum charge per payroll plus a per-check fee. Direct deposit options add to the cost. Generally, the vendor automatically transfers money from the practice's checking account to cover the payroll, tax deposits, and vendor fees.
General management — You can select any number of management options, from a monthly visit from an experienced practice management professional to a full-time on-site manager who is actually on the payroll of a management firm. Fees are typically tied to some form of cost-plus approach using the salary of the manager as the base for the computation. If you already employ a manager, but need support from someone more experienced, consider a monthly retainer that would include a minimum number of hours of support.
Outsourcing practice management can also provide your practice with access to specialized professionals such as certified professional coders and billing experts.
If you decide to outsource these services, be sure to check references to find out if client financial performance improved as a result of their efforts and if the advice the clients received was beneficial and realistic.
Information technology — If you don't want the headache or capital costs of buying and maintaining new software systems, a growing number of practices are turning to application service providers (ASPs). These vendors charge a monthly access fee, typically tied to the number of users, which allows the practice to use the software via the Internet. The vendor maintains the database and the typical tasks, such as server maintenance and daily backups, are no longer your practice's to handle. You'll still need someone on staff, however, to keep your tablet PCs, laptops, wireless network, and other practice-owned equipment running smoothly.
Outsourcing IT may seem more attractive as the deadline for compliance with the HIPAA security rule approaches in April 2005. The rule requires system backup and disaster recovery, password protection, and encryption.
Apart from ASPs, practices also are using IT consultants on an hourly or retainer basis. Some vendors sell time blocks, which include prepaid hours of effort. While the cost per hour decreases with the size of the block, be sure not to overbuy.
Making a decision
The critical points that must be considered in making the decision between internal and outsourced are price, accountability, and flexibility.
Are you willing to pay more for better results? For example, the practice might be spending 5 percent of its revenue on its billing operation, but its collection rate may be 4 percent below what is typical for the specialty. Spending a few more dollars on a billing service may result in far more revenue. Typically, any outsourced service will cost you as much, if not more, than it would if handled internally. You need to see enhanced performance or cost savings to make it worthwhile.
When evaluating price quotes from various vendors, practices can use data published by the Medical Group Management Association (MGMA), that indicate the cost for various practice operations on a dollars-per-physician basis. You should be able to duplicate the service internally for the amount shown on the MGMA report. The Cost Survey: 2003 Report Based on 2002 Data can be ordered directly from MGMA.
In addition to making sure you get a fair price, you'll want to make sure that you get what you pay for. Some questions to ask vendors include: • What information will be provided to the practice leadership? • What assurances will the vendor offer related to performance, and what standards will they use as a measure? • What termination options are available if performance is not as expected?• Will the vendor modify their service to match the way that the physicians want their practice to operate?• How frequently will your practice have access to senior consultants or managers?
Identifying vendors
You can find potential partners by asking other physicians whom they use. Also try an Internet search, your professional society (many have a screening program for vendors, such as FP Assist, sponsored by the American Academy of Family Physicians), or firms that you encounter as exhibitors at professional meetings. Often medical supply, pharmaceutical, or banking representatives, your attorney or accountant could be excellent resources for recommendations.
Some services require knowledge of your specialty; others are generic to medical practices. A billing company should have a list of practices in your specialty that have used their service; management firms can be more general but should have experience with practices of your size and understand your budgetary constraints.
Keep in mind that the decision to outsource aspects of practice operations is not final. Evaluate vendor performance, and if you're convinced that you could do better, you can always elect to bring the services back in-house. Be sure, however, that you have had a frank discussion with your vendor about your concerns before terminating a relationship. Frequently, problems are a result of incomplete information. You're busy, and once you outsource tasks, you may pay less attention to operational details — but in the long run, it is still your practice.
Greg Mertz can be reached at editor@physicianspractice.com.
This article originally appeared in the November/December 2003 issue of Physicians Practice.
Should You Outsource?
Getting Help Out of HouseBy Gregory Mertz
Few family physicians would argue that managing the business of medicine is more challenging now than ever before. Practice revenue is flat, or in some markets, declining; practice expenses, such as staff salaries and malpractice premiums, continue to grow; and the burden of government regulations, such as HIPAA, CLIA, and OSHA, are more onerous than ever.
