What does a healthy medical practice look like?

It’s an irony of ironies. Americans spend far more than any other nation on their healthcare, enjoy the benefits of the latest and greatest technologies and research, but remain chronically discontented with what they are getting. Patients blame physicians; physicians blame lawyers; and everyone blames the government. Two recent high-profile reports highlight the dilemma:

• In 1998, Louis Harris and Associates found that 79 percent of the population said their system needs either "fundamental change" or to be "completely rebuilt."

• In 1999, the Institute of Medicine released their landmark report, “To Err is Human,” estimating that between 44,000 to 96,000 people die each year in U.S. hospitals due to medical errors that could have been prevented. It describes the healthcare system as being “at odds with itself.”

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Even far earlier, astute observers recognized the complexity and challenges of sustaining a high quality healthcare system. Consider this quote from Francis Peabody in a 1927 address to Harvard medical students:

“When one considers the amazing progress of science in its relation to medicine during the last thirty years and the enormous mass of scientific material which must be made available to the modern physician, it is not surprising that the schools have tended to concern themselves more and more with this phase of the educational problem…” 

Peabody reminds his audience of the need to balance medical advances with healing relationships; to hold on to traditional bedside manners while bringing the latest medical knowledge to the patient relationship.

Even the father of modern management, Peter F. Drucker, acclaimed in Management Tasks Responsibilities Practices (1973) that the typical hospital has grown into “one of the most complex social institutions around.”

How is it possible, in the face of such complexity and historical momentum, to create a healthy environment for the delivery of medical care? What can an individual medical practice do to become a healthy place to work and to receive care?

The quest for answers to these challenges drove me to reflect on what I have learned from nearly 400 clients across the U.S., and from my healthcare development experiences in developing countries such as Honduras, Romania and Kyrgyzstan.

Defining a Healthy Medical Practice 

Health is difficult to describe in individual human beings, much less in organizations. We all know of apparently robust athletes who die suddenly of some obscure undiscovered condition; and of other, more unattractive figures who wallow in unhealthy behavior to a ripe old age. Life isn’t fair. Genetics and environment conspire against some of us and leave others relatively unscathed. 

Organizations are much more than the collection of individuals that compose it, and the health of an organization depends on much more than the physical and emotional health of its members. Consultant Tony Smith is the author of Parzival's Briefcase: Six Practices and a New Philosophy for Healthy Organizational Change, in which he highlights the following characteristics of a healthy organization:

• one must have a vision;

• intentions must be understood;

• work must be executed with integrity;

• life should be experienced fully;

• expression should be stressed; and

• relationships must be based on knowledge

Smith and others have attempted to characterize the healthy organization as a place that feels good, but I think there is more to it than that. The Institute of Medicine has held out the goal of making medical care safe, but I think there is more to a healthy organization than the absence of errors as well. It has to be a place that knows what it is about, that balances a host of competing interests, and that enriches the lives of those who serve as well as those who are served. Thus, my definition: 

A healthy medical practice is an exceptional place to work and an exceptional place to receive care. It is a sustainable enterprise with compassion in abundance.

Getting Healthy Again 

OK, so what does that mean for a medical practice? Here are a few practical ideas for developing and sustaining a healthy organization: 

• Spend some time to build consensus about the purpose of the medical practice. It may seem obvious that you’re in the business of taking care of patients, but an honest assessment of the organization’s behavior may reveal other – sometimes conflicting – purposes. In most practices there are times when financial ambitions can compromise patient service or employee morale; or when being satisfied with minimums can compromise quality of care. Build a mission statement that can serve as a pre-made standard for how the organization wants to hold itself accountable. Build it with input and honest feedback from everyone – physicians, staff, and patients, and then share it widely so the organization can function transparently by the standard it wants to uphold.

• Build a budget to balance competing interests among physicians’ needs, patients’ needs and staff’s needs, and to guide day-to-day management decisions. An operational budget can function as a benchmark for accomplishing the goals the practice intends to accomplish. When you compare actual monthly revenues and expenses with the budget, you can quickly identify early warning signals in time to take corrective action, or to dig deeper into an understanding of why the variances occurred. In short, a budget gives you an opportunity to manage the effects of business risks in real time.

Will a healthy organization have a healthy bottom line? Healthy organizations understand that profits are necessary for sustainable growth, but they also understand that pursuing profits to the exclusion of other goals is short-sighted and will ultimately weaken the organization. 

• Build systems of feedback to nurture good communications. At a minimum, physicians and staff should conduct regular meetings to share information that impacts the organization’s ability to fulfill its purposes. Groups that are committed to building its organizational health also commit to receiving and listening to feedback from patients. A patient satisfaction survey is the most common form of this feedback, but other organizations might want to include focus groups for in-depth insights, a toll-free phone number for patients to vent their feelings and impressions of how they were served at the practice, or an in-office suggestion box where people can express their concerns.

Medical encounters can be intense human interactions. Physicians and their support staff are dealing with people at some of the most vulnerable moments of their lives. Systems that foster good communication all around are vital for managing medical and business risks, building trust and all its healing qualities, and for deepening relationships that serve as the foundation for patients to thrive. Consistently healthy communications help medical practice organizations find the deep satisfaction that comes from serving others. 

• Healthy organizations are continuously learning. They are courageous enough to regularly critique everything they do, with an eye toward improving it and getting better results. The prevailing attitude is one of constructive discontent. Physicians and staff alike are constantly ready to abandon processes and methods that aren’t working well, and are ready to try new ideas with a spirit of adventure and curiosity.

Continuous learning applies to medicine as firmly as it applies to business methods. Physicians in healthy organizations are likely to have constant access to the internet for the latest information about diagnostic and treatment options. They may systematically submit to regular reviews by their peers, and keep an eye open for cutting-edge technologies that can help them improve their role in healing relationships. They are likely to be early adopters of electronic medical records, online interactions with their patients, and principles of open access, all with the goal of building healthy patient relationships. 

This list isn’t intended to be comprehensive, but it is designed to stimulate ideas for physicians and managers. It hints of ways to assess your own organizational health, and to identify the steps to take to increase it. It doesn’t definitively solve all the national problems related to under-served populations, medical errors, declining reimbursement and increasing costs, but it demonstrates that healthy medical practices can go about their business in spite of all the complex challenges.

About the Author: Ken Hekman is a medical management consultant based out of Holland, MI. For more information or consultation go to www.hekmangroup.com or email Ken@hekmangroup.com.