Finding the Sweet Spot in Your Medical Practice

“If you don’t know where you are going, any road will get you there.”

—Lewis Carroll in Alice in Wonderland

Finding the sweet spot begins with identifying your strategy.(1) Practices that lack a simple and clear strategy are likely to fall into the categories of those who: 1) failed to execute their strategy; or 2) worse, never even had one. In an astonishing number of practices, doctors and practice administrators face overwhelming obstacles because no clear strategy exists to guide decision and behaviors of those people who “make or break” the practice. Complaints and questions abound in such practices, such as the following:

• We are so busy with patient care that we don’t have the time to develop a strategy.

• Should we expand our operation and take on a new associate or create a satellite office in the suburbs?

• Should we offer early morning hours, which will certainly increase the cost of our overhead/personnel?

A successful practice can increase power and focus with a strategic statement that all team members can internalize and use as a compass to point the direction for every decision and action.

Figure 1. Location of the “sweet spot.”

Think of a large medical practice as consisting of 100 discrete iron filings, each one representing an individual and valued employee. By scooping up the filings and dropping them onto one piece of paper, you will create an artistic mess, with each filing pointing in a random direction. In other words, if you take 100 smart hard-working people and plop them into a practice, each individual will make what they think are right decisions for the practice—but the result will be a lot of good decisions leading in a variety of directions and resulting in confusion and frustration.

Rather than trying to scoop up all 100 metal filings, if you pass a magnet under the piece of paper those filings and consider your Physics 101 knowledge, the filings will line up in one unified direction. Similar to the magnet pulling the filings, a well-articulated and internalized statement of strategy aligns individuals’ decisions and behavior within a practice. A clear, concise, meaningful strategy enables everyone in one practice to make decisions that reinforce one another and move the practice in one strategic direction. With everyone in the practice moving in the same direction, the practice will more likely benefit from improved patient outcomes, decreased costs, and reduced overhead—the “triple win.”(2)

Unfortunately, physicians and office managers commonly lack awareness of the fundamental elements of a strategy statement, making development of a strategy nearly impossible. With the knowledge of the elements, articulation of the strategy, and clear consistent communication of the strategic direction, the leadership team can create a roadmap for everyone on the team to follow and instill a competitive advantage that becomes a part of the practice’s DNA.

Three Elements of a Strategy Statement

The three components of a good strategy statement are 1) objective, 2) scope, and 3) advantage. “These elements are a simple yet sufficient list for any strategy that addresses competitive interaction over unbounded terrain.”(1)

The Objectives

A strategy statement must begin with a clear articulation of the ends the strategy will achieve. “To begin with the end in mind means to start with a clear understanding of your destination.”(3) If a practice has an unclear sense of what that practice aims to achieve, then the odds are stacked against the practice reaching the goal or objective. The objectives should be specific, measurable, attainable, results-oriented, and time bound. In other words, the strategic objectives include not only a clear endpoint but also a realistic date for reaching it. For example, an objective of attracting the highest percentage of new patient retention would be made more powerful by adding specifics, such as increasing the number of new patients by 3% in nine months. Objectives should be on the leadership level of a successful practice, should be limited to two to four objectives, and should provide the basis for creating the entire practice as well as individual performance objectives.

Strategic objectives act as the catalyst, and, therefore, should not be confused with the mission, vision and values of a practice. Mission statements explain why a particular practice exists or the value proposition in a particular competitive space, with a vision depicting what or how the practice wants to be seen by customers, competitors, and the community.

Medical practices often confuse a strategic objective with cliché or mission statements. A strategic objective is not, for example, the platitude of “maximizing patient satisfaction.” A strategic objective reflects the mission of the practice. For example, a practice whose goal is to offer superior customer engagement might consider a strategic objective including “responding to patients’ inquiries within 24 hours for non-urgent calls or e-mails.” Of course, urgent or emergency calls will be returned sooner.

Because most medical practices compete without a clear vision, they rarely act in alignment with a clear mission and reach specified objectives. For example, if your vision aims to focus on being highly responsive to patients’ phone calls and e-mails, then a strategic objective would be needed for accomplishing this behavior that differentiates your practice from others in the community.

Defining the Scope

Defining the scope sets the strategic boundaries of the practice. More specifically, the scope clarifies what is included and excluded from a practice in term of three dimensions: 1) patients; 2) staff; and 3) services. Clearly defined boundaries clarify activities the practice should emphasize and, more importantly, activities the practice should avoid. For most practices in most situations, clearly defining the desired patient takes precedence. A practice may set one boundary as treating only women, and then the scope can be further to focus on services to treat women with infertility issues or to focus on nutrition and weight loss. With clear boundaries, the staff’s talents and activities can be better aligned, and can become more efficient and more productive in achieving strategic objectives that drive the mission and fuel the vision.

Defining the Advantage

“Clarity about what makes the [practice] distinctive is what most helps everyone in the practice understand how they can contribute to the successful execution of its strategy.”(1) An advantage that positively differentiates your practice from others in the community increases the probability of success in a competitive environment, in which medical teams strive to increase the number of patients with a staff that provides distinct, reproducible, and value-added services. You must ask, “What will our practice do differently, better, faster compared with other practices in the region?” For example, if you declare that your unique advantage to your patients is that they will wait less than 15 minutes to see a physician or mid-level provider, then you must deliver on that advantage to provide a competitive strategy. If a patient waits 60 minutes to see the doctor, the practice will disappoint patients and possibly find patients leaving the practice to find a practice that keeps their promises.

