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Click on the links below to to access the corresponding newsletters.

Resources for Your Patients

Increase Cohesion Making Decisions as a Group

Interviewing Structure and Consistency

Finding Physicians that Fit

Dr. Mark Huth on Medical Practice Efficiency

Resources for Your Patients

A shared decision making resource with specialty vetted recommendations for common conditions that need discussions, often challenging for the physician.

www.choosingwisely.org.

TMF Health Quality Institute, Austin Texas offers free download of medication teach-back cards for use with your patients. They are short, clear and written at the patients’ level of understanding. They include a few sentences about the drug, when to seek medical attention and lists of generic and brand name drugs. They can be found at:

http://www.beckershospitalreview.com/quality/patient-safety-tool-clinical-teach-back-cards.html

 

End of Life Care

Ellen Goodman’s Conversation Starter Kit.

http://theconversationproject.org/starter-kit/intro/

Physician orders for life-sustaining treatment paradigm

www.post.org

POLST Oregon

www.or.polst.org

 

Increase Cohesion Making Decisions as a Group

Health care professionals tend to be perfectionistic and believe their way is the ‘right’ way to do things. The truth is there are many ways to do things. How do we agree upon a best process, given so many different opinions?

Make the Commitment

We have a frank discussion about the value of moving our perspectives from ‘my way is the right way’ to ‘the outcome is being achieved and I can live with this way.’

Use Data to Measure Need and Success

Ideally we have a goal that everyone can support. A big issue today is the amount of time providers spend documenting in the medical record. What data can help us? We know our primary care patient volume is 20 patients per day for 10 providers totaling 200 patient encounters per day or 1000 per week. Anecdotally the providers report taking between 1 and 4 minutes per patient to complete non-value added, but necessary computer documentation. That totals 1000 to 4000 minutes or 16-66 hours per week for the group as a whole. That time could be better spent, but the documentation must be completed. Can we improve it? It might be worth taking a closer look.

We set a target of 50% reduction in time taken to complete computer documentation. Our plan is to identify the most efficient way to streamline computer work. Our team would consist of 2 physicians, IT and the Administrator (project manager).

Understand Our Providers

Our first PDSA would be a survey of all physicians to identify the current methods, strengths and weaknesses and get suggestions. The data would be analyzed by the team and reported to the whole group for feedback.

The team would then be tasked with creating the ideal process(es) for piloting. We add our follow-up plans to the calendar and will report to the group every two weeks.

Now we have begun the process of moving away from ‘how I would design it’ to ‘what’s the most efficient way to get this work done.’ And our group is developing better decision making skills.

 

Interviewing Structure and Consistency

Interviewing is an acquirable skill that is well served with preparation and structure. Consistent interviewing questions can be improved over time as you find those that really get to the heart of finding your most desired qualities in a physician.

Your interview questions should evolve from the behaviors that you value most in physicians. If you haven’t, take the time to define them. Ideas include flexibility, performance under pressure, thinking quickly on one’s feet, listening, response to information one doesn’t like, ability to handle conflict, ability to handle feedback, timeliness, ability to collaborate with peers.

Group interviews can be helpful to get multiple perspectives. Many medical groups host a social gathering so they can meet the new candidate. The gathering is part of the interview process and observations should be recorded. An experienced colleague suggested not having too many people at the informal gathering where the candidate can become part of the crowd and no one really gets a good look at their social skills. Conduct a brief discussion of their strengths and weaknesses.

 

Do Your Homework

Do not omit the reference and background checks. Ask how long they have known the candidate and how they worked together. Check on timeliness, what types of conflicts they observed and how the candidate handled them, what they saw as strengths and weaknesses. Take a few moments to consider what characteristics the reference did not compliment.

The internet can be your friend. I found several good ideas from experienced interviewers by searching ‘interviewing techniques.’

 

Finding Physicians that Fit

Successful physician recruitment is critical. The consequences of a failed new physician hire is financially and emotionally draining at best; devastating at worst.

