Some medical practices, both large and small, just have an air of positivity. They convey a sense of "charisma" and have physicians and staff who are generally happy and engaged. And they're profitable. Other practices lean the opposite way. They're squeaking by each month to pay the bills, have high staff turnover, and their physicians feel as though they're battling a daily grind. Why the big disparity? Sometimes there are external factors that wield a huge influence: patient population, geographic location, perhaps a very popular physician. But in many cases, success has more to do with how a practice is being run. Medical Group Management Association (MGMA) surveyed 676 group practices that were considered "better performers" in such areas as operations, productivity, profitability, and value. The findings revealed that certain factors are typically found in more successful practices. In an interview here at the MGMA 2018 annual conference this week, Halee Fischer-Wright, MD, CEO of MGMA and a pediatrician in Denver, Colorado, gave some unique insights into the results. Of note, even though the measures of success focused on profitability and operations, physicians in those practices tended to experience greater satisfaction in their work, says Fischer-Wright. "One finding was that in practices where the physicians are more satisfied, a large part of that had to do with the culture," says Fischer-Wright. "In a higher-satisfaction-practice culture, physicians and providers all the way down the line are fully engaged in their work and also have a feeling of autonomy." Halee Fischer-Wright, MD "The culture piece becomes as important as the traditional operations measures," she says. "In practices with great cultures, the practice is charismatic. You want to be in the practice; you want to be a patient there; you want to work there," she says. "It wins awards." By contrast, she notes, in a practice in a poor or troubled culture, there's unhappiness, a higher turnover rate, second-rate patient experience, and even more expense. "Culture makes a huge difference," says Fischer-Wright. "In a medical practice, unlike when working in a hospital, the practice can look at and decide what they actually want for this practice. Is it low turnover? More money? Satisfaction among the clinicians? Then they can work to make that happen." A key ingredient of many practices' success is teamwork, says Fischer-Wright. And yet teamwork is typically not taught in medical school. "As we were becoming doctors, nowhere along the line was there a place where we had to ask, 'How can I work with someone else to do this better?'" says Fischer-Wright. "We are not in an industry where we learned the values of working in teams." The Traits That Add Up to Success Beyond culture, there are eight key characteristics of better-performing practices. More patients. Better-performing primary care practices have almost 300—if not more—additional patient encounters per physician versus other practices. They're also earning 8.6% greater net income per physician. Nonsurgical specialty better performers have nearly 400 more patient encounters per physician and 6.1% greater net income per physician. Increasing the number of patients can be a small increase that's easy to absorb, says Fischer-Wright. She says that the practice where she worked added three patients per physician per day (going from 12 to 15), and it brought the practice to profitability. Monitoring of satisfaction. Better-performing practices are more likely to conduct clinician and staff satisfaction surveys. They want to take the temperature of their physicians and staff members and uncover any incipient dissatisfaction. And then they address it. Such practices tend to be open to suggestions, more receptive to feedback, and look for ways to improve. They also actively solicit feedback, knowing that many people are not comfortable with voicing discontent. More communication. An emphasis on improved communications was one notable feature of better-performing practices. The practices reported a variety of communication methods, including monthly meetings in which all staff were asked to help solve problems that were identified; monthly newsletters or email updates that showed a comparison against the practice goals; daily or weekly "huddles" of up to 15 minutes to catch up on immediate priorities; regular face-to-face communication, including management walk-arounds; and team-based or cross-functional committees devoted to improvement. Regarding physicians, Fischer-Wright referenced a popular maxim: "Do you want a team of champions or do you want a championship team? Physicians need to do a better job of looking for a championship team," she says. Continued learning. In practices where continued learning is emphasized, staff members not only are able to perform their work more knowledgably, but they also feel more pride in themselves. When a practice invests in its staff's education and skillsets, staff see themselves as an important part of the team and the team's success. Attention to finances. Keeping on budget is critical to financial success. Practices that do well closely monitor their budget against a plan and they regularly revisit their strategy. They don't wait until the end of the year, hand everything over to "the finance people," and wait anxiously to find out how the balance sheet is doing. Instead, successful practices proactively assess what's going well and what needs more attention—and perhaps revision. Regular assessment of staff counts. Better-performing practices invest in their personnel, cross-training staff to support all of the practice operations. Jobs are often less narrowly defined than in the past, and more staff are equipped to jump in and perform tasks that help the workflow when needed. New technology. Investing in improving operations by adding technology and tools is a frequent focus of better-performing practices. Typically, these practices have someone on the clinical or executive staff to do the research, stay abreast of options, and prioritize expenditures. Patient-oriented. Better-performing practices look for opportunities for patient engagement wherever possible. Patient portals are an example. Not only do they encourage more patients to come in for wellness visits, but they also provide increased access to the practice, which also helps revenue. "Healthcare has moved from the model where the physician was the center of the medical practice; everything, including scheduling, was developed around the convenience of the physicians," says Fischer-Wright. "Now we are moving toward more patient focus or more consumer focus. Many physicians are struggling with it, but those who accept it can do well." Source
