Why are some medical practices more patient-friendly than others? And why do we care? The simple answer is quality, competition and survival. The current medical business environment is hostile. To address the threats, one multispecialty practice leader asked several senior members for their perspective on the patient service problem. At a Tuesday evening meeting, he asked directly: What do you think is the problem and what do we do about it?
Joseph (family practice): The problem is our product. We are offering old-fashioned service that is now too time-consuming with waiting times soaring. If we stick to this tradition, we will go bankrupt.
Mary (psychiatry): I think it is more an issue of attitude and teamwork. Staff turnover is high while satisfaction is down. The psychological climate here is not supportive of patientsdoctors are too blunt, nurses too hassled and surly. The people are the problemchastise and fire.
Richard (practice manager): The people are a problem because we have not invested in the latest comforts for patients and staff. The medical business of the future seems to be in helping patients with all of their medical needs in a physical setting that mirrors home and hotel. We must be a part of thatmeaning we build a new surgery outpatient center with comfortable furnishings, cafeteria, free parking and state-of-the-art communications.
Readers will recognize these answers as the classic three parts of patient-satisfaction surveys: clinical technical processes, interpersonal concerns and amenities. However, modern complex organizations demand that we look more closely at the practice.
Experts promote the use of mental models that define and describe how organizations such as medical practices behave. One view depicts medical practices as networks of five systems: clinical procedures from diagnosis through treatment, structure, psychological climate, management and culture. Organization behavioral problemssuch as lack of patient-friendlinessare viewed as rooted in one, and frequently several, of the five systems.
Each participant in the example above identified a problem in a separate domain. And each had only a part of the diagnosis and a part of the solution. Experts are convinced that many problem-solving efforts fail because their analysis of the causes is not rich enough. A quick fix such as team-building that offers a psychological intervention will not solve the problem if it is rooted in poor medical practice, or a flawed incentive structure. In short, the solution lies in a multifaceted effort to address each dimension.
Five recommendations presented at a subsequent practice meeting illustrate the approach. To improve the patient-friendliness of the practice the partners will:
- Redefine the core procedures, balancing traditional caring with new ways to improve productivity, e.g., that also reduce wait time (clinical product and process).
- Conduct a salary survey and make adjustments if lack of parity with competitors is found (structure).
- Get feedback from employees about the patient-friendly climate, conduct team-building sessions and offer training on patient communications (psychological climate).
- Develop a strategic plan for the practice analyzing new threats and opportunities in the health industry (e.g., competitor facilities), the practices historical strengths and weaknesses, and create a vision of a desired future (management).
- Conduct a culture audit to determine the degree to which the staff model and promote a patient-friendly atmosphere. Consider ways to communicate to the staff the strength of discipline diversity and the value of patient points of view, e.g., annual meetings, internal letters and personal visits by practice leaders attuned to the importance of this message (culture building and change).
James Ziegenfuss Jr.Pennsylvania State University