Don’t let yourself be victimized by flavor-of-the-day’ theories
Here’s how to make the consulting experience more palatable
Tired of hearing the latest consultant’s pitch before you’ve even implemented the philosophy of the last consultant? Had enough of the endless series of seminars that promulgate new theories on how you should do your job?
Rapid regulatory and market changes are forcing the health care industry to constantly redefine itself, and too often that results in managers struggling through the two-year implementation of last year’s theme as this year’s hot topic hits the boards.
What’s an access manager to do? Besides throwing up your hands in disgust, there are steps you can take to hire the right consultants, help direct their work, and generally make the experience a more positive, effective one.
Professionals with experience on both sides of the issue working with consultants and serving as consultants themselves shared with Hospital Access Management some thoughts on who to hire and how to take control of the changes in your operation.
"Before I go out and hire a consultant, I come to a general realization of why I want one. Either I don’t have the time or I don’t have the resources to do what needs to be done," says Pat Wulf, vice president of operations for HealthTask, an Atlanta health care outsourcing firm, and a former senior manager in the consulting groups of Price Waterhouse and Ernst & Young. "Once I’ve made that decision, it’s a matter of sitting down and telling [the consultant] what I think my problem is," he says. "The key thing is, they may meld my vision or approach [with theirs], but they’re going to solve the problem I tell them to solve."
Sometimes a director of access services, although expert in the field, may seek outside help because he or she is too close to the situation to see the glitches in the system, notes John Hansmann, MSIE, region manager of management engineering for Intermountain Health Care in Provo, UT. Hansmann has worked in private consulting as well as on hospital staffs.
"So much depends on the particular situation you’re in," he says. "Do you have the expertise to figure out the problems and also the time to do it?"
If your organization is going through a change especially if you’re in a difficult situation or need a quick fix consultants can bring a lot of expertise to the table, Hansmann adds. But he cautions, "Don’t take what they say as 100% gospel. Make sure it really fits."
Whether you seek help from one of the so-called "Big Six" consulting firms, such as Ernst & Young, Arthur Andersen, or DeLoitte & Touche, or from a smaller local or regional company may depend on the size of your hospital, Wulf says.
"I came out of the Big Six, and the thing you get there is the bigger-picture perspective," he says. "Most of the work we do is in larger hospitals, but you’re more likely to find a mom-and-pop company working with smaller rural hospitals."
Still, Wulf emphasizes that he would not hire a consulting firm on the basis of its name. Instead, he suggests checking the background of the people you would be working with. "While the firm can supply the methodological experience, you’re still hiring an individual team," he points out. "I want to know who’s going to service me. What qualifications does that person bring?"
Unless you’re a major player in the health care business, Hansmann says, hiring a Big Six firm likely means working with a junior member of the company. "A partner will be assigned to the project, but that person shows up once or twice," he adds. "Most of the work is left to a junior partner, and you may not get the results you want."
Pricing is tiered so you pay a lower rate for the services of less experienced staff members. But overall, the Big Six firms are more expensive, Hansmann says, charging hourly fees ranging from about $100 for a junior technician to between $400 and $500 for partners and other upper echelon personnel.
Another drawback with a large consulting company is that if you’re looking at a niche, the help these "big picture" firms offer may be too general to be useful, he says. A hospital desiring to examine its preadmission process, for example, may do better to hire a consultant specializing in that area. However, it may be harder to find these kinds of firms, which tend to be smaller and more regional in focus. Hansmann suggests networking with colleagues and contacting professional organizations to get recommendations.
Be careful when considering a smaller, lesser-known firm, he advises. "There are unscrupulous ones that will take on anything and everything they can get their hands on, just to get the business and the experience. Take a look at their backgrounds, talk to references, and get a personal feel for them."
Also try to tie payment to results, so "they have to come up with something legitimate or they don’t get paid," Hansmann says. With that arrangement, the consultant might guarantee a certain dollar amount of savings and receive a percentage of that amount say 10% as a fee. However, that’s not a common way of doing business. It’s mostly fee for service, based on the number of hours. In some cases, the consultant may charge a fixed amount based on an estimate of the hours that will be required, a practice known as the "capitated approach."
A plus for nationally known firms is that they may deal with specialty subcontractors to whom they will refer your business, rather than take on an area in which they’re not experienced, Hansmann says. Usually this is a friendly, o-cost referral, he adds.
"Good consultants don’t lambast the compe-tition, they work with it," he says. "They know that if they can’t provide a service and try any-way, their reputation has gone down the tubes. They’ll pass your business along, and they’re real careful about not passing it along to just anyone, because their reputation is still at stake."
Confidentiality is crucial
Before hiring any consultant, Hansmann advises, check references and ask, "Would you have these people back?"
"Look for people you can have a decent relationship with," he says. "The trust level has to be there, whether it’s a department or the entire organization. If they do what they need to be doing, they’re turning your operation upside down, and you need to know that they won’t tell the competition."
For that reason, Hansmann suggests putting a confidentiality clause in the contract. With the big firms, however, confidentiality isn’t an issue; it’s just understood, he adds.
Another item that might be included in the contract is whether the consulting firm merely participates in the design or sticks around to help implement the new program, he says. There are advantages and disadvantages either way. Staying through implementation means the consultant can correct errors as they arise, ideally without too much delay.
On the other hand, Hansmann says, if the consultant remains too long, employees may lose their sense of participation and begin to feel that changes are being forced on them.
"Look at the culture how the employees and managers react to the implementation process," he suggests. "If they can’t take ownership [with the consultants around], then live through it yourself. If they can take accountability, you can say, It’s our project; these guys are just helping us do it,’ then keep the consultants in, and there will be great benefits."
Maintaining a solid understanding of your culture will help fend off "flavor-of-the-week" syndrome, which brings a new management or organizational philosophy into vogue before you’ve had time to digest the last one. The best way to deal with that is to have a strong sense of what your operation needs and then determine if it makes sense to incorporate some or all of a hot new theory.
"Stay attuned to trends in the industry, read through them, but remember that at the end of the day it has to be your organization," says Wulf. "I personally never go with the way the wind is blowing but just say, "Here’s the new fad. Can I overlay that with my plan, and is there any benefit to that?"
If it looks like there is some benefit, then sit down with the consultant keeping in mind his or her thinking and your vision for your own operation and figure out how to go forward, he advises.
"Some people do buy fad consulting, but I was always more successful addressing a specific problem," Wulf notes. "TQM [total quality management] drove me nuts. People were buying it right and left chanting mantras of quality and hoping something would happen without a clear vision of how it could help."
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