Most physicians have a team of trusted advisers, such as an attorney, an accountant, and an investment counselor, who regularly assist them with personal and business issues. Yet when it comes to running the day-to-day aspects of their medical practices, physicians depend heavily on their own skills to make key decisions. But increasing business demands may well exceed the desire, available time, or the ability of many physicians in their part-time role as owner/manager of their practice, even with the assistance of an office manager or administrator.
To respond to this gap, more practices are electing to contract for management services with outside organizations, such as management services organizations (MSOs) and local consulting firms. How can you decide if such an arrangement can benefit your practice?
What to outsource
Contracting for management and support services is not a new concept for the healthcare industry; hospitals have been doing it for years, for services that range from placement of the CEO to food service and janitorial management. Medical practices now have a growing menu of service options as well.
Not all practices can benefit from outsourcing, and not all services need to be outsourced. The first step is to decide what aspects of your practice, if any, are good candidates for outsourcing. The services mentioned below are not the only ones available for outsourcing, but they are the most common for physician practices. Use the following questions to help focus your thinking. If you answer "yes" to most of the questions, it will be worth considering outsourcing.
Billing• Is your overall collection rate declining? • Are your accounts receivable (A/R) too high?• Are you experiencing an increased number of denied claims?• Are you facing a major investment in new hardware or software?• Are you finding that the number of staff needed to get the job done is growing?• Is turnover requiring too much time and attention?
Payroll• Are you concerned that payroll information will be shared with staff members who don't need to know? • Are you unable or unwilling to spend the time, or add the staff, to manage payroll internally?• Are you routinely paying penalties associated with late tax deposits or periodic reports?• Would you like to have access to more advanced payroll services, such as direct deposit?
Management• Are you unable to find the right person to help manage the business?• Do practice demands keep you from monitoring your manager's performance?• Do you have the sense that the staff is running the practice - not you?• Do you periodically need access to higher level advice than your current management can provide?• Are you planning to expand or contract the practice?• Do you have multiple people performing tasks that could be handled by a single, more experienced manager?• Do you feel that your practice's cost structure is too high, but you can't determine what to do to resolve those concerns?
Information technology (IT)• Have your data needs exceeded your capabilities?• Are you unaware of solutions that may improve practice performance?• Are the growing costs and hassles associated with routine upgrades a growing concern?• Are hardware problems causing disruption in practice operations?
How outsourced services work
Once you have decided to outsource part of your business, it's important to find the best possible contract. Costs and terms vary widely based on what you want done, but here are some general guidelines.
Billing — While some billing firms provide a "one-size-fits-all" approach, many are offering options that allow practice staff to perform some of the tasks and permit physicians to access data and reports online. This flexibility can be an important feature for more sophisticated practices.
Most billing service companies charge a percentage of the funds that they collect on behalf of the client practice. Fees are affected by the size of each claim, the number of monthly claims, the scope of tasks provided, and the payer mix.
Be sure to talk about performance standards in your contract with a billing service. Fees should be tied to collection percentages and days in accounts receivable. Processing electronic claims or providing patient statements may cost more. Some firms may offer additional services such as coding education, or provide you with access to their software for appointments and reporting.
Payroll — Many firms provide routine payroll services that include generating paychecks, direct deposit, preparing routine payroll tax filings, and annual employee statements (W-2s and 1099s). Many now accept direct downloads from practice accounting systems such as Peachtree, QuickBooks, and others.
Larger practices can also get time clocks that are directly integrated with the payroll system.
For smaller practices, outsourcing payroll can help you address privacy concerns. You don't want staff members to know what others (or the physicians) earn. It usually costs more to outsource payroll than to handle it internally, but the hassle factor is lower. Pricing typically includes a minimum charge per payroll plus a per-check fee. Direct deposit options add to the cost. Generally, the vendor automatically transfers money from the practice's checking account to cover the payroll, tax deposits, and vendor fees.
General management — You can select any number of management options, from a monthly visit from an experienced practice management professional to a full-time on-site manager who is actually on the payroll of a management firm. Fees are typically tied to some form of cost-plus approach using the salary of the manager as the base for the computation. If you already employ a manager, but need support from someone more experienced, consider a monthly retainer that would include a minimum number of hours of support.
