A Patient’s Perspective

The changes to the healthcare industry are increasingly focused on addressing patients as consumers. Such a change means that providers must of course emphasize quality and work toward price transparency, but they must also seek to determine what patients desire most. It is this last effort that is transforming the healthcare sector more like businesses of other sectors; what consumers want, is what drives competition and ingenuity (and oftentimes commoditization).

Perhaps more than ever, physicians need to be focused not just on attracting more patients, but also on not losing the patients they have.  Under the healthcare reform legislation, the federal government views patients as consumers.  Consequently, national attention has been placed on the patients as consumers, and that attention has not gone unnoticed.  Indeed, patients are educated healthcare consumers and many are tired of being treated poorly.  Aside from physician-specific interaction, there are four areas practices should be attentive to in order to prevent losing current patients.

Staff Demeanor.  The correlation between respect and patient safety has been well-documented, but a disrespectful staff can also impact the health of your practice.  Whether it is absent-mindedness or plain unprofessional behavior on behalf of your staff, these poor attitudes will lead to lost patients.

No matter how small the staff, most practices could use a primer (or refresher) on customer service.  Using words such as “please”, “thank you”, and “you’re welcome” can go a long way.

Office Appearance.  There are many things your practice can do to overcome this without spending a ton of money on remodeling.  Does your staff straighten magazines and tidy up throughout the day?  How old is your reading material in the lobby and waiting areas?  It is a good rule to never have magazines that are a year old.  When is the last time your lobby received a fresh coat of paint?  If you have a small operation and do not have janitorial service nightly, then on the “off” days, have your receptionist run a vacuum through the lobby area at the end of the day.

Design Elements.  Patients prefer hospitality design elements.  To this end, medical offices and hotels share the challenge of designing facilities that are cost-effective, are functional, and promote their organizations’ missions.  Research shows that facility design influences customer behaviors and brand perceptions in a variety of industries.  Customers make decisions about a company’s capabilities and quality based on their perceptions of the physical setting.  Such consumer decisions are very important in healthcare since clinical outcomes are often intangible and difficult to measure for non-clinicians.  Research has shown that a patient’s perception of quality can be influenced by facilities design.  Several studies found that patients surveyed in physically attractive waiting areas gave higher ratings on quality of care and patient-staff interactions.  These patients also were more willing to recommend the facility to others than those surveyed in comparatively unattractive waiting rooms.

Appointment Scheduling.  Scores of data from patient satisfaction surveys show that patients are extremely frustrated when their appointment time is delayed significantly.  While patient care is certainly not as programmed as an automated manufacturing line, many practices could run much more efficiently if they scrutinized the operational flow of the practice.  As time-impacting issues arise during the day, communicate that to your patients.  They will be much more forgiving if they are aware of the schedule; remember, it is highly unlikely that this appointment to your office is the only thing they have on their agenda for the day.

Physicians should take a measured approach to the future of their practice, keeping in mind that patients define value as appointment access and availability.  Patients still tend to assess provider quality in terms of service and access.  It’s the wait time, the rude staff, and the inability to stick to a schedule that anger patients.  The key is to not have patients leave the practice because of poor office policies or simple misunderstandings.


Contact ABISA for healthcare consultancy support or speaking engagements.

Evolutionary Strategic Planning

Some of my counterparts have a firm belief that strategic planning is a rigid process which should occur once every three to five years.  The process they undertake is often done during an off-site planning session with the outcome being printed up in a large three-ring binder.  In less than six months, those binders are sitting on a shelf somewhere collecting dust, never to again see the light of day.

I, on the other hand, believe that strategic planning should be a continuous process involving the ongoing adjustment of means and ends.  We should also view planning as an evolutionary process involving continuous adjustment and improvement.  We can think of strategic planning as solution-by-evolution rather than solution-by-engineering.  We should generally not view strategic planning as trying to solve a problem in one iteration because most healthcare business problems are too complex (especially in today’s environment) to be solved that way.  To quote Helmuth von Moltke (German Field Marshal):

“No plan survives contact with the enemy.”

In many cases, it is more advisable to find a workable solution quickly and improve the solution as time permits.  What matters most is not generating the best possible strategic plan (the polished edition for a revered binder) but achieving the best possible result.  Oftentimes, a reasonable course of action executed quickly and aggressively is better than an optimal course executed too late.  We should generally view strategic planning as evolving continuously and iteratively toward the best executable solution that circumstances allow until the process is interrupted by the imperative to act.

Strategic planning bridges the gap between where we are standing today and where we want to reach.  It is a requirement for a sustained competitive advantage.  Left to its own devices however, strategic planning leads to rigidity.  Following a predefined plan when circumstances are changed may not bring positive results for the healthcare organization.  Effective strategic planning continuously refines and deepens the plan as time permits.


