Timothy
S. Hollingshead, DPM, President, The Hollingshead Group
I recently took a road trip that led me through some of our country's
most beautiful scenery. Everything from the Great Plains, to the Rocky
Mountains, to the desert. During this trip I sat in about the same place
in the same environment listening to the same question, "Are we
there yet?" While everything around me changed I remained relatively
the same. Over the last decade we
have witnessed dramatic changes in the healthcare scenery. Much of which
has left us feeling like victims, as if we, the providers, the main
producers, the backbone of the industry, could only sit idly by and
watch the scenery change. We have witnessed the rise and fall of managed
care, the exodus towards practice management companies and now the retreat
from such enterprises. Our overhead expenses have continued to increase,
reimbursements decrease, and malpractice claims have grown. With all
of the change in our industry how much have we changed? "Are we
there yet?" The most important and powerful change that we now
can effect is in leadership.
We are reaching a time when the median number of doctors in practice
has only known managed care. They have never truly appreciated the value
of their service, skill, and/or knowledge. Many doctors became "clock
punchers" relegating the duties of leadership to practice management
companies, business
managers or some other surrogate. In many cases this has proven to be
ineffective, and even disastrous. Take a moment and recall your own
experience, or that of a colleague who may have left the area or retired
early. We see through these experiences that delegating the leadership
responsibilities of a group or solo practice to these outsourcers has
done very little to return the control of the business of medicine to
the rightful authority, nor has it produced more free time, reduced
our risk of a malpractice claim, or eliminated the stress. Physicians
are buying back the ownership of their clinics and practices. The realization
of who controls the industry is slowly dawning. We can no more offload
our responsibility. We are only victims if we choose to be such. The
responsibility is ours and ours alone. By learning and even mastering
the skills of leadership we can control the business of healthcare.
We can learn to love the practice of our skills instead of hating the
prospect of another full day. We can reduce the risk of malpractice
claims.
In
a previous article we discussed how excellent communication skills could
mitigate the risk of malpractice claims. Communication is but one of
the principles of good leadership. I find it interesting to note that
the laws of man can be manipulated even cheated upon and one may still
derive a level of success. But how secure is that success? Just look
at the news reports of all of the corporate "leaders" who
are being indicted and even convicted for crimes that began as a mere
manipulation of the numbers. Of equal interest and perhaps more substance
is the fact that one cannot manipulate or cheat the processes of nature
and hope to achieve any success. How many farmers do you know who would
expect a harvest without planting? How many ranchers could expect production
without feeding their stock? I am not suggesting that we give up our
profession to become farmers and ranchers. However, the principles of
the law of the farm or harvest are natural and lasting and dependable.
When these principles related to this law are applied to the business
of medicine we can go beyond success. From this law we are given principles
of success and inspired leadership. It puts order to our business, decreases
the stress, helps us make the time we have been trying to find, improves
our risk management, and after all is said and done, it is renewing.
It takes work to apply it; it cannot be cheated, and best of all it
is proven. There are seven principles in the law of the harvest. These
are vision, planning, seedbed preparation, planting, cultivation, irrigation,
and finally the harvest.
As
physicians we have a natural responsibility toward developing our respective
roles as leaders. This role of leadership is multifaceted. We have a
responsibility to lead our patients and to provide leadership in the
office. The responsibility to lead our patients is often confused with
what many of us consider our right to dictate care. When we exercise
this perceived right we often assert our values upon our patients and
remove from them their responsibility to makes choices. When this is
done we have assumed not only all of the credit but all of the blame.