Outsourcing practice management can also provide your practice with access to specialized professionals such as certified professional coders and billing experts.
If you decide to outsource these services, be sure to check references to find out if client financial performance improved as a result of their efforts and if the advice the clients received was beneficial and realistic.
Information technology — If you don't want the headache or capital costs of buying and maintaining new software systems, a growing number of practices are turning to application service providers (ASPs). These vendors charge a monthly access fee, typically tied to the number of users, which allows the practice to use the software via the Internet. The vendor maintains the database and the typical tasks, such as server maintenance and daily backups, are no longer your practice's to handle. You'll still need someone on staff, however, to keep your tablet PCs, laptops, wireless network, and other practice-owned equipment running smoothly.
Outsourcing IT may seem more attractive as the deadline for compliance with the HIPAA security rule approaches in April 2005. The rule requires system backup and disaster recovery, password protection, and encryption.
Apart from ASPs, practices also are using IT consultants on an hourly or retainer basis. Some vendors sell time blocks, which include prepaid hours of effort. While the cost per hour decreases with the size of the block, be sure not to overbuy.
Making a decision
The critical points that must be considered in making the decision between internal and outsourced are price, accountability, and flexibility.
Are you willing to pay more for better results? For example, the practice might be spending 5 percent of its revenue on its billing operation, but its collection rate may be 4 percent below what is typical for the specialty. Spending a few more dollars on a billing service may result in far more revenue. Typically, any outsourced service will cost you as much, if not more, than it would if handled internally. You need to see enhanced performance or cost savings to make it worthwhile.
When evaluating price quotes from various vendors, practices can use data published by the Medical Group Management Association (MGMA), that indicate the cost for various practice operations on a dollars-per-physician basis. You should be able to duplicate the service internally for the amount shown on the MGMA report. The Cost Survey: 2003 Report Based on 2002 Data can be ordered directly from MGMA.
In addition to making sure you get a fair price, you'll want to make sure that you get what you pay for. Some questions to ask vendors include: • What information will be provided to the practice leadership? • What assurances will the vendor offer related to performance, and what standards will they use as a measure? • What termination options are available if performance is not as expected?• Will the vendor modify their service to match the way that the physicians want their practice to operate?• How frequently will your practice have access to senior consultants or managers?
Identifying vendors
You can find potential partners by asking other physicians whom they use. Also try an Internet search, your professional society (many have a screening program for vendors, such as FP Assist, sponsored by the American Academy of Family Physicians), or firms that you encounter as exhibitors at professional meetings. Often medical supply, pharmaceutical, or banking representatives, your attorney or accountant could be excellent resources for recommendations.
Some services require knowledge of your specialty; others are generic to medical practices. A billing company should have a list of practices in your specialty that have used their service; management firms can be more general but should have experience with practices of your size and understand your budgetary constraints.
Keep in mind that the decision to outsource aspects of practice operations is not final. Evaluate vendor performance, and if you're convinced that you could do better, you can always elect to bring the services back in-house. Be sure, however, that you have had a frank discussion with your vendor about your concerns before terminating a relationship. Frequently, problems are a result of incomplete information. You're busy, and once you outsource tasks, you may pay less attention to operational details — but in the long run, it is still your practice.
Greg Mertz can be reached at editor@physicianspractice.com.
This article originally appeared in the November/December 2003 issue of Physicians Practice.
Thursday, January 24, 2008
GOOD MORNING VIETNAM…
Reflections from Martin Luther King Celebration and the need to recognize there is still a lot of unfinished work to eliminate health care disparities.
