Thursday, June 21, 2018

Life’s Work: Kareem Abdul-Jabbar. How Does this Translate to a Healthcare Practice?

This was an interesting piece to come across in the venerable Harvard Business Review, a magazine that caters to a business audience. Profiling a sports star is a bit out of the box, but the lessons offered are useful in a number of ways for business leaders. Some of Abdul-Jabbar’s insights apply to managers and “captains of industry” in the C-suite, but many of them apply to workers at any level.

One of the most celebrated basketball stars in history failed in his attempts to become a head coach in the NBA after he retired from playing. But he has successfully changed course and become a successful writer, historian, and filmmaker, specializing in telling the stories of unsung heroes in African-American history. The Harvard Business Review interviewed him about his philosophies and practices that have produced success on and off the basketball court. His life lessons include the following:
  • To really excel, it takes both talent and hard work, but a good work ethic trumps natural talent every time. A talented ball player won’t succeed unless he or she practices long and hard.
  • Abdul-Jabbar had a reputation in the NBA as a focused, but not very personable, player, and it followed him when he was trying to break into coaching. He notes that as he has matured, he has learned to be more sociable and outgoing.
  • He found success as a team captain as a leader by example. He stayed in shape and constantly worked on his fundamentals.
  • He earned a right to be heard by his managers and coaches by approaching them with due respect. They would then listen to his suggestions and criticisms.
  • He is often contrasted with his effervescent teammate Magic Johnson. Abdul-Jabbar learned to enjoy the moment from Johnson, and Johnson learned from Abdul-Jabbar to temper his reaction to each victory (or loss) by focusing on the long haul, a season of 80-plus games.
  • Abdul-Jabbar doesn’t see his career as a writer as a “transition,” but more as leveraging something he has always enjoyed. He was good at English and writing, and in recent years he has cashed in on it on the best-seller lists.

These concepts can prove helpful in managing people and in the environment of any business, including a healthcare practice. Abdul-Jabbar's philosophy that hard work trumps talent every time applies to hiring processes, personal self-discipline, and leading a work team. You may hire a very skilled or knowledgeable staff member, but if he or she doesn’t have a strong work ethic, you’ll be disappointed.

As he talked about himself, Abdul-Jabbar recognized his tight focus and imperfect social skills were both assets and liabilities. His focus helped him lead others by example when he might otherwise not have been an effective encourager. And he found that his personality worked well when teamed with someone very different—he and Johnson balanced each other out in some ways.

If your style is focus and hard work, it provides an example for your staff. If you are more open and sociable, you might be more encouraging and helpful. Just make sure you have some focused workers around, too. As one of the all-time great NBA players, Abdul-Jabbar was never quite able to become a head coach as he had hoped. A great player doesn’t necessarily translate into a great coach. By the same token, a great worker on your staff might not make a good candidate for a supervisory or management position. Keep that in mind when you think you might want to promote one of your star performers.

Thursday, June 14, 2018

Look to Your Employees for Innovative Ideas

Funny thing about the way physicians are trained and socialized in America: They’re taught to be independent thinkers. And while that may make them excellent clinicians, sometimes it can get in the way of creating and cultivating an organization that thinks, learns, and develops new ideas. Successful businesses—the superstars you read about in magazines—are invariably recognized as innovative organizations. Smart organizations tap into the collective brain power of entire business—from the “C” suite to the lowest-grade, common laborer.

We’ve caught glimpses of this principle inside top-performing medical practices, too. When you
walk through the front door of such practices, you’re not greeted by the general chaos that seems to plague many operations. There is a calm efficiency that is downright palpable. Everyone seems to know his or her job, and they’re discharging their duties with poise and confidence. Underlying many of these operations you’ll find dozens—perhaps hundreds—of little ideas and innovations that have made the practice run smoother. And a good deal of the ideas came from the staff workers—not the physicians or the administrator. The practice leaders were smart enough to recognize that the people who actually do these jobs know a great deal about the problems and challenges they face every day.

The leaders have encouraged, recognized, and rewarded innovation from their staff members,
and it pays off in improved operations, higher staff morale, and a culture that consciously looks
for ways to learn and improve.

