Avoid assumptions when consultant-hunting
Here’s how to circumvent consulting nightmares
Health care institutions hire consultants for a variety of reasons. Employees may not have time to do the work themselves. An outside company can bring expertise the provider may not have. Someone may want to sell an idea to the board of directors and need a high-profile consulting company to back it up.
Whatever the reason, there is at least one disastrous consulting experience for every successful outcome. Sometimes, encounters with consultants simply leave access managers drained, frustrated, and feeling their institution threw a lot of money at a problem without getting tangible results.
There are several ways to help make the experience not only tolerable, but productive, suggests David Morgan, managing partner of Health Care Systems Management in Framingham, MA. Morgan, who has worked as a consultant on his own and with national firms, offers the following guidelines:
1. Avoid assumptions, on either side of the table.
When a hospital brings in a consultant to provide certain expertise, it’s easy for that provider to assume the consultant knows what he or she is doing, Morgan says. At the same time, he adds, it’s easy for consultants to assume the hospital is in agreement with what they’re doing.
"When people bring in consultants and don’t control them, the consultant may lose touch with the institution and where it wants to go," he says. "If you’re not sitting down together on a regular basis, the scope of the project changes a bit. It may be a great job, but it’s not the job the hospital wanted." The hospital staff’s lack of time — one of the reasons it needed a consultant — can exacerbate the problem, he adds.
Morgan cites one situation in which consultants came in to do a job and approached it in the way they thought best. Meanwhile, the hospital liaison went on to something else as soon as he brought the consultants on board.
"In this case, the communication from the medical staff was not getting back to the consultant," he says. "By the time someone was brought in to rectify things, there was too much of a gap between the institution and the consultant — too much animosity."
2. Don’t let a good rapport result in loss of perspective.
The flip side of the above problem can occur when hospital and consultant hit it off beautifully, Morgan points out. "If the consultant develops a really good rapport with an institution, [staff] are asking, Can you look at this and that?’ The next thing you know, the scope of the project is different, and the hospital has spent more money than planned or the original project is not fully done."
Schedule weekly, or at least biweekly, meetings with the liaison from the consulting firm to talk about where the project is going, he advises. "Lots of firms produce weekly reports, but those don’t capture the flavor of personal meetings."
3. Don’t end up with just a document for the bookshelf.
Consultants often are hired to identify problem areas, and there is some validity to that objective, Morgan says. The institution may use the findings in strategic planning and may implement changes as a result, he says. Too often, however, that approach means the hospital "ends up with a document for the bookshelf."
"I tend to like to do roll-up-your-sleeves consulting, in which I find and deal with with issues and become totally immersed in the institution," Morgan says. The most effective outcomes, he suggests, are when the approach is, "I have a problem — fix it."
The most expensive part of hiring a consultant is the time it takes to learn the issues, Morgan says. "Usually, the least expensive part of the project in terms of manpower and time studies is implementing the solution. But many times, people don’t go there and don’t resolve their problems.
"Come to some sort of conclusion as to what the work project will be, with a definite outline of what the product will be," he adds. "You don’t want to end up with a document and a problem not fixed."
4. Benchmarks are just tools.
"One thing I see a lot is hospitals trying to take an idea from one place and implement it somewhere else," Morgan says.
It’s not appropriate to compare registration times when one hospital uses a point-of-service device to swipe cards, another is on a computer network that automatically retrieves information, and another relies on verifying insurance over the telephone, he says.
One institution he worked with had the technology to do remote registrations but made the decision that good patient care requires personal contact with the patient, Morgan notes.
"There are horror stories," he adds, "of consultants coming in and saying, This is how we’re going to do it.’ They never worked with the staff, and the moment [the consultants] walked out the door, it falls apart."
5. Look at different types of companies before hiring a consultant.
Although there can be more prestige or credibility associated with a "Big Five" consulting firm, many times a smaller firm can stay more focused on a hospital’s project, Morgan says. "People hire consultants for a lot of different reasons. Generally, when hospitals are looking to explain or sell something to the board, they tend to go with a high-profile company. I’ve actually done work and had the work repeated by larger companies because they carry more weight than I do."
But with smaller firms, he points out, it’s even more important to "make sure they have the expertise they say they do. Interview people, look at their book of business, see where they’ve worked and how. Results are a great thing. Take a look at outcomes and call references."
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