….on this special day when many in America pause to celebrate the life and explore the dream of The Reverend Dr. Martin Luther King, I am honored to be in the presence of one whose primary mission or may I say, whose dream, as Surgeon General was to assure that we, Americans of color—the Negro, the Latino, the Asian, and Hispanic—and the people indigenous to America—the Mexican, Navaho, Dakota, Cheyenne, and other native peoples stayed healthy long enough to dream and work for the promise inherent in the philosophy of Dr. King—that all men are created equal and have the inalienable right to life, liberty, and the pursuit of happiness. As an Emergency Room doctor who was fortunate to study and learn under some gifted urban E.R. doctors, I have seen almost everyway medial care in this digital age can save lives and everyway humans can die; whether by gun, knife, drug, car or neglect. I have seen how poverty kills. I have also seen how poverty challenges faith, hope and love to kill dreams. As Zora Neal Hurston, a medically-neglected queen of the Harlem Renaissance wrote “there is something about poverty that smells like death… dead dreams dropping off the heart like leaves in a dry season, and rotting around the feet.” Hurston died destitute in poverty from complications of hypertensive heart disease—a stroke caused by untreated high blood pressure. Therefore, Dr. Satcher, on this day that we commemorate the life of a man whose voice and vision filled the emptiness in so many souls with hope and reason, I salute you and thank you for your public service and unselfish commitment to eradicating racial and ethnic disparities in access to health care. I thank Dr. Sathcher for working to rid our communities of Newports, Winstons, Camels, Virginia Slims and the Marlboro man, and obesity; and for being one of the first in this Country who preached violence as a public health issue to mostly unhearing ears. I commend you for your selfless dedication to public health.
The meanings of the Martin Luther King, Jr. Holiday were eloquently phrased by Dr. King’s widow. Mrs. King wrote, among other things, that the King Holiday “is a day of interracial and intercultural cooperation and sharing. No other day of the year brings so many peoples from different cultural backgrounds together in such a vibrant spirit of brother and sisterhood. Whether you are African American, Hispanic or Native American, whether you are Caucasian or Asian American, you are part of the great dream Martin Luther King, Jr. had for America. This is not a black holiday; it is a peoples’ holiday. And it is the young people of all races and religions who hold the key to the fulfillment of his dream.” That is why I cherish the King Holiday. It is our yearly reminder that all people have the right to dream and that we should not be afraid to dream. But if we fail to set goals at every step and reassess and change what needs to be changed, if we fail to cherish ourselves and other, even those who make life difficult, and if we are diverted by the dreamless critics who discourage, our dreams will remain what they are. The King Holiday is a reminder of our potential and our responsibility to self and community.
Dr. King’s was a man of genuine wisdom and I am truly grateful because my brothers and I are the realities—the consequences of his dreams. I am grateful for the sparkle of my grandmother’s eyes when we graduated from college. I am thankful for the joy of my grandmother and parents when my brother and I were accepted into and graduated from medical schools and their celebration when we matched into the residency programs of our choice. These accomplishments of Green Streeter’s are the outcome of dreams inspired by Dr. King’s selflessness advocacy for equality and his dedication to us as a people. My grandmother Mazie and my parents truly believed in Dr. King’s dream and I am proud to say that my brothers and I gave and, hopefully, will continue to give life to the dream.
Inherent in Dr. King’s philosophy is the truth that life is not about circumstances—it is about choices and what we think. We can all dream but like someone wrote “we are what we think… all that we are arises with our thoughts, we make our world… what we think we become. Our potential is infinite; if we think we can do it, we can; we must live up to potential. Dr. King showed us the way and I pray many will be willing to walk it. Explore the world, live, love and cherish people, and let your life be an adventure, mistakes and all—and also as Langston Hughes reflected, “hold fast to dreams” let them become your reality.
….on this special day when many in America pause to celebrate the life and explore the dream of The Reverend Dr. Martin Luther King, I am honored to be in the presence of one whose primary mission or may I say, whose dream, as Surgeon General was to assure that we, Americans of color—the Negro, the Latino, the Asian, and Hispanic—and the people indigenous to America—the Mexican, Navaho, Dakota, Cheyenne, and other native peoples stayed healthy long enough to dream and work for the promise inherent in the philosophy of Dr. King—that all men are created equal and have the inalienable right to life, liberty, and the pursuit of happiness. As an Emergency Room doctor who was fortunate to study and learn under some gifted urban E.R. doctors, I have seen almost everyway medial care in this digital age can save lives and everyway humans can die; whether by gun, knife, drug, car or neglect. I have seen how poverty kills. I have also seen how poverty challenges faith, hope and love to kill dreams. As Zora Neal Hurston, a medically-neglected queen of the Harlem Renaissance wrote “there is something about poverty that smells like death… dead dreams dropping off the heart like leaves in a dry season, and rotting around the feet.” Hurston died destitute in poverty from complications of hypertensive heart disease—a stroke caused by untreated high blood pressure. Therefore, Dr. Satcher, on this day that we commemorate the life of a man whose voice and vision filled the emptiness in so many souls with hope and reason, I salute you and thank you for your public service and unselfish commitment to eradicating racial and ethnic disparities in access to health care. I thank Dr. Sathcher for working to rid our communities of Newports, Winstons, Camels, Virginia Slims and the Marlboro man, and obesity; and for being one of the first in this Country who preached violence as a public health issue to mostly unhearing ears. I commend you for your selfless dedication to public health.
