St. Vincent's Hospital Manhattan announced it has laid off 180 of its 3,800 employees, blaming the recession and two years of healthcare cuts and taxes imposed by the state of New York. Michael Fagan, a spokesman for the hospital, said in an interview that those being laid off ranged from administrative workers to support workers in food service, housekeeping, and clerical jobs. He said some nurses—the only medical staff members laid off—were affected, but he could not say how many. St. Vincent's, with 366 beds, is a major presence in Greenwich Village and the latest among a handful of community hospitals in New York City and the surrounding area to lay off workers in recent months. The hospital came out of bankruptcy two years ago, and it continues to carry some debt, Fagan said.
A woman says she was ignored for so long at a Las Vegas hospital that she went home and gave birth to a premature baby that later died. Nevada State Board of Nursing administrator Debra Scott wouldn't provide specifics about the complaint stemming from 25-year-old Roshunda Abney's attempt to get treatment Nov. 30 at University Medical Center, the region's only public hospital. Witnesses who were in the waiting room have corroborated accounts by Abney and her fiance, Raffinee Dewberry. Hospital chief Kathy Silver has promised action against those responsible if the allegations are true.
The Congressional Budget Office (CBO) has concluded, after evaluating tort reform research and meeting with healthcare experts, that "the weight of empirical evidence" currently demonstrates a link between tort reform and the use of healthcare services.
The CBO response is to questions posed by Sen. Jay Rockefeller (D-WV) regarding its recent analysis of the budgetary effects of proposals to limit costs related to medical malpractice, as described in a letter to Sen. Orrin Hatch (R-UT).
In the Hatch letter, CBO said tort reform would lower healthcare costs both directly by reducing medical malpractice costs, and indirectly by reducing the use of healthcare services through changes in the practice patterns of providers.
CBO estimates that enacting a package of proposals outlined in that letter would reduce federal budget deficits by about $54 billion during the 2010-2019 period. Those proposals were estimated to decrease spending by roughly $41 billion and increasing revenues by roughly $13 billion over that same period.
If I had a dollar for each time the word "quality" was mentioned during the current healthcare reform debate on Capitol Hill, I might have enough money to fund healthcare reform.
But while quality in healthcare is important, its viability, along with cost containment and value, has been pushed to the background in light of other issues—such as the public insurance option or abortion—until this week.
On Tuesday, 11 freshman senators unveiled a list called their "value and innovation package" that they say takes ideas from the private and public sector to improve quality and value through delivery system reform. They proposed this as an amendment to the current Senate healthcare reform bill now being debated on the Senate floor.
One of the senators, Mark Warner (D-VA), who years earlier founded the company that became cell phone giant Nextel, said in a briefing introducing the proposal that maybe healthcare should take a page from the business community to move quality and innovation issues to another level.
He said the proposed package could do what the iPhone did to the cell phone—take it to a new level with "a whole new series of apps" and then "move us in a direction that is much stronger at making sure we get cost-containment in place."
Among the areas that Warner and his fellow senators are seeking changes are:
Expanding the number of health conditions tested under a national Centers for Medicare and Medicaid Services pilot on payment bundling currently proposed in the Senate bill.
Giving the Health and Human Services Secretary greater flexibility in administering the proposed Medicare Shared Savings Program, which would reward accountable care organizations that successfully coordinate care to lower costs and improve the quality of care.
Promoting pilot testing of pay for performance programs for providers, such as inpatient psychiatric hospitals, long term care hospitals, inpatient rehab facilities, and hospices.
Modernizing the computer and data systems of CMS to support improvements in care delivery.
But will this achieve the quality that we need in healthcare? Even the senators admit that more work needs to be done. So where else do we look. Maybe—like Dorothy says in the "Wizard of Oz"—there's no place like home.
On the same day that the senators were introducing their amendments, Institute for Healthcare Improvement CEO and President Don Berwick asked the question at the group's annual forum on Orlando: "How could Congress possibly know enough to specify for every community the exact design for . . . care that is safe, effective, patient-centered, timely, efficient, and equitable?"
The answer is it can't know. But the home team does. Berwick used the example of Cedar Rapids, IA, where the three competing hospitals in town put aside their differences to meet with each other to cooperate on quality.
"The doctors are a free-standing group, but they constantly work with hospitals on quality and improvement. They study their own utilization patterns and they create their own protocols and stick buy them," Berwick said.