Innovation and its inspirations aren’t really as mysterious as they seem. The really great performance-enhancing ideas don’t come from the research lab or the executive suite. They come from the people who daily fight the company’s battles—those who serve the customers. Successful corporations that have developed a culture and reputation for innovative ideas have found ways to harness the creative energies and insights of employees across all functions and ranks. These companies have cultivated “innovation communities”—work groups that tackle projects and problems in place of the traditional strategy to engage a team of expensive consultants. These groups provide the opportunity to give new shape and purpose to knowledge already possessed by those employees. Companies establishing successful innovation communities share key characteristics and strategies:

• Creating the space to innovate. They designate time and organize effective meetings and
communication mechanisms.
• Getting a broad variety of viewpoints. They deliberately cross horizontal boundaries to get
input from all management (and non-management) levels, and they cross vertical boundaries
to break down information “silos” and allow knowledge to spread among even unrelated departments.
• Creating conversation between senior management and participants. They require senior
management to pay attention to what participants are saying.
• Pulling, not pushing, participants to join. They recognize that they can’t force anyone to share
the knowledge they have.
• Keeping development costs low by tapping unused talent. Participants usually continue to perform their regular roles even while working on the innovation project.
• Recognizing collateral benefits that sometimes equal or exceed the innovations themselves.
Developing a “learning-organization” culture yields benefits that improve morale and company
• Recognizing that measurement is key. A company can sustain an innovation community
only if it can produce demonstrable value.

Successful companies keep track of how many innovative ideas make it from the communities’
drawing boards to actual implementation—and measure the results.

Thursday, June 7, 2018

Are Performance Reviews Losing Steam?

The annual or semi-annual rite of passage called, “the performance review” has fallen into disfavor among personnel managers in recent years. Dreaded by managers and employees alike, several studies suggest that such evaluations aren’t very effective in improving performance, even as they cause inordinate amounts of stress around the company.

One company dropped its traditional review process for its 450 employees in favor of weekly one-on-one meetings during which supervisors discuss performance goals with each employee. The dialogue invites the employee to evaluate himself or herself using an online app, and the self-analysis serves as a springboard for discussion with the supervisor. Instead of basing pay on an annual review score, employees receive equal raises annually. However, groups within the company receive performance bonuses that include stock options.

Some experts warn that simply doing away with formal reviews creates risk for companies—particularly when they need to dismiss an underperformer. An employer can find itself defending
a wrongful-discharge lawsuit if it can’t show a pattern of poor job performance. But companies that have transitioned away from traditional reviews successfully have maintained some kind of deliberate feedback mechanism. The feedback is usually delivered in a dialogue approach—as opposed to the traditional top-down method. Rather than looking at performance annually or semi-annually, feedback becomes part of an ongoing discussion throughout the year.

Finally, companies happy with their transitions from traditional reviews have removed—or
diminished—the connection between performance feedback and pay raises. Employees demonstrate greater willingness to participate openly and honestly in feedback dialogue when they don’t fret over whether a bad score will affect their paychecks.

Most of the time, we’re offering advice to practice leaders to start doing meaningful performance reviews. Groups of all sizes notoriously neglect giving structured feedback to employees. But nearly everyone hates performance reviews. Managers and doctors don’t like to give them, and staffers don’t like to receive them. Everyone feels uncomfortable. Human resources experts increasingly criticize the typical annual (or semi-annual) performance review plan used by many employers today. Research indicates that companies seldom get the results they seek—and clumsy bosses often don’t handle well the awkwardness associated with delivering employee report cards. But that doesn’t mean you should abandon the concept. Failure to give any honest, actionable feedback is actually worse than stumbling through an annual review process. By “actionable,” we mean criticism or praise that the employee can use to improve or sustain performance. Thoughtful critics of annual reviews are often proponents of more frequent, ongoing dialogue that keeps every well they do their jobs. 
  • Where do they excel? 
  • What needs tweaking? 
  • Where are they missing the boat altogether?

For the manager or owner, this has huge implications. It’s much more than the occasional pat on the back or “attaboy” and “attagirl.” Labor laws and today’s litigious workforce require businesses to maintain thorough documentation that will support management decisions if ever challenged in a Department of Labor complaint or wrongful-discharge lawsuit. If you need to discipline or dismiss an underperformer, you had better be able to show a pattern of unsatisfactory job performance and a record of your failed attempts to correct him or her. 

