Medical Practice Communications

Effective physician leaders are effective communicators. They express themselves well both orally and in writing. Further, they project an image of self-assurance and of understanding. These attributes are continuously communicated by their actions and demeanor.

Effective communication is also important because a large portion of a physician’s time is spent communicating with others. A physician’s day is filled with face-to-face communications with patients, patients’ families, employees, and referring physicians.

Effective communication is a necessity for positive and productive medical practice workplace interactions. Here are five ways physicians can improve their communication skills when interacting with staff:

  1. Be open and approachable. Physician leaders must communicate an aura of approachability. If they do not, their employees will be reluctant to tell them of potentially dangerous situations because of their fear of harsh rebuke or excessive punishment. As a leader, physicians don’t only lead; they must also stay open and listen. Put people at ease and listening intensively when communicating with team members. Ensure to make eye contact, smile, and ask open ended questions.
  2. Focus on clarity. People cannot be led if they cannot understand what the leader says, means, or expects. There is no place for ambiguity in practice management. Clear direction is a critical dimension of practice climate. When people understand the mission, values, standards, and expectations of the practice, they can do what needs to be done. Lack of such understanding leads to false starts, ineptness, and discontent.
  3. Explain your reasoning. When communication is effectively used, people do not feel like pawns. Rather, they understand and subscribe to the goals and values of the practice and feel empowered, not dominated. When the reasons for orders are not apparent, the likelihood of the orders being disregarded increases.
  4. Take the quality and sanctity of communication seriously. Physicians can share information with staff through regularly scheduled meetings. They can inform team members of upcoming events so people can plan ahead. Even trivial rumors must be squelched, as the transmission of accurate information is vital.
  5. Pay attention to reactions. One thing great communicators have in common is their heightened sense of situational and contextual awareness; they are great listeners and astute in their observations. When they talk to team members, outstanding physician leaders watch the expressions of those in the audience to be sure they are taking in what is being said. Where there is any doubt, physicians must ensure understanding by making a clearer restatement or requesting that an employee repeat the message in his own words. Important oral communications are sometimes followed up in writing to ensure uptake and understanding.

It might seem easy, but communicating effectively actually takes quite a bit of finesse. George Bernard Shaw is quoted as having said, “The single biggest problem in communication is the illusion that it has taken place.” Indeed the office can often be rocky due to poor communication.

Effective communication is a necessity for positive and productive workplace interactions. Becoming a more effective communicator will not only make your employees more motivated and productive, but will also have a positive effect on your practice environment.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Smart Budgeting for Medical Practices

An accurate, useful budget can help physician owners and medical practice administrators make sound, strategic, and disciplined choices.  Unfortunately, too few practices actually take the time to create a meaningful budget, instead seeing the endeavor as a complex, time-consuming process that likely will not be used.

If you’re continually seeing failure at budgeting, the best place to look is usually at the fundamentals. It only takes a fundamental misstep or two to transform a well-planned and well-formed budget into a complete disaster.  Budgets should be realistic, flexible, and consistent with practice goals and objectives.

Here are three keys to consider that will point you on the right track toward success as you build your budget:

  1. Know why you are budgeting. If you’re developing a budget just because someone says it’s a good idea, it probably won’t help very much. Similarly, if you’re just following the steps in a practice finance workbook because it suggests this is a great way to move towards financial success, budgeting won’t help much at all.  The reason for budgeting is to help you spend less than you earn. It shows you where your spending weaknesses are and provides the structure for you to get stronger in those areas.
  1. Be realistic. It’s not going to work if you make huge, unrealistic assumptions right off the bat. Small steps work; big steps result in failure.  Operating a practice can be unpredictable at times, and things happen that are out of your control.
  1. Be flexible. There will usually be moments when you’re learning to budget when you discover that some element of your budget is just not right. It’s not realistic because you forgot about some key piece of information while making your plans, and that means the budget you developed doesn’t really work.  Don’t panic.  Don’t abandon your plans.  Just go back to your plans, make the needed adjustments, and start over again.  This is normal, it happens to everyone.  It does not mean your budget was a failure at all, it just means it needed to evolve a little bit.