And, the hospitals are in the process of agreeing to have only one cancer center in town—"because the town needs only one." And, he said, they have only one cardiac surgery program as a way to get better results at lower costs.
The result in Cedar Rapids—and in many other areas across the country—are lower healthcare costs (27% lower than the average community, according to the Dartmouth Atlas) and quality of care "that is just about as high as any we can find in our country," Berwick said.
So back to our question of whether we can legislate quality. Berwick said Congress is leaving the redesign to the local community of healthcare providers and organizations.
But let's face it: it sure would be cool to have some great apps—in the form of payment reforms, payment rewards, improved data use, and expanded use of technology—approved at the national level to make quality healthcare a reality everywhere.
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For decades, periods of severe financial pressure and uncertainty have been fertile ground for the explosion of highly successful products, services, and companies. Apple, Fortune magazine, General Electric, Gillette, Hewlett-Packard, Kellogg's, Microsoft, Motorola, MTV, Revlon, Trader Joe's, and Disney are among the firms that began their road to competitive and financial success and brought innovative new services and products to the market in periods of extreme duress. Baystate Health, Geisinger Health System, Mayo Clinic, Advocate Health Care, Ohio Health, Henry Ford Health System, Celebration Health, Baptist Health Care, Baylor Health System, Kaiser Permanente, and Scripps Health are among a number of healthcare organizations currently achieving similar distinction under adverse market conditions. Designing revenue growth strategies that are bold in nature and accelerating the implementation of those strategies are fundamental to the success of healthcare organizations.
In recent years, many healthcare executives have pursued growth with an emphasis on building inpatient volume in existing high-margin services. Looking forward, given current and pending reductions in reimbursement and the expected impact of healthcare reform, revenue rather than volume will be the appropriate focus of growth initiatives. Further, achieving revenue growth in cardiovascular, orthopedic, neuroscience and other traditional surgical services by driving volume through existing models of care delivery will become increasingly difficult. Instead, more effective avenues will involve clinical innovation, resulting in new services and products (e.g., wireless medicine), lower cost locations, and models of care delivery. Similar to the companies and healthcare providers referenced above, an organization's future success will depend on setting bold strategies and accelerating implementation. Organizations simply cannot afford to "hunker down" and watch competitors leap past them.
At first glance it appears that "bold" is a relative concept and can be situational. Interviews with a sample of hospital executives across the nation in early 2009 revealed widely differing perceptions of what made their successful strategies bold. Several pointed to specific changes made to the features of services or products, while others focused on the degree of impact achieved once implemented. Some focused on collaboration with powerful strategic partners, while others noted the degree of risk taken.
After more careful scrutiny, it becomes evident that for a strategy to be bold it must simultaneously push boundaries on two dimensions: nature of change (innovation) and degree of change (impact). The extent of innovation takes into account the way in which the product or service provides new ways to meet customers' needs specific to access, information exchange, ease of use, clinical outcomes, and pricing, among other factors. The degree of impact takes into consideration the extent of change the product/service affects in terms of quality, efficiency, satisfaction, awareness, preference, market share, and profit. Each of these two dimensions can be viewed as a continuum extending from a "low" to a "high" level. Strategies on the high end of both dimensions would be bold "game changers" with a higher return on investment. Frequently, a degree of risk is inherent to bold strategies. Risk takes into account the extent to which a product or service is ahead of its time; the amount of investment and length of time to ROI; its divergence from established patterns and partners; the amount of collaboration with competitors; and the probability and cost of failure. A strategy does not need to have a high level of risk to be bold. Rather, for a bold strategy to be successful, it is critical that the risk be accurately characterized and managed. Figure 1 illustrates how a bold strategy fits within a three-dimensional landscape composed of these three characteristics (innovation, impact, and risk).
While many types of bold growth initiatives exist in healthcare, they can be grouped into four categories of strategies: 1) acquisitions/mergers; 2) physician-oriented; 3) patient and employer-oriented; and 4) technology-oriented. An example of an organization pursuing a bold acquisition/merger strategy is El Camino Hospital, a 300-bed community hospital in northern California. El Camino accelerated its entry into a target market by acquiring, closing, re-structuring, and re-opening Los Gatos Community Hospital, a competitor. Innovation was incorporated through changing the dynamics of patient access and physician integration. The hospitals are in the process of achieving significant impact in increasing residents' awareness of the organization and increasing patient volume and income. The initiative was managed within an environment that had a high degree of risk associated with four factors: the management team had no prior experience operating a multi-hospital system; the closure and reopening of the acquired entity had to be expedited to avoid significant loss of physicians, clinical staff, and patients; the market entered was highly competitive; and a large investment was required during a recession.