How can medical groups find physician colleagues that fit their culture? As importantly, how can you determine in advance that a practitioner will not come in outside of working hours for a meeting, acts out every time they become frustrated, cannot complete their documentation timely or will not agree to collegial researched standards? I like the John Wooden quote “Ability may get you to the top, but it takes character to keep you there.” Or, as I think of it, smart people can get through medical school, but it takes character to become a valued member of a medical group. How do we find that character?

Begin with the idea that your candidate should be doing most of the talking. Recognize that many people need a few moments to collect their thoughts. Get comfortable being silent while waiting for them to respond. Sit back in your chair. I like to smile and encourage them to take their time. Make notes; a common practice during interviews.

Interviewing for behavioral self-management is challenging. Present a few typical clinic scenarios and see how your interviewee will or has responded to an unexpected urgent patient and their very anxious spouse, how to handle the routine frustration of already falling behind on documentation at 10 am and/or how to give performance feedback to their MA. Give a quick overview of your provider summary screen and see how they react while trying to pick up the navigation in real time. What other challenging clinic scenarios do you have?

These questions check to see if what drives the interviewee matches the position and your culture. “Tell me about what motivates you?” “What frustrates you?” When the candidate talks about past frustrations, he reveals details about his personality, diplomacy skills and ability to work on teams. Does the candidate answer by discussing minor irritations — or ways that he successfully resolved serious conflicts?

Here are interview questions that target the candidate’s conflict resolution skills. “Tell us about a time when you had a conflict with a peer, what the conflict was, what you did, how it was resolved and what, if anything, you would have done differently.” I find most people need to take a little time to think about it. It’s an absolute red flag if they can’t come up with an example. Some common causes include lack of personal insight and not taking responsibility for one’s part in a conflict.

Medicine is a profession that extends beyond the patient care visit. Identifying how much conflict the physician will experience if they are needed outside of clinic hours for projects or patient care is becoming more important and these questions take aim at that idea. “Where do you see your best ability to contribute to the group?” “What areas of interest do you have?” “What might be your availability?”

Here are some good overall questions. “When have you been most satisfied in your life?” “Why should we hire you?” When the interview is complete, in addition to their clinical competence, you want to have a view of your candidate’s social, emotional and behavioral tendencies.

 

Dr. Mark Huth on Medical Practice Efficiency

Imagine that you could reduce your operating costs by 5, 10 or 20%. Do you have the vision and patience to achieve those results?

Dr. Mark Huth, MD, FACC, is a believer in efficiency science. Dr. Huth completed his fellowship at the University of Washington and has been practicing cardiology for 29 years. He is the quality and efficiency champion for Southern Oregon Cardiology in Medford where he’s practiced for the past 19 years.

His first formal exposure to lean concepts was from the American College of Cardiology for CHF. Initially, their medical group operating costs were well over the MGMA Cardiology average. Their current costs are about 5% below the average.

They started by considering the patient experience from first contact through discharge. They used the same criteria to evaluate each piece of the process—amount of time and number of touches. Wherever possible, they wanted one touch to complete the task and no stacking papers. Over the course of 18-24 months, they reviewed each process from the physician’s work flow to cleaning the exam rooms.

A big challenge was getting physician buy-in. They used data to measure themselves and for complex processes, they conducted pilots before rolling them out. “If the testing is done well, the value becomes self-evident,” stated Dr. Huth. “You work at it until you make it right. Overhead dropped enormously and we were able to decrease staffing.”

What is Dr. Huth’s advice to his colleagues? “Persistence, persistence, persistence. Make sure the proposals are real and you can back them up. You must have a physician champion who can work with his or her colleagues when issues arise. After the initial work you can maintain your efforts with a slightly different, less intense approach.”

Create succinct documents for each and place them on a flash drive for the new providers

The new providers review the documents and then each is discussed during their orientation meetings prior to beginning their first day of work.

Maintain frequent contact with the new provider until they report they are comfortable. Have a mechanism for getting the providers questions answered quickly.