So if it sounds inviting to you to do away with those annual reviews (those evaluations
you never get around to anyway), be prepared to adopt a new system to provide and record performance feedback. Failing to do that increases your risk exposure. 

Thursday, May 31, 2018

Responding to a Subpoena in the Healthcare Practice

If you’ve ever seen the look on an inexperienced receptionist’s face the first time a process server shows up at your front desk, you already know that your entire staff needs clear-cut policies and procedures about what to do when a subpoena arrives at the office.  Most subpoenas, of course, arrive by certified mail and demand medical records, but however an order comes through the door, each staff member needs to understand his or her role and responsibilities in responding to it. 

When the court orders a witness to appear or a party to provide documentation for legal proceedings (like a trial or deposition), it issues an instrument called a “subpoena.” Governing authorities, like a state medical board, or an attorney general can issue subpoenas as well. Medical practices receive subpoenas frequently to demand copies of medical records—usually in preparation for malpractice and personal-injury lawsuits.

Here are some general guidelines for offices when they receive a subpoena:

Secure and prevent changes in records. Designate a person responsible to ensure that subpoenaed records are pulled from general filing and kept safe from routine destruction or archiving. Create a policy prohibiting alterations of these records.

Create a record log. Note the date when the practice received the subpoena and when a response is due. Determine which subpoenas can be handled as “routine,” and which ones require special handling—such as calling in legal counsel. Determine if you need additional time to produce records (say from archives or remote locations) and ask for an extension (in writing).

Make sure you have no valid objections before releasing records. If, for example, the requestor fails to include a proper written release authorization, do not send records. Under the advice of counsel, there can be other reasons for objections as well. When the request is unreasonably intrusive or expensive to comply with, an attorney may object.

Watch for special circumstances regarding sensitive information. Records containing patient information regarding mental health and certain infectious diseases require special written release under most circumstances. At times a court may allow the provider to redact irrelevant information that could prove detrimental if released.

Produce organized copies. Number each page of a chart to be turned over, and log the exact page numbers included in the package as well as the date you send them. If you need to delete information, make sure the released records show exactly where the deletions were made and the reasons for the deletions. Healthcare providers walk a fine line between the demands of a court order and compliance issues associated with HIPAA and state patient-privacy regulations. Step off that line in either direction, and you could be liable for fines and sanctions from either side.

Although this post provides a good overview that you can use to guide your policies and procedures, it’s up to you to think through each staff member’s role—from receptionist and records clerk to administrator and physicians. Create written procedures that describe exactly what to do. Be as specific as possible, and make sure that proper administrative personnel and affected physicians are notified immediately upon being served. Do not authorize clerical workers to make decisions about legal responses. Their roles should be well supervised—especially when a case calls for extraordinary decisions. And reemphasize the need for confidentiality—not just to protect patient rights, but to protect physicians and the practice.

Tuesday, May 29, 2018

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Thursday, May 24, 2018

Good Business from Marketing that Focuses on Patient Comfort

Using nothing but “commonsense” marketing, a solo OB/GYN practice in New York built its business more rapidly than expected. Its initial marketing focused on two primary elements: a patient schedule that minimized waiting and an emphasis on patient comfort throughout the practice. Rejecting the sterile environment at the fairly large group practice where they once worked, the physician and manager decided to get away assembly-line, high-production atmosphere.They chose design elements to soothe patients and create a serene environment. They used fabric and wood, and soft colors and patterns that tend to calm visitors. Attention to detail yielded rooms that made provision for personal privacy and comfortable seating for companions. The fetal nonstress test room includes a comfortable recliner for the expectant mother. The consultation room feels more like a parlor than a meeting room. Generous placement of flowers throughout the facility adds to the homey atmosphere.When deciding to extend the physician’s availability with a nonphysician provider, the practice sought out a young, female physician assistant especially to make teenagers’ first gynecological examination or contraceptive consult less threatening. Patient charts include significant personal and family information, like important events, to prompt the physician to ask questions and make comments that demonstrate his personal interest in their lives. Finally, the practice makes diligent use of its Web page and Facebook presence to provide reliable information and help patients feel more connected with the practice. As a result of all these efforts, the seven-year-old practice continues to run at capacity—and has even added extended hours two nights per week and Saturday mornings.