"We intentionally built a bold strategies category into our recent strategic plan," said Ann Fyfe, vice president of business development at El Camino Hospital. "The acquisition of a competitor in a target market is expected to dramatically enhance our collaboration and alignment with physicians in that area and significantly increase patient revenue at both the new and our main campuses. Similarly, we saw an opportunity to link clinical innovation in genomics to enhancement and growth of our existing oncology and cardiovascular services while substantially differentiating our organization."
El Camino Hospital's initiation of the nation's first community hospital-based genomic medicine institute is illustrative of the physician-oriented bold strategy category. Innovative elements of the strategy included the design of personalized patient therapies based on the genomic analysis and the formation of a strategic partnership with DNA Direct, a firm providing 20 board-certified genetic counselors with different specializations. Significant impact is being realized in three ways: resolving barriers to the use of genetic testing and thereby delivering significant new value to patients via personalized medicine; positioning the organization as a destination for "leading edge" care; and considerably shifting market share and patient volume. The strategy was managed in an environment that had a moderate to high degree of risk related to implementing a clinical service ahead of its time and leaping beyond the hospital's historical capabilities.
A Texas-based community hospital offers an example of the patient and employer-oriented category. It is pursuing accelerated entry to targeted markets on both sides of its current service area and simultaneously creating barriers to competitor entry in those regions by establishing a joint venture with a large retailer that would incorporate health clinics in its stores in both markets. A moderate level of innovation will be incorporated specific to patient access and care coordination through the use of electronic medical records and other tactics. The strategy is anticipated to have a high level of impact specific to creating awareness, preference, and use of the hospital by two large new pools of patients. The strategy was managed within an environment that has a high level of risk considering that the hospital had no prior experience with retail healthcare and the return on investment is deferred.
To be bold, a technology-oriented strategy must create a fundamental change to one or more of the following: the location, process, outcome, and/or cost of clinical care. Such strategies typically involve disruptive innovation rather than an iterative evolution. For example, the adoption of a 128 slice CT scanner would constitute an incremental evolution. In contrast, implementation of a handheld MRI device would be disruptive and bold. Technology-oriented bold strategies are demonstrated by companies that are achieving innovation in diagnostic and therapeutic clinical equipment as well as those developing wireless healthcare products. This includes using smart phones and wearable, ingestible, and implantable monitors and medication delivery products. A few examples among the many exciting concepts are physiologic function monitoring, cardiac function monitoring, mobile medication reminders, and wireless band-aid based sensing and communicating devices.
A close review of the organizations briefly described above and others reveals that there are 10 critical success factors for the pursuit of bold growth strategies. Those CSFs are summarized here:
Create/reinforce a culture that emphasizes openness to change, taking control of transforming the organization, as well as accepting and learning from failure. Avoid "hunkering down."
Allow flexibility to reallocate capital and operating funds mid-year to capitalize on new qualified opportunities that are suddenly identified.
Identify the implications of the convergence of trends within and beyond healthcare.
Change and integrate the organization's structure, process, people, resources, and rewards as needed to streamline and accelerate analysis and decision-making related to bold strategies and their implementation.
Strong, proactive, and visible support by the CEO.
Designate a "champion" for the growth initiative. Free-up 30 to 100% of his or her time to devote to that initiative, and allow for changes in processes so he/she can expedite analysis, decision-making, and implementation.
Once a decision is made, all parties must be fully "on board" and committed 24/7 to success. There are no allowances for second guessing or foot-dragging.
Where possible, leverage existing resources (e.g., minimize time to market and investment) and/or utilized strategic partnerships (e.g., expertise, brand identity, funding)
Be creative in considering a broad array of sources for and creative approaches to accessing capital
Establish and reinforce accountability
To enhance an organization's future success, its leaders should not wait for change but instead "drive" it with bold revenue growth strategies. The identification of opportunities for those strategies is simply the initial step. A second critical component is to accelerate the decision-making and implementation of those strategies.
Mark Dubow, MSPH, MBA, is a senior vice president of The Camden Group in its Los Angeles office. He may be reached at MDubow@TheCamdenGroup.comor (310) 320-3990.For information on how you can contribute to HealthLeaders Media online, please read our Editorial Guidelines.