The meanings of the Martin Luther King, Jr. Holiday were eloquently phrased by Dr. King’s widow. Mrs. King wrote, among other things, that the King Holiday “is a day of interracial and intercultural cooperation and sharing. No other day of the year brings so many peoples from different cultural backgrounds together in such a vibrant spirit of brother and sisterhood. Whether you are African American, Hispanic or Native American, whether you are Caucasian or Asian American, you are part of the great dream Martin Luther King, Jr. had for America. This is not a black holiday; it is a peoples’ holiday. And it is the young people of all races and religions who hold the key to the fulfillment of his dream.” That is why I cherish the King Holiday. It is our yearly reminder that all people have the right to dream and that we should not be afraid to dream. But if we fail to set goals at every step and reassess and change what needs to be changed, if we fail to cherish ourselves and other, even those who make life difficult, and if we are diverted by the dreamless critics who discourage, our dreams will remain what they are. The King Holiday is a reminder of our potential and our responsibility to self and community.
Dr. King’s was a man of genuine wisdom and I am truly grateful because my brothers and I are the realities—the consequences of his dreams. I am grateful for the sparkle of my grandmother’s eyes when we graduated from college. I am thankful for the joy of my grandmother and parents when my brother and I were accepted into and graduated from medical schools and their celebration when we matched into the residency programs of our choice. These accomplishments of Green Streeter’s are the outcome of dreams inspired by Dr. King’s selflessness advocacy for equality and his dedication to us as a people. My grandmother Mazie and my parents truly believed in Dr. King’s dream and I am proud to say that my brothers and I gave and, hopefully, will continue to give life to the dream.
Inherent in Dr. King’s philosophy is the truth that life is not about circumstances—it is about choices and what we think. We can all dream but like someone wrote “we are what we think… all that we are arises with our thoughts, we make our world… what we think we become. Our potential is infinite; if we think we can do it, we can; we must live up to potential. Dr. King showed us the way and I pray many will be willing to walk it. Explore the world, live, love and cherish people, and let your life be an adventure, mistakes and all—and also as Langston Hughes reflected, “hold fast to dreams” let them become your reality.
Monday, January 7, 2008
What They Don’t Teach You in Business School
“I want to fly out to Louisiana and help.” That was the first instinct of hundreds of our faculty and many of our emergency medicine physicians at the University of South Florida as Katrina struck the Gulf Coast a few years ago. And despite pleas that volunteers should work through organized venues, many did go out on their own and satisfy a need that exists in all physicians and scientists—helping one patient at a time. Fast forward a few days to a call I received from one of my business colleagues that the power brokers in the New Orleans region were planning the rebuilding of New Orleans, a project to make the city more attractive to tourists and more “profitable” to those involved.
Never was the dichotomy between my physician mind and my MBA mind clearer. Former Gov. Richard Lamm of Colorado said it well when he stated, “American medicine is practiced one patient at a time. What makes a person a wonderful practitioner by definition makes them a poor allocator of resources.” So is that it? Should we feel comfortable training the next generation of physicians and nurses in a virtual business vacuum, secure that we are protecting them from the “dark side” of the business of healthcare?
Almost 10 years ago I embarked on a project to examine the medical mind vs. the business mind. It involved interviews and case studies with several hundred medical students, residents, and academic and private physicians, with similar studies for MBA students, men and women in business, and MBA professors. Our data accentuates a gulf between physicians and MBAs. In one case study, participants needed to question the “rules” and be creative in order to come up with a win-win scenario. Of the physician group, 87 percent “blindly followed the rules” and preferred the more mainstream “win-lose” strategy. For the MBAs, only 18 percent fell into that trap.
