Physician Management 201: Move to head of class
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Probably the most popular information requested of me is how a hospital can compete with the freestanding ASC down the road. It is still the most frequently asked question I receive when I meet with a hospital administrator. There are some lessons both sides of the industry can learn.
First, physician satisfaction must be achieved. While it is not the most important issue -- quality of care and patient safety will always share that No. 1 slot -- it is the predominant reason why a physician will use one ambulatory surgery program -- regardless of the structure-- over another. Let's review some of the points that physicians look for in an ambulatory surgery program. After spending 27 years in the OR as a scrub tech, becoming an RN and later a CRNA, and finally starting my own ASC and management company, I have learned a few things in these areas:
* Control.
Physicians want an element of control over their own destiny. In other words, they want, and have a right -- unless you can do the surgery yourself -- to be included in the decision making at the facility.
They, more than any of us, have earned that right. Without the physicians, we have nothing but pretty buildings and empty ORs. For some unknown reason, many individuals cannot grasp that logic.
Including your MDs can be as simple as asking their advice on issues related to the management or organization. You don't need to heed that advice if it doesn't make sense to you, but it costs you nothing to ask. How many times have you inadvertently snubbed your physicians? Probably more often than you realize. There are measures you can take that will ensure inclusion of your physician partner that are too detailed to list in this column, but make it a point to ask their advice on issues.
* Turnaround time.
With many physicians facing reimbursement cutbacks, now more than at any other time, efficiency is important to your surgical staff. They need to get in and out of your center in the most expeditious manner possible.
If your turnaround time is more than 20 minutes, you run the risk of losing that surgeon. While surgeons may not wish to go that far, they may be forced to make that unpopular decision out of the need to see more patients in their office and spend less time in your lounge waiting for their cases to begin.
* Management style.
There are many styles of management. I have my masters degree in management and, at the time I went to graduate school, I believe there were seven defined management styles. I will not bore you with what they are, but there should be a new one added: subservience.
While you may not like the name, in reality, that is the style you must adopt in the center. We are a service industry, and the customer is always right. The physicians are our customers, and their patients are our paychecks.
I am always amused at administrators of ASCs or hospitals who believe they are on par with their physician constituents. The fact is the surgeon and the patients pay our salaries. In any dispute with the surgeon, even if you win, you lose.
The best way to deal with the management of physicians is not to get into a win-lose situation to begin with. You need to adapt your bylaws to allow for physician input on any issue they wish to participate in. Your style is what is important. The dictatorial administrator is gone or will soon be, along with the inflexible, rigid individual who sees only black and white and not the gray areas in physician opportunity at the center.
Style is important in all aspects of our jobs. Some have it or can learn it. Others operate by rote and do the same things they always have done without thinking about what they are doing or why.
Add a touch of class
* Class.
Anything worth doing should be done with class. When I sit down with physicians at XYZ hospital, and they tell me what needs to be changed at the center, one of their top complaints about a center is that it has no "class." When you probe, you find out that they are talking about the staff as well as the physical plant.
Is your center classy, or does it just provide surgery to the physicians? You would be amazed at how quickly and inexpensively you can add class to your center from the physical side. You can give your front desk staff buttons that ask, "Can I help you?" or "Ask me!" Put a couple of plants on the floor next to your reception desk, and add a brightly colored picture over the desk. Get rid of the clutter where your patients interact with the business office or the registration desk. Offer valet parking. Set yourself apart from the crowd and the competition.
The employee side is more subtle and takes more work. If you have sacred employees who don't assist you in giving a sense of class to your center, put them where they can't interfere with the physician or patient relationship. They don't have to be the focal point of everyone that walks in the door or interacts with the physician.
Spruce up you people as well as your physical plant. Maybe it's time to change your uniforms to a brighter more vibrant color that attracts attention to the fact that your staff has personality. Get rid of the drab and washed out fabrics of the 80s. Go for color.
Although I will be assaulted by every nurse out there for this next suggestion, I would love to see the nursing hats come back in style. They set us apart. Wear them proudly along with your nursing school pin -- and be noticed. It is important to your physicians and more importantly to their patients. Be different.
* Outside evaluations.
Ask for help. This is some of the advice I give to my clients that you can have for free.
Working with physicians is the most difficult and rewarding job out there. They are different. They are trained differently, and they think differently than we do. That's one of the reasons they are so exciting to work with. Any manager can eventually convince another manager of the need for change in a certain area, but if you can convince a physician -- that's when you know how good you are.
Don't be afraid to ask for help. There are plenty of people in your organization that would be honored to see your center through their eyes and give you feedback. Often the simplest solution is discovered by an outsider who is not blinded by the facts and the weight of past discussions. Use those people to give you an honest appraisal of your facility and your relationship with the physicians. All too often your surgeons will tell you what you want to hear and just continue to tolerate the situation until something better comes along; but they usually tell a perfect stranger the truth -- in stunning detail.
* Profitability.
Everyone loves a winner, and everyone wants to be associated with a winner. One of the best overall methods of judging how well a center is run is through its cash flow, profitability, or contribution to the organization.
A well-run center or profitable ambulatory surgery program is a major attraction for physicians. It represents stability. Physicians love and seek stability, and they should expect it. If you keep beating them over the head with how much money you're losing or how your hospital is demanding staff cutbacks, you're going to scare them away. Why? One of the most common reasons they give me is that they wonder how you can afford to give them the equipment they need to grow their practice or service if you can't even afford to buy staff lunches.
So many times a program will put itself into a downward tailspin because the managers say too much to the wrong people. Unless the surgeon can directly assist you in your quest for profitability, don't bug them with your financial problems, regardless of how positive a relationship you feel you have with them. Very often, we start self-fulfilling prophecies.
(Editor's note: To suggest ideas for the column or to provide feedback, contact Earnhart at 5905 Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: ptvr93a @prodigy.com.) *
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