With season's greetings and wintry weather on many minds, let's look at a series of related precautions that can keep your patients, staff members, and buildings safer.
1. Holiday decorations: As reported previously on HealthLeaders Media, holiday decoration policies must emphasize the need to keep lights and ornaments free of fire safety risks. Decorations should not obstruct egress routes or hang from sprinkler heads, and electrical components in decorations and light strings must have an appropriate tag from a testing laboratory (e.g., Underwriters Laboratories). Steven MacArthur, safety consultant for The Greeley Company, likes the idea of creating a list of acceptable decorations that can be referred to year after year. Encourage safety and ask employees to note ideas and products that meet fire safety requirements, and then create a catalog of those items, MacArthur said. Staff members can download a free holiday decorations monitoring checklist from HCPro's Hospital Safety Center.
2. Portable space heaters: It's common for space heaters to start showing up in parts of the building that are subject to drafts, but these items are a significant fire risk if used improperly. The Life Safety Code generally prohibits space heaters hospitals unless:
They are used in non-sleeping staff and employees areas
The heating elements of the appliances don't exceed 212° F
The Joint Commission takes it a step further by prohibiting space heaters in nurses' stations, a point brought up by George Mills, FASHE, CHFM, CEM, senior engineer at The Joint Commission, during this summer's American Society for Healthcare Engineering's annual conference. If you're accredited by The Joint Commission, make sure your space heater policies reflect the commission's thinking and that staff members have received education about how and where to use these appliances.
3. Sprinkler pipes: A burst sprinkler pipe can make for a messy and potentially costly cleanup. Take steps now to avoid frozen sprinkler pipes if your hospital is in a cold climate. Have your maintenance crews check the following locations, which may experience chilly air or have poor insulation:
Loading docks
Parking garages
Ambulance bays
Main entrance lobbies
Linen chutes
Elevator machine rooms
Unheated stairwells
4. Ice and snow: Most hospitals are already on top of keeping parking lots, sidewalks, and main exit routes clear of snow and ice. However, don't forget to check on designated exterior egress routes or discharges that perhaps aren't used very often. If those "forgotten" egress routes are blocked by snow, for example, it may be impossible for someone to use it during a fire evacuation. That situation is dangerous for people and also could run you afoul of Joint Commission life safety requirements. Also be sure that if any employees are clearing snow from elevated surfaces, such as a roof, that appropriate measures are taken to ensure their safety.
5. Main lobbies: Slush and water are common near main entrances as people track snow in with their footwear and clothing. It's a good idea to increase mopping frequencies in those areas during stormy days or temperature thaws to avoid slippery floors. Some hospitals have borrowed an idea form the hotel industry by offering plastic, disposable umbrella sheaths to visitors, which help contain water dripping off umbrellas. Search for "disposable umbrella bags" on Google too see examples.
When M. D. Anderson Banner Cancer Center opens its doors in Gilbert, AZ, in fall 2010, its first patients will have the benefit of testing out features that were made with them in mind. Not the latest clinical technology or electronic medical system—though there will be plenty of that—but rather water features, gathering spaces, a massage parlor, and an appearance center.
The cancer center, which is a joint venture between Phoenix-based 22-hospital Banner Health and the University of Texas M. D. Anderson Cancer Center, is designed with an emphasis on evidence-based design and patient and family experience.
"We're very much of a high-tech provision of care, but we always make sure that's coupled with making sure it's high touch," says Pam Nenaber, CEO for Banner Gateway Medical Center, also in Gilbert, AZ. "The high-tech around you and the convenience to provide the right care gives you the opportunity to provide that high touch. We also make sure we integrate the family into the patient care setting so we take a lot of care thinking about where the family will be waiting and how the family is incorporated into the care rooms."
Executives organized focus groups made up of local patients whom they consulted with throughout the design process. They plan on eliciting more focus group feedback during construction to be sure they're on track. Workers broke ground on the planned 120,000 square foot, three-story building on December 1. The center will support outpatient services, including physician clinics, medical imaging, radiation oncology, and infusion therapy.
Cancer centers need to pay especially close attention to the patient experience and evidence-based design because of the extent of the patients' and families' involvement.
"Cancer patients typically will be at a facility for an extended period of time—getting testing, seeing physicians, and receiving treatments," says Margaret Row, MD, MBA, associate vice president of global clinical programs at M.D. Anderson. "So we try to make the environment as comfortable as possible by using the outside environment."