What we found is that even conservative academicians recognize the need for changes in the way we educate and select physicians. Some key issues:
► Are GPAs and MCATs still the “gold standard” for predicting success in a future where the differential diagnosis is as close as your palm (electronic or anatomic)? Simply put: Would a candidate with a 3.2 GPA and 26 in her MCATs, with superb communication skills, coordination proven on her simulation tests, and a finely tuned eye as evidenced by her fine-arts college minor be a better practitioner in the information world of 2020 than a candidate selected by traditional means?
► We can no longer relegate the real-world curriculum to a few “business” courses. Leadership in medicine is not about teaching “Excel for Dummies.” Instead, there was unanimity in our findings that there is no optimistic future in academic medicine without training physician scientists who understand collaborative negotiations, small and large group communications, making patients happy, running an effective meeting, and how to be an individual in an organization. When we taught these skills to residents, their optimism about the future of medicine increased, along with their desire to be creative.
► Professionalism is not just a competency for academic physicians; it is our lifeblood. As a dean who has had the honor of presiding over two medical schools, neither of which owns a hospital, I am convinced that uncompromising dedication to the principles of professionalism that are unique to academic health care allows us to train our future generation with the tools of the business world without being lost to “the dark side.”
As an MD-MBA, I am caught between a love of academic health care and a stark realization of the business imperative. My Wharton professors used to preach the importance of “getting back to business basics” during periods of stress. In reality, nothing could be further from the truth. Spreadsheets don’t solve these challenges. Our ability to succeed gets down to people, or what my business colleagues call “human assets.” Further, our ability to maximize those assets depends on leadership—defined as creativity, communication, negotiation and team building. We can ill afford to not teach our emergency medicine residents and students leadership in the business world while preserving what made them interested in medicine. And while integrity and professionalism will predicate our success in a new future, those attributes will never show up on any spreadsheet.
Never was the dichotomy between my physician mind and my MBA mind clearer. Former Gov. Richard Lamm of Colorado said it well when he stated, “American medicine is practiced one patient at a time. What makes a person a wonderful practitioner by definition makes them a poor allocator of resources.” So is that it? Should we feel comfortable training the next generation of physicians and nurses in a virtual business vacuum, secure that we are protecting them from the “dark side” of the business of healthcare?
Almost 10 years ago I embarked on a project to examine the medical mind vs. the business mind. It involved interviews and case studies with several hundred medical students, residents, and academic and private physicians, with similar studies for MBA students, men and women in business, and MBA professors. Our data accentuates a gulf between physicians and MBAs. In one case study, participants needed to question the “rules” and be creative in order to come up with a win-win scenario. Of the physician group, 87 percent “blindly followed the rules” and preferred the more mainstream “win-lose” strategy. For the MBAs, only 18 percent fell into that trap.
What we found is that even conservative academicians recognize the need for changes in the way we educate and select physicians. Some key issues:
► Are GPAs and MCATs still the “gold standard” for predicting success in a future where the differential diagnosis is as close as your palm (electronic or anatomic)? Simply put: Would a candidate with a 3.2 GPA and 26 in her MCATs, with superb communication skills, coordination proven on her simulation tests, and a finely tuned eye as evidenced by her fine-arts college minor be a better practitioner in the information world of 2020 than a candidate selected by traditional means?
► We can no longer relegate the real-world curriculum to a few “business” courses. Leadership in medicine is not about teaching “Excel for Dummies.” Instead, there was unanimity in our findings that there is no optimistic future in academic medicine without training physician scientists who understand collaborative negotiations, small and large group communications, making patients happy, running an effective meeting, and how to be an individual in an organization. When we taught these skills to residents, their optimism about the future of medicine increased, along with their desire to be creative.
► Professionalism is not just a competency for academic physicians; it is our lifeblood. As a dean who has had the honor of presiding over two medical schools, neither of which owns a hospital, I am convinced that uncompromising dedication to the principles of professionalism that are unique to academic health care allows us to train our future generation with the tools of the business world without being lost to “the dark side.”
