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Medical practice leadership & the will to act

By Howard J. Peterson

Most articles (and I’ve written many) seek to provide the newest innovation, a unique idea, an approach not tried before or a fresh application of an old idea. The central premise of each article is that one of these revelations may promise to solve a long-standing problem (usually financial in nature) or to resolve the consequences of the latest reduction in reimbursement for patient services.

New information has obvious value, and with the pace of change in health care we need to relentlessly pursue it. But, is it the most likely source of resolving the problems in your physician organizations? Are you unduly confident, even dependent that a new idea or the latest innovation is the path to solving your long-standing issues? Is it realistic to believe that significant, undiscovered insights are likely to be the essential catalysts to ameliorating the chronic financial problems of your physician practice? Or is the source of solving your problem to be found within your immediate control; with the information you already possess?

Short of the unlikely reversal of prevailing reimbursement policy or revision of the current course of regulation, experience suggests that the best performance of physician organizations will not be found in the new idea. It will be found in the will to act. It will be found through leadership within your organizations which elects to use the information you have assembled.

Well-read physicians and thoughtful practice administrators have a command of most of the relevant ideas affecting practice performance. These physicians and administrators know which ideas are likely to help achieve the best possible performance of their organization under the prevailing circumstances. Introspection will support that claim.

However, there are many, seemingly good, reasons why leaders elect not to act even when they possess the relevant facts:

We believe or convince ourselves that we have insufficient information to proceed.

Consider some examples.

The work load of our physicians suggests that their productivity is less than the readily available national standard; but we stand unconvinced because we don’t have local, comparative data that would confirm this lower productivity. We cling to the hope that there is another way not yet revealed which will present an easier resolution to the problem.

Our practice is, apparently, out of compliance with billing standards and compliance will result in a decline in gross billings, making it necessary to find significant cost or revenue improvements. Or, we like the way things are done today, we understand them, we promote the status quo.

The economics of reimbursement will only support a mid-level provider (e.g., nurse practitioner) instead of another physician. We’ve never had nurse practitioners in our practice and we’ve never been comfortable with this approach. We find short-term “fixes” which allow us to delay the resolution of the fundamental, underlying problem.

We buy a new machine for which we can make new gross charges instead of addressing the cost performance of our practice.

We contemplate the potential that solving the problem may be a threat to our own personal stature within the organization.

We know the size of the practice requires us to merge to survive, but who will be the lead administrator after the merger? Or, we recognize that there are political consequences to implementing the necessary changes and, therefore, elect not to face them.

Seemingly everyone in the practice understands that a change in leadership in the practice is essential if the practice is to perform better. However, the change means challenging the role of a long term, senior physician.

In short, we are reticent to act. We embrace a sense of constancy. A state of normalcy. We are sometimes like the light bulb in the old joke: How many psychiatrists does it take to change a light bulb? Answer: One, but the light bulb has to want to change.

And so, we continue to focus on the constant pursuit of new ideas. But senior physicians and administrators have a core leadership responsibility to consider the premise that some of our organizations suffer mostly from a lack of implementation. A lack of leadership. A lack of the will to act.

What will differentiate the organizations that will be the recognized leaders and achieve financial health in the prevailing circumstances? I believe it will be the willingness of leadership to assume the risks inherent in change.

A predominant quality required of leaders today is the ability to act in the face of ambiguity. The consequences of change are often unclear. However, experience and carefully considered judgement by effective leaders most often prove to overcome the risks of ambiguity.

That assumption of risk by practice leaders will be rewarded both in the performance of physician organizations and the recognition of their leaders. It is time for each organization to look critically within itself, to examine its governance, its elected or appointed leaders and to place a resounding priority on the will to act.

Howard J. Peterson is principal-in-charge of Health Care Services, East Region, of Larson, Allen, Weishair & Co., in Philadelphia.

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