An accurate, useful budget can be a valuable decision-making tool to analyze potential business threats and opportunities and help physician owners and practice administration make sound, strategic, and disciplined choices.

When properly executed, a practice budget will quickly become one of the most valuable resources in a practice’s decision-making toolbox.  A proactive, comprehensive budget gives a practice the ability to properly track results, identify areas of concern, and quickly intervene when issues arise.

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Contact ABISA, a consultancy specializing in solo and small group practice management.  Visit us at ABISALLC.com.

Social Media Policies

Is your medical practice’s social media policy adequate? By now every physician should be aware of the benefits that can be bestowed upon their practice as a result of social media. Indeed many practices are engaging in one or more social media platforms on a regular basis. Moreover, staff members are most definitely active in social media, and probably use it while at work.

Physicians and practice managers must be smart about training employees on what they should and should not share online. Staff in your practice could incur liability on behalf of your practice as a result of their comments on social media. Because of the confidentiality rules in HIPAA, staff training is important. You should constantly remind employees that they are representatives of the practice.

You should also have some sort of social media policy in place. Here are a few key items your policy should include:

Guidelines and expectations. Your policy should set clear expectations for how team members (as representatives of your practice) must conduct themselves online.

Your policy should clearly state that there will be no posting of protected health information (PHI) and that employees are not allowed to use social media in work areas near patients. Be specific in training your employees and inform them to avoid identifying patients in any way on social media — this includes names, unique characteristics, etc.

Some practices do not allow employees use social media for personal reasons on work time. While that is fine as a policy, it does not circumvent the need to appropriately train your staff. Moreover, it can be hard to police.

It is advisable to discourage team members from participating with patients on various websites. If they do engage patients on social media, they certainly should not be discussing patient-related matters.

Lastly, someone (most likely the practice administrator) should be designated as the spokesperson responsible for answering questions about your practice on social media.

Penalties and consequences. Penalties for data breaches increased under the American Recovery and Reinvestment Act so your policy should make it clear to employees about the consequences of their actions on social media sites. An individual claiming they did not know they violated HIPAA is subject to a minimum of $100 per violation. A HIPAA violation due to reasonable cause and not due to willful neglect carries a minimum fine of $1,000 per violation. A HIPAA violation that is due to willful neglect (but corrected in short order) is subject to a minimum of $10,000 per violation. Lastly, a HIPAA violation that is due to willful neglect and not corrected carries a minimum fine of $50,000 per violation. The maximum fine for each of these four categories is $50,000 per violation.

Explanations of rules and regulations. The social media policy should outline what is illegal, what is considered confidential information of the practice, and what is protected health information.

It’s not enough to have a social media policy — employers should put in just as much time and effort in training their employees on the ins and outs of the policy. Make it a separate document from the employee handbook.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Thinking Through Your Decisions

Practice managers know that there are four key objectives at the core of process improvement:

  • To remove waste and inefficiencies
  • To increase productivity and asset availability
  • To improve response time and agility
  • To sustain safe and reliable operations

The question is, how do we do all this? I would suggest a proven technique known as the OODA Loop.

The OODA Loop consists of four overlapping and interacting processes. Managers must

Observe the current situation and form theories,

Orient the picture by setting improvement targets and determining root causes,

Decide by developing solutions, and

Act by means of implementing and evaluating.

The OODA Loop can be subdivided further into an eight-step problem solving process.

Observe

Step 1: Clarify the Problem

This is a critical step. You need to recognize the correct problem and be sure it is completely understood by all. It helps to state the problem by developing a “problem statement” in terms of what, where, when, and the significance. You also need to “lay eyes” on the situation, ensuring you have first-hand observation. This will then help in drafting a flowchart that diagrams the steps of the process. Lastly, you need to conduct surveys and interviews, talking with the “customer” or end user who determines the value of the process under review.

Step 2: Break Down the Problem and Identify Performance Gaps

It is tempting to jump to action but you must refrain from doing so just yet. Gather and review the key data. Understand what data is necessary and what role it plays in problem solving. Are there gaps in your analysis? Are there bottlenecks in the process you are reviewing? Under this step, you must also look at waste in your practice as it relates to the problem. There are generally eight types of waste: defects, over production, waiting, over processing, transportation, intellect, motion, and excess inventory. You should always look for waste in your processes.