As an MD-MBA, I am caught between a love of academic health care and a stark realization of the business imperative. My Wharton professors used to preach the importance of “getting back to business basics” during periods of stress. In reality, nothing could be further from the truth. Spreadsheets don’t solve these challenges. Our ability to succeed gets down to people, or what my business colleagues call “human assets.” Further, our ability to maximize those assets depends on leadership—defined as creativity, communication, negotiation and team building. We can ill afford to not teach our emergency medicine residents and students leadership in the business world while preserving what made them interested in medicine. And while integrity and professionalism will predicate our success in a new future, those attributes will never show up on any spreadsheet.
Friday, January 4, 2008
Wednesday, January 2, 2008
Tips for those going to the Emergency Room...
Subject: EMERGENCY DEPARTMENT RULES"This is all so true!!" says Debra R., EMT/PCTRules for the Emergency Room:Here are some tips to those who may end up in an ER, be it yourself or a family member.
If it requires the ambulance team and entire truck crew of firefighters to transport you and safely place you on a hospital stretcher, it is time to go on a diet.
When you present to the triage nurse, do not tell him/her that your doctor called ahead. If you survey our waiting area, probably 50% of the people waiting said the same thing, and the other 50% use the ER as their regular doctor.
Never start out by saying, "I was searching the Internet . . . "
When asked how much you weigh, please do not give the "Deer-In-The-Headlights Look", and tell us you "really don't know". It's a simple question with a simple answer.
Just because you have a phone and know how to call 911, we are not impressed by your arrival on an ambulance stretcher. You had better be sick.
If you came escorted via EMS for multiple complaints that started more than one week ago and your entire family followed the ambulance to the hospital, you will be labeled a ninnie and treated like one, enjoy the waiting area with your family.
One complaint/ailment per visit, please.
Just because you came in on a ambulance, doesn't mean you're going home on one. You better start making arrangements, now. I am not driving you home, or figuring out how to get you home. Cab vouchers are not an option.
If you have one of these four, go to your own doctor in the morning: A Migraine; the Flu; a stomach virus; or a stuffy nose.
Do not ask us how long it will be. We don't know. I don't know what is coming through my door 30 seconds from now,so I sure as hell don't know when you're getting a room.
We have priorities. We understand that you have been waiting for two hours in the waiting room. If you don't want to wait, make an appointment with a doctor. The little old lady that just walked in looking OK to you is probably having a massive heart attack. That is why she goes first.
If your mother is a patient and we ask her a question, let her answer it.
If your child has a fever, you had damn well better give him Tylenol® before coming in. DO NOT let the fever remain high just so I will believe the child has a fever. Do you want your child to have a seizure? Do you?
If you are well enough to complain about the wait, you are well enough to go home.
Do not utter the words "it is in my chart", I don't have your chart, and I don't have the time to call and get it. Just tell me. It is faster.
We know how many times you've been to an ER. We can usually tell if you are faking it during the first 5 seconds of talking to you. Do not lie to us. If you lie about one thing, we will have to assume you are lying about everything. You don't want that.
If you have diabetes and do not control it, you are committing slow suicide.
If you are a female between 16 and 42 and your last period was between 28-35 days ago, please don't waste our time if you are here for Abdominal Pain & Vaginal bleeding. Guess what!!?? You got your period, again.
Do not bring your entire posse with you. One person at the bedside is all you need. It is really difficult to move around seven people who are in the way if you are really sick.
Every time I ask you a question, I learn more about what is wrong with you. I don't care if I asked you what day it is four different times. Each time I ask, it is for a reason. Just answer the questions, regardless whether you have answered them before.
If you want something, be nice. I will go out of my way to piss off rude people.
Our definition of sick is not your definition of sick. If a member of the ER staff says that someone is sick, it means that they are in the process of DYING. They have had a massive stroke, are bleeding out, having a heart attack, or have been shot. We don't consider a kidney stone, sick. Painful, yes. Sick, no.
At any given time, one nurse has four patients. One doctor has up to 15.
There is a law (similar to Murphy's) in the ER. If you have four patients: one of them will be sick (see above for definition); one of them will be whining constantly; one of them will be homeless; and one of them will a delightful patient. (don't be the whiner). Please.
