The Physician-Centered Practice™

“The nucleus of the Physician-Centered practice is one physician and one patient,” Robert F. Priddy

Robert F. Priddy, President

Physicians are knowledge workers. Does that surprise you to hear this? Probably not, but do you know how knowledge workers are defined? Thomas H. Davenport, in his book, “Thinking for a living, How to Get Better Performance and Results from Knowledge Workers[1],” uses this definition:

“Knowledge workers have high degrees of expertise, education, or experience and the primary purpose of their jobs involves the creation, distribution or application of their knowledge.”

So for the record, physicians are knowledge workers. The question is how do physicians “get better performance and results.” Davenport answers that question through a discussion of understanding knowledge workers’ unique needs and then building their jobs around them. We believe the way to accomplish that for physicians’ is the physician-centered practice.

The very use of the term “physician-centered practice” may cause some angst. After all, isn’t healthcare’s goal to be patient-centered? Let’s begin by describing and discussing the physician-centered practice. As knowledge workers, physicians are at the top of the food chain in their practices. Other staff certainly have focused expertise and are absolutely necessary to the success and well being of the practice, but if clinical expertise and the use and delivery of clinical knowledge is the chief “product” of the practice, and the physician is the critical agent of that knowledge, then the physician is the center of the practice.

Unfortunately, clinical expertise, and the use and delivery of clinical knowledge are not always considered a practice’s chief products. This is where conflict begins. Situationally, numerous other people or tasks take center stage. And absent clear focus on the chief “product,” practices become derailed. The more frequently this occurs, the more generally dysfunctional the practice becomes – and the greater the need to refocus on the physician.

The physician-centered practice focuses everyone in the practice on creating an environment whereby physician knowledge can best be delivered, based on the individual needs of each physician. Critical to implementation is recognizing this is not a one-size-fits-all approach. Much like examining a patient, the process may be consistent but each outcome is unique. Once this is accomplished, those situational issues are handled much more effectively and consistently.

Think of this simply as the nucleus of clinical practice – one physician and one patient. Everything else builds from that relationship. This is a challenging point of departure, even for physicians who have seen their authority, their credibility and their value eroded over the past two to three decades. It is challenging to go back to the basics, the elemental forces of medicine. The driver is not the payor, not the “formulary,” not the administrator, and the product is not “volume.” The physician is no longer an interchangeable commodity, a cyborg functioning mechanically to produce a process, but rather a knowledge worker charged with complex fact gathering, analysis and treatment.

Supporting the development of this new paradigm are five components elemental to building the physician-centered practice.

·      Defining and measuring physician needs

·      Creating physician-centered staff responsibilities

·      Developing mutual expectations from and for patients

·      Effecting operational strategies and processes to support the physician, the staff and the patient

·      Implementing financial procedures to pay for all the above.

Defining and measuring physician needs. This component requires the most explanation for two reasons. First, this is the area universally overlooked in terms of practice management, improvement and other organizational and development approaches. Second, knowing and satisfying physician need is the basis for addressing all other practice needs and objectives in the physician-centered practice. Third, and perhaps most importantly, U.S. physicians consistently believe practice cannot be changed, and that they are expected, if not required, to constantly adapt their needs and interests to those of a sponsoring organization, other practice members or the whims of ancillary staff.

While discussions of “needs” can range between the abstract and the situational, individual’s behaviorally defined work needs are neither. Numerous studies have determined that we each have highly definable needs falling into various categories. Birkman International, a Houston firm specializing in assessing behavioral work needs, has developed an instrument to categorize, measure, and define individual work needs (The Birkman Method®, www.birkman.com). Using such an instrument, physicians can identify and measure their specific work needs along functional categories. These categories can then be interpreted to develop strategies, expectations, processes, policies and procedures to manage staff communications and responsibilities, office/practice work flow and processes, and to provide a framework for creating expectations of patients and to establish and manage patients’ expectations of the practice and the physician.

This type of work-focused behavioral data, serves as the foundation for the physician-centered practice.

