A case where captives were drained of their blood so it could be sold to private medical clinics raises serious concerns about the complicity of the medical establishment and the lack of proper oversight over hospitals and clinics in India. The case could become a problem for the country, which is becoming a leading destination for so-called medical tourism. Some 500,000 Americans travel overseas each year for medical treatment, according to the National Coalition on Health Care. Much of the medical tourism are for treks to Asian hospitals in Thailand, Singapore and India.
Editor's note: The following is an excerpt from A Marketer's Guide to Physician Relations, written by Kriss Barlow and published by HealthLeaders Media.
Just as best-practice organizations need capable staff, so, too, do they need capable management. As the number of physician relations programs grows, there is a tremen-dous opportunity for those who want to rise to the level of management. Regardless of the program's maturity, effective leaders continue to balance their ability to look at the whole ladder, while never losing site of the individual rungs.
The manager's day comprises many parts that hopefully form a satisfactory work experience for the manager and for the team. The best managers have a range of abilities that form the right skill set for the role:
They help staff establish the right habits and stick with them. Good work habits are the underpinning for any position, yet it is much different when you can actively monitor work performance in an office or a unit than out in the wild blue yonder. The best managers find creative methods and design systematic tools to keep apprised of their team's level of effectiveness in the field. They use tools such as performance man-agement systems, weekly reports, ride-alongs, and field assessments to create a strong work environment. They trust their instincts in this area. If a representative is slacking off on appointments, they are comfortable confronting him or her even when lacking hard evidence. The approach and finesse that is required in this instance makes a real difference among strong physician relations leaders.
They reward the positive. In a job that has a fair amount of rejection, the best managers find positives and recognize them. The world of working with gate-keepers, sitting in a practice for an hour only to have the doctor get called to deliver a baby or stepping out of the car in August heat and humidity is not glamorous. In addi-tion, those who are good at their jobs add a full dose of pressure on themselves to keep up the pace.
They recognize the positive attributes of their staff, and they do so in front of others. They put team members' names in their reports and call out members when members have a good idea or create inroads when others were unable to do so. Personal recogni-tion goes a long ways on a day full of rejection in the field.
They let people whine just a bit but continue to be proactive, as if to say, "Let's move on with what we can control-forward focus is the way to go."
They keep the internal team on task and accountable to its obligations. The pace and the list of tasks on everyone's plate--including the operations staff--is significant. Even when there are great systems in place, there are times when the changes asked for by the physician relations team may get pushed to the back burner. With capable management, there are regular and systematic reminders, and there are documented expectations based on the internal communication plan. This is a tremendous motivator for physician relations staff, not because the staff expects that problems will always be fixed immedi-ately but because the staff knows that there is someone who will bird-dog the issue and always go to bat for the staff's needs.
There are innovators who push themselves and the team further. What an awesome attribute for a physician relations leader to have. It is that blend of intuition and spark that lends itself to saying, "Let's try to position the orthopedic service with Dr. Smith this way and see if we can have an impact." It is the willingness to try a new approach to tracking or another way of looking at the integration plan with operations. It is not as though every idea is a magical success, but it does create wonderful synergy within the team. It creates market opportunity, even if only one out of every four ideas is a keeper. In the clutter of the market, that one idea may differentiate your services and cement a referral relationship. The part of innovation that separates great managers from the "all ideas, no substance" type is that the great manager has learned to share the idea, test it, gather feedback, and realize that beyond the idea there is a process for implementation that must be fine-tuned.
They create tools that demonstrate value. This is the attribute that is often the most obvious to people outside the department. Because the internal departments all have grids, outcomes, trended data, etc., they are interested in seeing if a "relationship program" can do the same. The best program leaders carefully think about the tools they need to be effective in creating the role, evaluating the role, reporting on barriers to suc-cess, and advancing the position. Some of today's tools are created to assess what is working internally, while others are designed to show the program impact. Most of the best program leaders with whom I have worked will quickly create preplanning, out-come, and issue reports. They balance measurement of activity in the field with the out-come and return on investment for the organization. With the ability to replicate the findings and report them out on a monthly basis, the best leaders use the database and other tools to more specifically home in on trends or market opportunities.
They make work fun. Of course, when you have oversight for a group of people who are gregarious, there is an almost mandatory obligation to lighten things up every now and again. Most field representatives are pushing hard to meet their weekly de-mands. The boss who can remind them they are valued, do something spontaneous, or make everyone laugh is a welcome addition to any management rank.
They are straight shooters. Every bit as important as a little fun in the workday is the ability to know that if things are not going well with performance or with the ability to fulfill obligations, the leader must work to educate, demonstrate expectations, and critique behavior that is below the norm. The team appreciates that the leader requires adherence to baseline expectations not only for the field role but also for interactions and behaviors that are in keeping with the team's reputation.
They have the right skills. The essential skill is the ability to balance people issues and organizational needs. There regularly will be compelling needs that are gathered in the field, as well as from department leaders begging the relationship leaders to "go tell them about our new service." On both sides there needs to be careful management, the ability to ask good questions, to decide what fits with the strategic goals and what would be nice versus what is essential to address to earn more referrals. Both tactics have chal-lenges. The expectation is that, regardless of the starting frame of reference, the right leader has the skills to create the right climate for success by working with both internal and external customer groups.
