Twenty five common mistakes can limit patient care success

Failure to address these 25 issues is central to limiting a practice's patient care success.In other words, address these issues in your business plan to ensure success.

Michael H. Riegger

1. Individualized Home Care Instructions. A practice goal is to send home each and every patient with individualized written home care instructions delivered and reviewed by staff before the client gets the bill. The client who departs without them forgets the specifics of the home care mandates and consequently these duties do not get completed. When home care duties are not completed and the patient does not recover, the practice gets the blame.

2. Listen To The Staff. Central to a smooth-running practice is the staff input to the practice operation. Strange as it may seem, the astute practice leader is listening to the staff as a basic daily activity. Many methods exist to get staff input, e.g. meetings, focus groups, but none is more important than the practice leader who yearns for staff input.

3. Dreaming. Call it vision, call it dreaming, but the practice with a dream is going places. Dreams become the driving force, the energy, the engine, the motivation to make that daily effort. Successful practice leaders have a dream-ask one.

4. Work Smart. Central to success is to work smart - not longer, not harder, not forever. Effective practice leaders and managers learn to delegate to others with the time, the energy and the talent. The use of a personal assistant and the ability to delegate permits the practice leader the time needed for the other issues that cannot be delegated-such as self education and reading.

5. Client Education. Call it marketing, call it time-consuming, but call in the client to give them the education they need to understand why a procedure, or diagnostic, is recommended. Unlike human medicine where the insurance company is paying the tab, our clients pay the tab with their discretionary funds. The informed client is going to appreciate the value for funds spent when they understand.

6. Read a Case a Day. The philosophy of an apple a day keeps the doctor away follows with the premise of "look up a case a day" to make the doctor's day. It takes only a few minutes every day to look up a case, a medical issue. Successful clinicians have the discipline to spend that time.

7. Dark Side of Incentive Programs. In corporate America, most every incentive program instituted has been dumped because of the dark side. Incentive programs are designed to stimulate targeted issues like growth. Yet, it is the unintended consequences of incentive programs that injure the business. Thus, dump every incentive program every year and begin a new program.

8. Cleanliness. A smelly clinic drives folks away. And room fresheners just mask the smell. Clean clinics are attractive inviting places. The guests coming in the (clinic) front door appreciate a clean environment.

9. Long-term Plan. Good planning is essential to arrive at the Dream (see #3). A five-year plan is essential to arrive at the Dream. Luck does not fit into this scenario. Good luck many times is the result of hours and hours of hard work on the plan.

10. Monthly Budget Review. Budgets are central to get to the Dream. A clear distinction exists between budget and expense analysis. The budget is the plan; the expense analysis is what happened. Practice budgets must reflect the philosophy of the Dream and The Plan (#9). Specifically, successful practice leaders budget for the priorities and deliver. An educated staff happens because staff education was budgeted and spent.

11. Sabbatical. Thinking outside the box, you think? Well, get outside the box to see what others are about and up to. As it is, very little innovation is happening these days. Learn about management, critical care, orthopedics, dental, whatever. People going places, go to places to learn.

12. Medical Records are the Center. Human medicine has established that medical records of a practice reflect the care of the patients in a hospital. Sure, there can be good and bad days in the medical recording, but the successful practice has active medical records. And sorry folks, computer invoicing systems are not medical records. Medical records must be the center of a practice's nursing. Specifically, the medical record must reflect what medication was given, by whom. Include an active check-off box when the procedure occurred.

13. Outside Business Seminars. The blind leading the blind happens. But when practice leaders go to business courses in other industries, we bring home that information and blend it into our environment.

14. Personal Development Books. We learn medical stuff in school, in classes, in short courses, but each animal is attached to a human. So intense is the medical education of the professional, there are those who say that the professional's personal human development stops during the professional education. So many good books are out there to assist in human relations development. Successful practice leaders, to lead in this era, need good human skills. Ask a successful leader about his or her favorite book.

15. Time Management System. Time flys is a cliché, and we all get the same 1,440 minutes per day. Yet, some make better use of their time. It is not an accident. Busy people always have time for the priority duties on a daily, weekly and annual basis. Ask a successful manager about his or her favorite time management tactic.

16. Laugh. Laughter is the best medicine, and we spend so much of our lives working. Ask yourself if you can laugh at work these days? Do you? If you cannot laugh at work where can you laugh? A practice with laughter is a happy place, and happy places produce good patient care.

17. Fire Godzilla. We all have had them; the extremely talented, hard working, go-getter, staff member that everyone hates. The Godzilla employee or the Gestapo supervisor puts the damper on laughter. They must go. Once one has moved these folks on to another business, good employees show up to be hired. And guess what? You'll start to hear laughter again.

18. Staff Training. The trained, sensitive, attentive, dedicated staff does not just happen. Budget funds and time must be set up to develop folks to be there in place for the Dream to happen.

19. Rules. Rules to live by are essential in a practice structure. Written rules: To arrive on time, to complete the mundane duties of cleaning and to keep the peace. Good leaders know that while rules are essential, the rule is not more important than its intent.

20. Protocols. Written protocols are essential to the consistent delivery of virtually every step of the health care process. Excellent practices have clean, clear protocols. Get them from a well-run practice.

21. Meetings. Meetings are essential to the development of the successful practice. Meetings are where protocols are developed and delivered, staff input is sought to clear the path to the Dream, and a place to laugh while working. Weekly meetings are essential.

22. Time-based Fees. The whim of setting fees is out. Use the variable cost of support labor and cost of supplies in an algebra formula to set fees. Each practice niche has different variables and thus fees can be set to collect appropriate fees to fund the budget.

23. Pocket Card. The pocket card technique is a simple, effective method to ensure attention to behavior modification. It works like this: For the practice leader who wishes to be a better listener, put on a 3 x 5 card the words, "Listen actively." Crumple the card and carry it in a frequently used pocket for six weeks. At the end of six weeks, one will be a better listener.

24. Pocket Notebook. Forgotten ideas are a treasure. Every time a neat idea or issue pops into one's head, write it down. When I started preparing this column, it was entitled: "Ten most common management mistakes." I ended up with 34 (and could only edit it down to 25).

25. Re-evaluate Annually. Even with a Dream, a Plan, and a Budget and all the tools needed, we must re-evaluate the Dream. Things change, times change, information changes, we change, and thus the Dream must grow, must develop and evolve.