When I speak to lay groups about such topics as "How to Talk with
Your Doctor" I am always impressed with the seemingly paradoxical
affinity patients have for their doctors. The reasons to love their
doctors equal the reasons to hate their doctors. One such response came
unexpectedly when a middle aged, intelligent women reported how angry
it made her when her male Gynecologist said "I know more about
your body than you." However intended this statement is irresponsible
and condescending. Of course the doctor knows more academically that
is why the patient is sitting in our office. It is our job to know the
human body and how to treat its ailments. Wouldn't you think that a
women, or any patient for that matter, would be more in tune with their
bodies than we may ever assume? Think about it. A patient may not know
the scientific name, disease process, or prognosis but they do know
how they feel, what seems to work for them, and above all, they always
have a choice. But our responsibility as leaders of our patients is
to protect their right to make a decision and then the challenge is
to honor that decision. Through careful communication and effective
education patients can be lead to take responsibility for their role
in their healthcare. Early on in my practice I thought it to be a great
opportunity for me when a patient would say, "You're the doc, it's
up to you to make the decision." Now I recognize this as the patient
giving up responsibility for their healthcare. It then becomes my job,
as a patient leader, to educated the patient that although I understand
the disease process and I know what has worked well in my experience,
the ultimate decision is the patients'. IT is important to note that
this is the first step towards treatment plan compliance. We will discuss
in further articles more completely about how to motivate the reluctant
patient.
The fact that the doctor is the leader in the office is a concept that
is getting more and more attention. The doctor is the leader in the
office for two reasons. First, the doctor leads the staff. Leadership
in the office is a top down effort. We are ultimately responsible for
everything that goes on in our practices. This includes, but is certainly
not limited to, everything from sweeping the floor to collections, from
stocking the treatment rooms to patient satisfaction, from dedicated
loyal employees to the processes and systems used in the practice. Of
course this doesn't mean that we must do all of these things. However
we must delegate effectively and provide regular accountability for
the privilege of these responsibilities. We lead by example whether
it is good or bad. Do we demand our staff and patients to be on time
when we are not? Do we expect prompt payment when we do not return phone
calls in a like manner? How can the staff put patients first when the
staff feels like they come in last? The power of example is the very
foundation of our training programs. Early on we learn surgical techniques
and clinical judgment at the side of a mentor or teacher. This same
experience is a continuum in our practices. The second reason is that
the doctor is the main producer. It is this role that requires us to
examine and engineer systems and processes and streamline our efforts
without losing our effectiveness. The Time Efficient Patient Effective™
program is our approach to this challenge at The Hollingshead Group.
This program helps doctors recognize the straightest possible route
from point A to point B. It maximizes patient contact time without sacrificing
the effectiveness of the treatment plan. It is a time and effort management
program designed to make more discretionary time for both physician
and staff. As the main producer it is by our example of compassionate
patient care and effective use of time that will teach the other producers
in our offices and clinics. Experience and reality reveal that no one
will work harder than you, and most will work just enough to maintain
their employment
The
scenery will continue to change as we drive down the healthcare highway.
We can choose to be passengers and continue to complain about the trip
or we can take control of the vehicle through effective leadership and
make it what we want to be. As physicians we can control the business
of healthcare through learning some business and leadership skills.
This doesn't happen at a weekend course or an overnight seminar. Conversely
you will not need to get an MBA. However it will take time and dedication.
Physician leadership is essential if not required. Through effective
physician leadership we can reduce our risk of a malpractice claim.
Remember that change is not a destination, it is a process. I think
that we must continue to ask the question, "Are we there yet?"
Dr. Timothy S. Hollingshead, DPM is founder and president of The Hollingshead
Group, a program dedicated to showing physicians and health care professionals
how to go beyond the successful practice.
He is Medical Director for the Northeast Colorado Diabetic Outreach
program, and serves on the Advisory Board for the National Academy of
Child Development. Certified by the American Board of Podiatric Orthopedics
and Primary Medicine, he is also a fellow of the American College of
Podiatric Orthopedics and Primary Medicine. He is a recipient of the
Arthur Weinfield Memorial Award.
Timothy
S. Hollingshead, DPM, President, The Hollingshead Group
we
have witnessed dramatic changes in the healthcare scenery. Much of which
has left us feeling like victims, as if we, the providers, the main
producers, the backbone of the industry, could only sit idly by and
watch the scenery change. We have witnessed the rise and fall of managed
care, the exodus towards practice management companies and now the retreat
from such enterprises. Our overhead expenses have continued to increase,
reimbursements decrease, and malpractice claims have grown. With all
of the change in our industry how much have we changed? "Are we
there yet?" The most important and powerful change that we now
can effect is in leadership.
business
managers or some other surrogate. In many cases this has proven to be
ineffective, and even disastrous. Take a moment and recall your own
experience, or that of a colleague who may have left the area or retired
early. We see through these experiences that delegating the leadership
responsibilities of a group or solo practice to these outsourcers has
done very little to return the control of the business of medicine to
the rightful authority, nor has it produced more free time, reduced
our risk of a malpractice claim, or eliminated the stress. Physicians
are buying back the ownership of their clinics and practices. The realization
of who controls the industry is slowly dawning. We can no more offload
our responsibility. We are only victims if we choose to be such. The
responsibility is ours and ours alone. By learning and even mastering
the skills of leadership we can control the business of healthcare.