The broad brush of physician needs is strategy. What should be the practice’s general tone, tenor and orientation? The same needs analysis is used in operational situations as well, such as creating patient visit schedules, determining the appropriate billing reports and production information needed, and establishing staff responsibilities. Using measurable data to in turn drive formal policies and procedures removes much of the ambiguity from physician practices, which is one of the greatest causes of frustration for physicians, staff and patients.

Creating physician-centered staff responsibilities. If staff is helping the knowledge worker, the physician, meet his/her needs, then through the physician’s enhanced effectiveness the chief product of the practice will improve.

While you wouldn’t describe your staff’s primary role as making you happy, they must meet or help you meet your needs for you to be effective, and effectiveness breeds happiness. Therefore, physician needs-based criteria should be at the top of the list on your staff’s job descriptions.

Developing mutual expectations from and for patients. If physicians or “practices” clearly define for patients their needs and their expectations, most patients want to and will try to comply. And, if patients are adequately helped to present their needs and expectations to physicians and the practice, the physicians and/or practice can effectively address them. However, again, both physician expectations and patient expectations are wrapped in the cloak of the physician’s needs.

Effecting operational strategies and processes to support the physician, the staff and the patient. Now that physician needs are known, and these needs have been translated to staff responsibilities and operational processes, commit the resulting policies, processes and procedures to paper. Using “physician need” data to create effective documentation further removes ambiguity from the practice and creates a platform for operational and strategic consistency and continuity.

Implementing financial procedures to pay for all the above. Form follows finance. One of the greatest barriers to change is the belief we can’t afford to change. Therefore, not only must a practice’s financial house be in order; it likewise, must be built to support the physician’s needs in terms of total income and how that income is derived.

How the Physician-Centered Practice is different. The physician-centered practice differs from any other practice management or development process in three key ways? First, it uses scientifically derived objective behavioral data as the foundation for shaping and building the practice. And, just as physicians use a combination of objective and subjective information for diagnosing patients that same model is followed in diagnosing the physician’s work/practice needs.

Second, the physician-centered practice approach is individually and internally focused. That is, physicians or practices aren’t expected to comply with some outside parameter as a measure of success. All ob/gyn's or all internists will not follow the same paths to success. Their individual needs will determine both success and the changes required to achieve their individual success.

Third, the physician-centered practice establishes a lifelong strategic and operational practice framework. Behaviorists have determined that human work needs are quite static after reaching maturity. Although the means to satisfy needs may change, the end target is consistent. Therefore, unlike the practice management method de jour, the physician-centered practice, once established, represents a consistent course for physicians and staff to follow.

So, how can you turn your practice into a physician-centered practice? Take the first step by defining your own work needs. Although the easiest way to do this is to engage a consultant with both the necessary tools and experience to guide you in this process, you can also perform some self diagnosis. In determining work needs, look to underlying pathologies of both happiness and frustration. Do scheduling mix ups really set you off, are you happiest having a casual lunch with your staff, do you always want more financial data than your billing staff provides? Then ask yourself if those reactions are indicative of needs met or unmet. Then how do you shape them into new operational methods.

Finally, as we began this paper, it’s not trendy today to not be considered “patient-centric” or “patient-centered.” However, if understanding patients’ needs and finding ways to better satisfy them, and helping patients understand how better to communicate with you and you with them is the core of patient-centered practice, then the physician-centered practice meets those requirements and more. Most everyone would agree that too many so called patient-centered programs are just that, cookbook derived programs comprised of dos and don’ts. Whereas, according to Davenport, “Knowledge workers like autonomy... they would like autonomy as to the detailed processes they follow in doing their work.” Patient-centered programs generally remove that autonomy, while the physician-centered practice uses and builds on it.

The objective of the physician-centered practice hinges on developing a practice more responsive to the physician – happy physicians lead to happy staffs and happy and satisfied patients. Patients come and go, staff change practices with some regularity, but you are in your practice for as long as it exists! Shouldn’t your practice fit you?

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[1] Thinking for a Living, How to Get Better Performance and Results from Knowledge Workers. © 2005 Thomas H. Davenport. Harvard Business School Press, Boston, MA.