They are willing to be held accountable. There are many positions within healthcare where it's assumed you are doing your part if people generally like you and you manage your budget. The leader who takes on the physician relations function needs to be com-fortable with realizing that the program's success is measured by new growth. The leader is heavily judged on his or her ability to facilitate and manage this between inter-nal constituents and the external team.
Certainly, many of these attributes are consistent with those you desire in every leader. Again, the difference here is that the physician relations role is relatively new to the healthcare environment, so there is a lot of internal misunderstanding about what is ex-pected and how valued it is. The manager is the "face of the program" internally, so program positioning within the organization depends on how the manager carries the role.
To order a copy of A Marketer's Guide to Physician Relations, visit www.hcmarketplace.com or call HealthLeaders Media Customer Service at 877/727-1728.
Beaumont Hospitals has asked the state of Michigan for permission to build a $204-million emergency department expansion on its Royal Oak campus. If approved, the project would replace Beaumont's emergency center with a 96,000 square foot facility with 173 patient rooms, including an 11-to-20-room pediatric emergency unit. Also included in the expansion would be a 36-bed intensive care unit and four operating rooms.
Warren, MI-based St. John Health will trim its management staff and consolidate hospital programs to "take nonessential costs out of our operating structure," according to representatives from the health system. The changes are likely to result in some layoffs, and the system has created more than 20 teams to identify redundant programs and procedures.
Northeast Ohio Cardiovascular Specialists has entered into a five-year contract to join Summa Physicians Inc., the physician-practice arm of Summa Health System. "We feel like we're stabilizing the cardiology supply and creating a model that makes it more attractive to come to Akron, Ohio, so we can not only retain the people we have but also recruit new ones," SPI President T. Clifford Deveny, MD, told the Akron Beacon-Journal. The doctors also gain efficiencies with the deal, as well as salaried positions, said NOCS representatives.
Cincinnati-based Christ Hospital faces allegations that could cost it up to $400 million and expose its nationally known heart center as the beneficiary of an illegal kickback scheme. The complaint from a retired cardiologist charges the hospital and the Ohio Heart & Vascular Center with conspiring to steer patients and revenue to each other. The suit comes as the hospital is already spending tens of millions of dollars on new computer systems and other startup costs as it withdraws from the Health Alliance of Greater Cincinnati.
Kansas Board of Healing Arts Director Larry Buening and general counsel Mark Stafford have resigned amid criticism that they were slow to investigate complaints, including those against a doctor who lost 56 patients to overdoses. The agency oversees and licenses doctors and other medical professionals in the state, and the board vowed to continue improvements to make the agency more responsive.
Physician shortages are typically discussed in terms of quantity. We look at the static number of physicians entering the work force in relation to the rising demand for medical services. Last week I wrote about this topic by examining different specialties' effectiveness at recruiting medical students.
But there is a quality angle to it as well. A portion of the manpower shortage is tied more to how physicians work than the sheer number of physicians. The problems in care delivery wouldn't entirely vanish even if we somehow increased medical school enrollment overnight and injected new physicians into the work force. Today's doctors simply aren't collectively as productive as in the past, which means we need more physicians to treat the same number of patients as before.
This trend is partly due to a generation gap--Senior Online Editor Rick Johnson wrote a few months ago about Generation X and Y doctors' preferences for shift work and work-life balance. But the change can't be explained by that alone. Physicians of all ages are fed up with the business aspects of medicine and revolting against expectations of providing call coverage. More physicians, both older males and younger females, are also working part-time--nearly one in five according to the Cejka Search/AMGA 2007 Physician Retention Survey.
So facilities must adapt. I've been listening to Laura Boehlke Bray, MD, tell her story over the last few weeks as we've been preparing for next Wednesday's audioconference about part-time physician compensation, and I am impressed by how physicians and the administrators at her facility have been able to overcome some of these productivity challenges. She is a clinic chair with Duluth Clinic in Minnesota, which operates with one-third of its physicians working part-time. That's a lot of part-time employees for any business, let alone a physician organization. And the proportion is expected to increase in the near future, Bray says. Many of the clinic's physicians are in the demographic groups most likely to work part time; 45% of physicians are already 55 or older, and 60% recruited in 2007 are female.
How are they able to operate on a model that would have been inconceivable a few years ago? Duluth Clinic leaders have adapted by changing their attitudes about part-timers, she says. Without accommodating part-time schedules the clinic wouldn't be able to remain open, so leaders have made a conscious effort to value these physicians by redefining full-time equivalent and developing new operational and compensation plans.
Granted, with more than 400 physicians, it is easier for an organization like Duluth Clinic to diffuse potential costs associated with part-timers than it would be for a smaller medical practice (though managing roughly 130 part-timers isn't a simple task). But organizations of all sizes are going to feel the effects of the growing part-time trend and the lower productivity of today's workforce.
It's better to plan now before it becomes a full-time problem.
Note: If you'd like to hear more about how Duluth Clinic compensates its part-time physicians, there's still time to sign up for Proven Strategies for Part-time Physicians, a HealthLeaders Media audioconference on April 9 at 1 p.m. (EST).
Keith Solinsky, chief operating officer and principal with The Coker Group, discusses obstacles to implementing service lines and ancillary investments in a physician practice.