Orient

Step 3: Set Improvement Targets

Where do you want to be? Determine your desired outcome for the practice. Be sure to look at both strategic and tactical targets. Strategic targets are visions of what your practice strives to become. Tactical targets define the performance level necessary to make your strategic vision a reality. Remember to keep your tactical targets challenging but achievable.

Step 4: Determine Root Causes

This is the most vital step in the problem solving process. All too often practice managers find themselves addressing problems that have been “solved” many times before. This is usually due to directing problem solving efforts at the symptoms of a problem rather than at the root cause of the problem. It often helps to do much brainstorming and when you think you understand the cause of the problem, ask what caused the problem (continue to ask “why?”).

Decide

Step 5: Select Solutions

When selecting solutions, consider both quality and practicality. Be sure to also gain acceptance (or “buy in”) from those that must implement the solutions. Some key factors to consider when analyzing solutions include effectiveness, feasibility, and impact. When developing your action plan, be sure that you have created a clear and detailed plan that everyone can understand. Most importantly, build consensus with others by involving all of your team appropriately to cultivate a sense of ownership in the solution and in its success. Effective communications can be a deciding element as to whether the plan succeeds.

Act

Step 6: See the Plan Through

Collect data according to the action plan. Remember the old adage, “You can’t manage what you can’t measure.” You may need to implement a contingency plan as conditions change and you need to keep the project on focus. Continue to provide required training during this step as well.

Step 7: Confirm Results and Process

Ensure the plan is producing the intended results. Monitor the project for performance relative to: a) the baseline developed in steps 1 and 2; b) the improvement targets established in step 3; c) where you thought you would be at this stage; and d) meeting targets by the established deadline. You should return to any step as necessary.

Step 8: Standardize Successful Processes

This is the most commonly skipped and under completed step of the entire problem solving process. You can define this step by asking a series of questions : What is needed to standardize the improvements? Is the appropriate documentation in place? Were other opportunities or problems identified by the problem solving process?

If the answer to this last question is yes, begin the process over … that is why it is referred to as the OODA Loop.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

Telemedicine Roadblock

As the United States struggles with healthcare reform, including trying to figure out how to provide healthcare coverage to all Americans without having an ample supply of providers, one possible remedy looms on the horizon. Telemedicine has proven to increase access to care and reduce costs via teleconsultations and remote patient monitoring. However, there are several barriers slowing its adoption throughout the U.S. Among those barriers, is the issue of physician licensing and the politics of “Interstate Medical Licensure.”

To be brief, physicians are licensed by the state in which they practice medicine. Under the traditional practice of medicine, this allows the doctor to care for a patient that comes into their office. With telemedicine, however, the patient may not be physically located in the same state as the provider who is rendering care and under the current rules, this means the provider must be additionally licensed in each state where these new patients are located. The proposed solution is to offer an “Interstate Medical Licensure” . . . but it is subject to approval by each state’s legislature. Additionally, each state considering such a licensure may edit the proposal to fit the desires of their state, meaning it is highly unlikely that the laws will be identical in each state that adopts the solution.

The Federation of State Medical Boards (FSMB) drafted the licensure solution in September 2014 and several states are currently taking it up for discussion. Thirteen states have formally introduced the proposed statute in their legislative chambers and more than twenty-five state medical and osteopathic boards have publicly expressed support for the compact. The three states that have passed the Interstate Medical Licensure Compact:

  • South Dakota
  • Utah
  • Wyoming

The ten states that have introduced Interstate Compact legislation:

  • Illinois
  • Iowa
  • Maryland
  • Minnesota
  • Montana
  • Nebraska
  • Oklahoma
  • Texas
  • Vermont
  • West Virginia

Additionally, sixteen U.S. Senators have endorsed the measure. This barrier to telemedicine is slowly being addressed and there are certainly many opponents to interstate medical licensure. What are your comments about allowing physicians to treat patients across state lines?

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.