In 1999, my practice resolves to . . .

Experts fill in the resolution blanks

With the start of every year comes the hope of a fresh start. We make resolutions to be better people. But what resolutions should we make for our practices? Experts say practice resolutions should include everything from becoming computer-literate to being able to demonstrate you can provide cost-effective, high-quality care. One source even suggests that practices get back to the business of practicing medicine and outsource all other functions. By far, however, the most common resolutions revolve around improving customer service.

Peter Boland, PhD, a consultant with Boland Healthcare in Berkeley, CA, says practices must stop paying lip service to customer satisfaction and get serious about it. "Physicians don’t begin to understand how to increase patient satisfaction and develop customer loyalty. This is important because we have a misguided notion that patients won’t leave. [In reality,] patients will walk over a $10 increase in their health care premium." To start, you have to think of the patient as a customer. "This is offensive to some, but it is vital; it is a cultural shift you have to make," he says.

Whom should you emulate? Boland suggests dentists, who already do things like sending birthday cards to clients and providing gift certificates or coffee vouchers to patients who are kept waiting.

Don Lloyd, former administrator of Murfrees boro (TN) Clinic, also says improved customer service should be the No. 1 goal for practices in 1999. Lloyd, who is writing a book about the future of health care, says changes are going to occur in this industry not just because of economics but because of consumer demand.

"I think there is a pervading philosophy — even if physicians won’t admit it — that care is physician-centered, not patient-centered," he says. "We simply have to learn that care must be patient-centered. We have to be more respectful of their needs, wants, and fears. The coming century is one of accountability. Get ready for it, because baby boomers are rising up and demanding better than they have gotten."

Accessibility, attention, commitment

Lloyd says there are three things you can do to prepare for that future. First, be accessible by phone and in person. "When a patient calls, he or she has to be treated like they are important and be taken care of expeditiously and respectfully."

Secondly, when people come in the door, give them your full attention, he advises. "Try to determine what they really want and need that day and attend to it. Fit it to their schedule, not your schedule."

Lastly, ask patients periodically how they are doing. "The problem is, once you ask, you have to be committed to making changes. Because if you ask, there is a danger they will want that change."

Meryl Luallin, partner at Sullivan/Luallin, a San Diego-based health care consultancy, agrees patient satisfaction surveys are a great way to determine your strengths and weaknesses. "Make sure your survey has questions that will identify operations and performance issues," she advises. "A lot of surveys are just too short to be used in any meaningful way. They are so general you can’t learn enough to make the necessary changes."

Along with knowing what patients want, Luallin suggests you concentrate this year on making staff happy. That also will translate to higher patient satisfaction. "Happy employees make happy patients," she says. "So many people think that money makes for better performance. But that’s not true. If staff make a [cost of] living wage but get appreciation, it goes much further than a raise."

Remember, she adds, that just as physicians find themselves working harder to make the same amount of money, so is the rest of your staff. "Make up the shortfall in recognition. Find some means of noting achievement through a pat-on-the-back program."

Tied to staff and patient satisfaction must be physician satisfaction. "This is the hardest one," Luallin says. "Administrators tend to think that only money will satisfy physicians. But if there is no more money, you have to find another way."

She has done some research on this topic and found that what physicians want most is a "hassle-free" work environment. While much of the increased paperwork they face can’t be eliminated, you can make sure supplies are available when needed, staff are trained adequately, and complimentary notes and letters are brought to the staff’s attention. "Too much these days is recognition of those who complain. You have to start recognizing the positives."

Back to business basics

There are other resolutions our experts think practices should make. Keith Borglum, vice president of the Santa Rosa, CA, consulting firm Professional Management & Marketing, says many physicians, while knowing plenty about caring for patients, don’t have as much knowledge about business as does a 1998 high school graduate. Those doctors need to become adept at using word processors and the Internet.

Borglum also suggests practices re-evaluate their office systems, governance, and provider compensation methodology in anticipation of increasing managed care business, reduced reimbursement, and increasing overhead.

Lastly, he suggests administrators resolve to identify the "financial vital signs" of their practice, track them monthly, and compare them quarterly with standards in their specialty to maintain good "practice business health."

Boland says practices should know more about the care they provide and the business they run. A key resolution is to demonstrate and document to payers that you provide cost-effective care.

"You aren’t delivering quality care just because you say [so] or because you are board-certified," he says. "You need to scientifically be able to show your results and outcomes. Within three years, you should be able to how you got the patient back to work or home better, quicker, and cheaper. If you can’t do that, you’re dead in the water."

Finally, he offers perhaps the most radical of all resolutions: "Outsource everything that isn’t tied down, and then outsource that. Anything that doesn’t involve being a physician isn’t what your critical success is based on — that’s treatment of patients. You have no business doing the other stuff you are doing."

While many may not agree with that assessment, Boland says that is where health care is moving. To provide the best quality care and superior customer service, physicians will have to concentrate on practicing medicine and leave the rest to someone else.

Ann McFarland, interim chief operating officer at Baylor-Methodist Primary Care Associates in Houston, says patient and practice well-being won’t occur until her resolution is met: to eliminate all adversarial relationships that seem to govern the health care industry now. Sometimes it is payers against physicians, she says, sometimes patients against doctors, sometimes payers against employers. But always, there is adversity. Her resolution is for "employers, payers, patients, and providers to sit together once and for all to resolve all of the issues revolving around the delivery of care. Until we do this, chaos will continue."

What are your practice’s resolutions for 1999? Send us a fax or e-mail telling us your resolution and why you chose it. We’ll share the results in the spring. Send e-mail messages to Send faxes to (425) 828-9779.


Meryl Luallin, Partner, Sullivan/Luallin Inc., San Diego, CA. Telephone: (619) 283-8988.

Peter Boland, PhD, Boland Healthcare, Berkeley, CA. Telephone: (510) 524-4521.

Don Lloyd, Former Administrator, Murfreesboro Clinic, Murfreesboro, TN. Telephone: (615) 890-3120.

Susan Hogeland, CAE, Executive Director, and Laura Johnson Morasch, MPH, Director of Medical Practice Affairs, California Academy of Family Physicians, San Francisco. Telephone: (415) 394-9121.

Keith Borglum, Vice President, Professional Manage ment & Marketing, Santa Rosa, CA. Telephone: (707) 546-4433.

Ann McFarland, Interim Chief Operating Officer, Baylor-Methodist Primary Care Associates, Houston. Telephone: (713) 790-3806.