Contact ABISA for healthcare consultancy support or speaking engagements.

Planning for an Unknowable Future

The defining features of the strategic planning challenge are uncertainty and time.  More than anything else, considerations of time and uncertainty dictate how we approach strategic planning.  All strategic planning is based on imperfect knowledge and involves assumptions about the future.  By definition, strategic planning is future-oriented, and the future by nature is uncertain.  No matter how determined we are to be fully prepared for a situation, there are finite limits to our ability to plan for the future.  The more certain the future is, the easier it is to plan.  Alas, the difficulties with healthcare strategic planning.

Uncertainty increases with the length of the planning horizon and the rate of change in the healthcare environment.  By planning horizon, I am referring to how far into the future we try to shape events.  In order to be of any use, strategic planning must try to anticipate and actively influence the future.  By anticipating the future, strategic planning allows us to prepare and coordinate our actions.  The farther in to the future we can plan, the more time we can allow ourselves to prepare.  However, the farther into the future we plan, the wider the range of possibilities and the more uncertain our forecast.  A fundamental tension thus exists between the desire to plan far into the future in order to facilitate preparation and coordination, and the fact that the farther into the future we try to plan, the less certain we can be, and the less relevant our preparations may be.

Given the uncertainty of healthcare reform, we must recognize that the object of strategic planning is not to eliminate or minimize uncertainty, but to allow us to decide and act effectively in the midst of the uncertainty that is healthcare reform.  While strategic planning contains an element of forecasting, we must recognize that the object of strategic planning is not to predict the future.  To be clear, how accurately a strategic plan forecasts the future is not generally a measure of the plan’s effectiveness.  Rather, the measure of effectiveness is how effectively strategic planning allows us to adapt to an uncertain future.

Not only is healthcare reform uncertain, it is (and will continue to be) always changing.  Consequently, strategic plans tend to lose their value over time, and they must be updated as the healthcare landscape changes.  The more frequently and quickly the healthcare landscape changes, the more often a strategic plan must be revised.  Since physician leaders are already busy taking care of patients, we must use available strategic planning time wisely.  All planning takes time, so remember that strategic planning done well in advance of the need to act may actually permit us to act more quickly when the time for action arrives.


Contact ABISA for healthcare consultancy support or speaking engagements.

U.S. Nursing Situation

Registered nurses (RNs) provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members.  They work in a variety of settings such as hospitals, physicians’ offices, home healthcare services, nursing care facilities, correctional facilities, schools, or serve in the military.  Demand for nurses in the United States is constantly increasing.  Much of this nursing demand is attributed to the increasing size of our senior citizens.  Data from the National Institutes of Health shows that the population of senior citizens will increase 75 percent (to 69 million Americans) between 2010 and 2030.  Of course, as one’s age increases, so does the prevalence of adverse health conditions.  The National Council on Aging claims that 80 percent of senior citizens have at least one chronic condition and that 68 percent have at least two.

Unfortunately, there is an ever-growing shortage of nurses in the United States.  The Bureau of Labor Statistics reports that there will be a 1.2 million shortfall of RNs between 2014 and 2022.  The American Nurses Association projects that 700,000 nurses will retire or leave the labor force by 2024.  An article in the American Journal of Medical Quality demonstrated the forecasted shortages of RNs in each state.  The researchers assigned a letter grade to the states, predicting that the number of states receiving a “D” or “F” will increase from 5 in 2009 to 30 in 2030.  In their report, they note that all 12 states forecast to receive an “F” are in the south and west (Alaska, Arizona, California, Florida, Georgia, Hawaii, Idaho, Montana, Nevada, New Mexico, Texas, and Virginia).

The Institute of Medicine (IOM) released a report on the future of nursing in the United States.  In the report, they make the recommendation that nurses achieve higher levels of education and training.  By 2020, the IOM calls for the proportion of nurses with baccalaureate degrees to increase to 80 percent.  But that may be easier said than done, according to a report by the American Association of Colleges in Nursing (AACN).  The AACN states:

“U.S. nursing schools turned away 79,659 qualified applicants from baccalaureate and graduate nursing programs in 2012 due to insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints.”

And how’s the pay?  A recent study of 20,000 healthcare professionals found a decrease in nurse salaries over the past year.  In the survey, nurses reported a 3.1 percent decrease in pay, for an average salary of $61,875.  Additionally, the survey found that only 44 percent of nurses are satisfied with their salaries, with the dissatisfaction driven primarily by the perception that their pay is below what their experience warrants.  Consequently, 13 percent of nurses are actively looking for new jobs, while 17 percent are satisfied in their current positions and plan to stay there.



Contact ABISA for healthcare consultancy support or speaking engagements.