In addition to water features, the center will include evidence-based design aspects, such as an abundance of windows for natural light, artwork, many views of nature, and accessible gardens.
"There are things that are evidence-based design in terms of healing and construction and the way rooms are put together that promote a healing environment," Nenaber says. "The promotion of the healing environment also allows the staff to provide care in the most patient centered way."
Beyond the architecture, patient experience will be furthered by staff navigators that will promote personalized care and serve as touch points for patients and families.
"Cancer patients are with you for a long period of time so you want them to feel connected to the people and the facility where they need to come often, so we definitely look at it from their point of view" during the design process, Nenaber says.
By having heart failure patients monitor their own conditions after leaving the hospital, a partnership between South Jersey Healthcare and Pharos Innovations has the potential to reduce rehospitalizations and costs.
Through the program, heart failure patients at South Jersey Healthcare's two acute care hospitals have access to Pharos' Tel-Assurance remote patient monitoring system. Using the system, patients use a telephone or Internet connection and basic health measurement tools, such as bathroom scales and glucometers, to gather and report basic symptom information into a database reviewed by staff at South Jersey Healthcare.
"That information is usually collected before noon each day, and then after that time I access the program to look at any kind of clinical variance that the patient might have—signs that they are having some issues as far as heart failure is concerned," says Patricia Heslop, RN, clinical outcomes manager for heart failure at South Jersey Healthcare. "Then I would either contact them or their physician, and work on the appropriate intervention for the clinical variance."
By empowering patients to monitor their own conditions, they are more aware of their diseases, what causes their heart trouble, and when it is beneficial to implement home-based treatment or simple lifestyle changes rather than going to the hospital, Heslop says.
Heslop says that because of the program, she has noticed patients are well-informed on admission days, and are able to participate in their care more.
"It amazes me to find how many patients out there are not fully aware of the importance of taking care of themselves after they leave the hospital, and are not aware of the resources available to assist them in doing that," Heslop says. "We found that sometimes when we have patients discharged from here, we only have them return again within a matter of days, and some of the reasons they gave us for returning are just unbelievable."
The program was implemented in May, and an analysis was completed after the first four months of the program after 127 patients with congestive heart failure had enrolled, says Pharos CEO Randall E. Williams, MD.
At the end of four months, 62 hospital admissions had been averted for the people in the program, Williams says, and that was about an 83% reduction in admission rates compared to what was calculated as the control rate of admissions for this population. In addition, those patients who did have to be hospitalized experienced about a half a day shorter length of stay in the hospital, he says.
Williams says that while these results are only preliminary because it was just for a four-month period, "we were able to accomplish a significant reduction in admissions."
"And even those that did have to be admitted were able to get in and come home sooner," Williams says. "As we add more people to the program and they experience more time in the program, undoubtedly some of these folks will be hospitalized. But we are seeing quite a nice aversion of admissions so far."
Heslop says the program "absolutely" has the potential to keep costs down as well, because patients' length of stay will be reduced and they will be home for longer periods before coming back to the hospital. Williams says the average heart failure patient will spend an average of 1.5-2.5 days per year in the hospital, costing roughly $10,000 in related expenses.
The program helps by keeping those patients out of the hospital unless it is absolutely necessary, he says.
"We are already seeing in this four-month analysis some significant improvement in the costs of care because of the program," Williams says. "We are quite convinced that on a national scale there is a significant financial improvement for the country for programs like this should they be implemented broadly."
All these benefits provided by the technology improves quality as well, Williams says, by helping care teams provide better treatment.
"The way it does that is by creating this little daily action that patients need to take to hold them accountable to being part of that care team," he says.
That simple daily action allows the patients to feel they have much more instant access to their care team, but secondly acts like an accountability program that provides "instant feedback" about their behavior, Williams says.
Williams uses the example of a heart failure patient who eats dinner at a Chinese restaurant buffet the night before and then reports in the South Jersey database that their ankles are swollen and short of breath. He says a light bulb goes off and they often understand now for the first time in many cases that what they do daily impacts their condition.
When patients have that real-time feedback about their activities and how it ties in to their condition, they are more likely to be hold themselves accountable for less-than-healthy behavior, Williams says.
"Patients then develop more confidence, more comfort with their condition, and they know how to manage it and they feel like this little daily routine can keep them healthy and out of the hospital," Williams says.