We might be tempted to look at this solo practice as an example of “guerilla marketing,” that is, unconventional, low-cost marketing strategies that often get the best of larger companies’ expensive marketing campaigns in competitive environments. And while the term, coined and defined by Jay Conrad Levinson in his 1984 book, "Guerilla Marketing" (now in its fourth edition—2007: Houghton Mifflin), loosely applies here, most of these tactics simply come under one heading: Patient-centered operations. You might impress some patients with a great Facebook page and a knock-your-socks-off Website. You may come up with a great direct mail marketing plan or an effective, low-cost community health education program that brings great PR. But this New York practice figured out the importance of what patients really want. Patients want a comfortable clinical experience with minimal wait times, kind and caring staffers, and a sense that physicians give them plenty of time and attention. Nothing builds a practice faster. Nothing wins enthusiastic patient loyalty more reliably. You don’t have to spend an inordinate amount of money pursuing these goals—but you have to place patients at the center of all your decisions, strategies, and operational designs.Today’s healthcare environment seems to conspire against great “customer service” for patients. We infer that this solo practitioner left his larger group practice out of unhappiness and frustration over what he perceived to be“assembly-line” medicine. He appears to have proven that efficiency does not rely on sterile,draconian, and impersonal office systems.

Thursday, October 13, 2016

Ransomware in Hospitals: What Providers Face When Attacked

Healthcare providers are now discovering they are a soft target for highly sophisticated cybercriminals. It is nearly impossible for ransomware victims to crack a hacker’s crypto keys. The FBI is even on record advising ransomware victims to just pay.

In the July/August issue of, The Journal of Medical Practice Management, Bruno Kelpsas and Adam Nelson authored an article: “Ransomware in Hospitals: What Providers Will Inevitably Face When Attacked,” and describe the following scenario:

One Friday, Sally, a member of a local hospital’s finance team, receives an overdue billing statement from a vendor's email address. Being the end of the month, she considers this email a routine part of billing and reporting. Sally opens the email, as well as the attached contract in Word format. Suddenly, Sally’s monitor turns to a red screen, beginning with the word CryptoLocker.

Sally froze. She had heard about cyber threats in training, but in her trusted vendor's billing statement? Who would be as sophisticated as that? Sally immediately picked up the phone and called the IT department.

Too late.
Sally just experienced a highly advanced cybersecurity breach known as ransomware – this one specifically referred to as CryptoWall (CW). In the following moments Sally, IT, hospital executives, nurses, doctors, and patients will discover valuable database files have been locked. Being a threat to hospital operations and the Emergency Department, patients are moved to another physical facility for care. Typically, the only way for the hospital to regain access to its information is to pay the hacking agent a requested fee using Bitcoin.

Currently, the healthcare industry is responding to compromises on a reactive basis, much like the way in which the financial services industry simply replaces consumers’ credit cards after a retail breach, such as the recent attacks on Target and Home Depot. This security mindset is predicated on a lack of enforcement, the absence of appropriate penalties, and a culture of risk mitigation. Due to this attitude of acceptance, patients are consistently at risk of having their personally identifiable information compromised. To reset how healthcare organizations think about cybersecurity, measures must be taken proactively to protect businesses against impending attacks. Otherwise, breaches are likely to continue until stricter enforcements and penalties are put in place for healthcare companies and stakeholders.

All organizations need a proactive and comprehensive cybersecurity plan. However, although many operations have the “right” plan and necessary hardware, software, and processes in place, the reality is that many do not have the time and resources to implement their response plan and fulfill the necessary documentation requirements for HIPAA, the SEC, and State regulations, in addition to ensur­ing business continuity. Therefore, to get started, healthcare organizations must focus on the four pillars of security:
  • Governance risk and compliance; 
  • Security monitoring and management; 
  • Threat intelligence; and 
  • Incident response. 
Furthermore, organizations must layer their efforts from basic responsiveness to advanced responsiveness, and finally, become preemptive.

Once the strategy is developed and implemented, companies must conduct an internal review and gauge where teams will align with internal security: Be out of the security business, own some of it, or close the gaps. Ensure there is balance between managing the unexpected and current resources.

The healthcare industry is the #1 industry targeted by attackers. It is imperative for organizations to reevaluate the way they approach cybersecurity, rather than resting on their laurels in what is currently seen as the “new normal” security mindset.

The Journal of Medical Practice Management