We can learn to love the practice of our skills instead of hating the
prospect of another full day. We can reduce the risk of malpractice
claims.
In
a previous article we discussed how excellent communication skills could
mitigate the risk of malpractice claims. Communication is but one of
the principles of good leadership. I find it interesting to note that
the laws of man can be manipulated even cheated upon and one may still
derive a level of success. But how secure is that success? Just look
at the news reports of all of the corporate "leaders" who
are being indicted and even convicted for crimes that began as a mere
manipulation of the numbers. Of equal interest and perhaps more substance
is the fact that one cannot manipulate or cheat the processes of nature
and hope to achieve any success. How many farmers do you know who would
expect a harvest without planting? How many ranchers could expect production
without feeding their stock? I am not suggesting that we give up our
profession to become farmers and ranchers. However, the principles of
the law of the farm or harvest are natural and lasting and dependable.
When these principles related to this law are applied to the business
of medicine we can go beyond success. From this law we are given principles
of success and inspired leadership. It puts order to our business, decreases
the stress, helps us make the time we have been trying to find, improves
our risk management, and after all is said and done, it is renewing.
It takes work to apply it; it cannot be cheated, and best of all it
is proven. There are seven principles in the law of the harvest. These
are vision, planning, seedbed preparation, planting, cultivation, irrigation,
and finally the harvest. 
As
physicians we have a natural responsibility toward developing our respective
roles as leaders. This role of leadership is multifaceted. We have a
responsibility to lead our patients and to provide leadership in the
office. The responsibility to lead our patients is often confused with
what many of us consider our right to dictate care. When we exercise
this perceived right we often assert our values upon our patients and
remove from them their responsibility to makes choices. When this is
done we have assumed not only all of the credit but all of the blame.
When I speak to lay groups about such topics as "How to Talk with
Your Doctor" I am always impressed with the seemingly paradoxical
affinity patients have for their doctors. The reasons to love their
doctors equal the reasons to hate their doctors. One such response came
unexpectedly when a middle aged, intelligent women reported how angry
it made her when her male Gynecologist said "I know more about
your body than you." However intended this statement is irresponsible
and condescending. Of course the doctor knows more academically that
is why the patient is sitting in our office. It is our job to know the
human body and how to treat its ailments. Wouldn't you think that a
women, or any patient for that matter, would be more in tune with their
bodies than we may ever assume? Think about it. A patient may not know
the scientific name, disease process, or prognosis but they do know
how they feel, what seems to work for them, and above all, they always
have a choice. But our responsibility as leaders of our patients is
to protect their right to make a decision and then the challenge is
to honor that decision. Through careful communication and effective
education patients can be lead to take responsibility for their role
in their healthcare. Early on in my practice I thought it to be a great
opportunity for me when a patient would say, "You're the doc, it's
up to you to make the decision." Now I recognize this as the patient
giving up responsibility for their healthcare. It then becomes my job,
as a patient leader, to educated the patient that although I understand
the disease process and I know what has worked well in my experience,
the ultimate decision is the patients'. IT is important to note that
this is the first step towards treatment plan compliance. We will discuss
in further articles more completely about how to motivate the reluctant
patient. 
The
scenery will continue to change as we drive down the healthcare highway.
We can choose to be passengers and continue to complain about the trip
or we can take control of the vehicle through effective leadership and
make it what we want to be. As physicians we can control the business
of healthcare through learning some business and leadership skills.
This doesn't happen at a weekend course or an overnight seminar. Conversely
you will not need to get an MBA. However it will take time and dedication.
Physician leadership is essential if not required. Through effective
physician leadership we can reduce our risk of a malpractice claim.
Remember that change is not a destination, it is a process. I think
that we must continue to ask the question, "Are we there yet?"