Microsoft announced today that it expects to acquire Sentillion, Inc., an Andover, MA-based healthcare software company, which the technology giant said will "make it easier for nurses to use IT to improve patient care."
Microsoft believes combining Sentillion's context management and single sign-on technologies with its Amalga Unified Intelligence System (UIS), which provides real-time data aggregation, will give clinicians information about patients in real time and allow them to "the appropriate task with unprecedented speed. At the same time, the workflow of clinicians will be simplified, allowing them to spend less time navigating different IT systems and more time with patients," according to Microsoft.
"Microsoft and Sentillion share a vision of a connected health system in which the free and rapid flow of information, coupled with streamlined access to a hospital's myriad healthcare applications, empowers doctors and nurses to perform their roles with greater insight, speed and effectiveness," said Peter Neupert, corporate vice president, Microsoft Health Solutions Group. "As a result, our products and strategies are a natural fit. Joining efforts with Sentillion will allow us to amplify and accelerate the impact we can make in health IT and health globally."
Amalga UIS is used at more than 115 hospitals, including the Johns Hopkins Health System, New York-Presbyterian Hospital, Novant Health, and Seattle Children's Hospital. Sentillion's technologies, meanwhile, are in more than 1,000 hospitals representing 160 healthcare organizations, ranging from single facilities to large, complex multistate health systems, according to Microsoft.
The acquisition is expected to close in early 2010. Financial terms were not disclosed.
The first step toward implementing Lean in a physician practice is to assess the current work flow. It's crucial to first understand the practice's current state and the minutiae of what is going on in its environment.
"By that, we want to look at what are all the activities that go on to provide that service to the patient," says Larry Coté, president of Kaizen Institute Lean Advisors in Ottawa, Canada. "We look at information flows as well as patient flows and understanding all those activities from end to end."
Keeping track of analytics is of equal importance, says Frank Cohen, MPA, senior analyst at MIT Solutions in Clearwater, FL.
Cohen recently worked with a physician group that had just begun using an e-prescribing service because it wanted to reduce prescription errors. When he asked the group by what percentage errors had been reduced, practice leaders said they did not take any measurements.
"People who do Lean tend to ignore the analytics—the metrics—and that's where I think practices could improve significantly," Cohen says.
The two most common areas for improvement in physician practices are the patient flow and billing processes, Cohen says. "There are so many steps involved when a patient checks in and checks out, and the steps have so much waste associated with them."
After analyzing the patient flow at one practice, Cohen found that there were about three minutes wasted per patient visit. The practice managers scoffed at him, thinking three minutes wasn't so bad, until Cohen did the math for them.
Assuming they see 80 patients per day and waste three minutes with each, that adds up to four hours of wasted time. If the practice managers could shave off just one minute from each patient visit, and they generate $100 revenue per visit, that would give them an additional $2,000 per week in revenue. In many cases, this can be done by eliminating redundancy during check-in, Cohen says.
After the problem areas have been assessed, you should lay out an action plan for improvement. Coté calls this plan the "future state," which shows how the practice would ideally run once all of the nonvalue (wasteful) processes are removed. Although practices should not expect to reach this future state right away, it's helpful to give them a vision and strategy for the direction of where they are headed, Coté says.
Next, Coté suggests drafting a future state that sets goals for the coming months. When planning, Coté and Cohen caution that practices should carefully prioritize the processes they are going to attack. If they solve the front end of a process before resolving issues on the back end, it only creates another bottleneck.
Once you choose the areas you want to improve, the only thing left to do is go after them, Cohen says. And you don't necessarily have to work with a consultant to do so. "A lot of practices don't have the resources to go through this Lean Six Sigma stuff," he says. "A lot of times you are the team. You do your best at being able to get the people together that need to be involved."
But if you do enlist the help of a consultant, it's imperative that a practice stakeholder is the one who actually implements the changes. "Never have a consultant make the changes," Coté says. "Have them keep you on track and help you make changes properly, but the actual changes and ideas need to come from people who work in the system."
By committing time and resources, it's possible for a physician practice to go it alone.
"The other consultants probably don't want me to say it, but there's a lot of common sense involved in this," says Cohen. "There's a lot of restructuring in what you do. In some practices, it may be more efficient to bring someone in somewhere along the line to bring education, but most practices can handle it on their own."
This article was adapted from one that originally appeared in the December 2009 issue ofThe Doctor's Office, a HealthLeaders Media publication.