If you see someone pushing a big cart down the hall at full speed and you hear bells going off, do not ask for a cup of coffee. Someone is dying, you inconsiderate a*****e. In the ER, bells don't ring for nothing. Sit down, shut up, and let us work.
If you can bi**h about the blood pressure cuff being too tight, or the IV hurting, you are not in that much pain.
Physicians and nurses are not waiters. We are not customer service representatives. This is not McDonald's®, and you very well may NOT have it your way. Our job is to save your life, or at least make you feel better. If you want a pillow, two blankets, and the lights dimmed, go to the Ramada®.
If you have any sort of stomach pain and you ask for something to eat, you are not sick.
Do not talk s**t about the other members of staff I work with. The doctor that you hate? I work with him every day, and I know that he knows what he is doing. I trust him a lot more that I trust you. I am not here to be your friend, and neither is he. I will tell him what you said, and we will laugh about it. If you want a buddy, go somewhere else.
If you are homeless, don't ask for a bus token or cab voucher to get home. It just confuses the staff.
Please don't tell us how to do our job. Do we go to your place of business and tell you how to do your job?
Please don't bring in a "show and tell". If you have to fish it out of the toilet, it's really not necessary to bring it in, we will take your word. If you did fish something out of the toilet, you may not use my pen.
"Scientific Jargon"by Dyrk Schingman, Oregon State University
"After several years of studying and hard work, I have finally learned scientific jargon.The following list of phrases and their definitions will help you to understand that mysterious language of science and medicine.
"After several years of studying and hard work, I have finally learned scientific jargon.The following list of phrases and their definitions will help you to understand that mysterious language of science and medicine.
"IT HAS LONG BEEN KNOWN"... I didn't look up the original reference.
"A DEFINITE TREND IS EVIDENT"...These data are practically meaningless.
"WHILE IT HAS NOT BEEN POSSIBLE TO PROVIDE DEFINITE ANSWERS TO THE QUESTIONS,"... An unsuccessful experiment, but I still hope to get it published.
"THREE OF THE SAMPLES WERE CHOSEN FOR DETAILED STUDY"... The other results didn't make any sense.
"TYPICAL RESULTS ARE SHOWN"... This is the prettiest graph.
"THESE RESULTS WILL BE IN A SUBSEQUENT REPORT"... I might get around to this sometime, if pushed/funded.
"THE MOST RELIABLE RESULTS ARE OBTAINED BY JONES"... He was my graduate student; his grade depended on this.
"IN MY EXPERINCE"... once
"IN CASE AFTER CASE"... Twice
"IN A SERIES OF CASES"... Thrice
"IT IS BELIEVED THAT"... I think.
"IT IS GENERALLY BELIEVED THAT"... A couple of other guys think so too.
"CORRECT WITHIN AN ORDER OF MAGNITUDE"... Wrong.
"ACCORDING TO STATISTICAL ANALYSIS"... Rumor has it.
"A STATISTICALLY ORIENTED PROJETION OF THE SIGNIFICANCE OF THESE FINDINGS"... A wild guess.
"A CAREFUL ANALYSIS OF OBTAINABLE DATA"... Three pages of notes were obliterated when I knocked over a glass of beer.
"IT IS CLEAR THAT MUCH ADDITIONAL WORK WILL BE REQUIRED BEFORE A COMPLETE UNDERSTANDING OF THIS PHENOMENA OCCURS"... I don't understand it.
"AFTER ADDITIONAL STUDY BY MY COLLEAGUES"... They don't understand it either.
"THANKS ARE DUE TO JOE BLOTZ FOR ASSITANCE WITH THE EXPERIMENT AND TO ANDREASCHAEFFER FOR VALUABLE DISCUSSIONS"... Mr. Blotz did the work and Ms. Shaeffer explained to me what it meant.
"A HIGHLY SIGNIFICANT AREA FOR EXPLORATORY STUDY"... A totally useless topic selected by my committee.
"IT IS HOPED THAT THIS STUDY WILL STIMULATE FURTHER INVESTIGATION IN THIS FIELD"... I quit.
"This may be used or broadcast in any form as long as I receive credit.©Dyrk Schingman"as submitted by Tina Denetclaw, Pharm.D., BCPS
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