The strategic advantage statement includes two parts: 1) the value proposition; and 2) supporting activities. The value proposition explains why targeted patients should avail themselves of the services that the practice offers. For example, does your practice provide ready access to the practice and guarantee that patients can have same-day appointments, evening appointments, or appointments on weekends? Next, supporting activities address the unique aspects, services, or complex combination of activities allowing the practice to deliver the enhanced value that was promised to the patient. If you have a concierge practice, your promise offers house calls that few other physicians in your community offer or provide. With increased interest in telemedicine, your sweet spot may be offering scheduled virtual visits on the same day the patient requests a virtual visit; thus, your strategic advantage would create value within your area of expertise and propel the success of your strategic objectives.

Increased Strategic Power with Branding

Branding allows practices to find that sweet spot and turn tap water into Evian. Let us explain. Most of the population drinks water from the tap that is free and safe. Yet millions of people will buy bottled water (e.g., Evian, Fiji, SmartWater) at $1.50 or more for 16 ounces. That cost is 20% more than an equivalent amount of Budweiser beer and 40% more than the same volume of nutritious milk! That is an example of the power of branding.

Everyone believes their practice is special, unique, and offers the very best healthcare. When you hit the sweet spot, you clearly demonstrate your uniqueness and your superiority to other practices in the community. When you consistently hit the sweet spot, you can “sculpt” your practice and create an ideal medical practice where the patient is the focus, the staff enjoys caring for the patient, and the doctor does what he or she does best—that is, take care of patients in a uniquely distinct and valued matter and not be just a data collector for the electronic medical record.

It was just a few decades ago that doctors attracted patients by having an in-column ad in the Yellow Pages or placing an announcement of the intention to open an office in the newspaper. Doctors often had to wait several years for word of mouth to create a busy practice. Today, most doctors will not want to wait for years in order to have a busy practice. Now it is possible, even in the current healthcare crisis, to find the sweet spot in your practice and become very busy and successful very quickly.

An excellent approach to strategic planning for medical practices is to create a strategic worksheet (Figure 2). This worksheet would first list what has to be done within 24 to 48 hours, then start another column for what to do in the next 5 to 7 days, and finally add column for strategic action steps to be taken in the next 30 to 60 days. This is an excellent way to create and prioritize working strategy.

Figure 2. Sample sweet spot worksheet.

Strategic Implementation: Preparation and Focus

Any tennis player worth his salt will tell you that hitting the sweet spot requires preparation and focus. Preparation means getting ready even before walking on to the court, including stretching, applying a new grip on the handle of the racquet, adding new strings to the racquet, and even making sure the player’s tennis shoes are tied securely. Preparation to hit the sweet spot is equally critical for a successful practice. For example, the staff needs to be prepared to see patients before starting the clinical day in the office, including ensuring that all the reports and lab tests are in the electronic medical record, the exam rooms are fully stocked with the supplies and equipment needed for patient care, and even that the restrooms are clean and there are ample supplies of paper towels and toilet paper. Preparation helps to get each employee to narrow in on the sweet spot, get their heads in the game, and, in other words, focus on implementing a successful strategy. One way to prepare your team by communicating your strategy and strengthening your team’s focus on the win is a “morning huddle.”

In today’s turbulent, chaotic, and rapidly changing environment, the success of the modern practice depends on the promise to see that every patient has a positive experience. In most practices, the patients will spend more time with your staff than with the doctor. Therefore, it is essential to see that the staff is highly motivated to ensure that the patient’s interaction with everyone in the practice remains at a high level from the moment the patient walks into the reception area and checks in at the desk right up until they make their next appointment and check out of the office. One technique that one of us (NB) has found useful, practical, and effective is to have a morning huddle. This is a 1- to 2-minute meeting with the doctor and the entire staff to be sure that everyone is on the same page and all working together to create that positive experience for every patient. The doctor and the office manager have an immeasurable impact on staff motivation.

The morning huddle is a pause or time out at the beginning of the day, to ensure that the game plan for the whole day is executed properly, safely, and efficiently. The doctor arrives before the first patient is seen and reviews the daily schedule with the staff. Each appointment is reviewed for potential “gotchas” or sources of delay. For example, if a patient is returning to discuss a biopsy report, be absolutely certain that the pathology report is on the chart and has been reviewed by the doctor before he or she enters the room. Nothing is more discouraging to a patient than having to wait for the report to come from the pathologist or the hospital. Patients who have had a biopsy are anxious about the findings, and a delay of even a few minutes can add to their anxiety. Just as patients have been preparing for several days for the visit, it is reasonable to expect the practice to take the same care in preparing to review a report or even a simple blood test.

Another example is anticipating the special needs of a patient with limited mobility. Having a wheelchair ready before the patient arrives sends a powerful and caring message. You also can make certain that a room that accommodates a wheelchair is available for the patient and they aren’t kept waiting in the reception area until a room is available.

If a patient is going to have an office procedure, the morning huddle is a time to be sure that all of the instruments, medications, and a plan for achieving a comfortable room temperature are in place for the procedure. The doctor doesn’t want to be in the room doing the procedure and have to send someone out to obtain more medications or supplies. The morning huddle also may be used to alert the staff about any VIPs that will be coming to the practice and to be extra vigilant for their needs and wants.

This time also can be used to inform the staff about any visitors that are expected that day and to be sure that everyone knows about the visit and is ready to make sure that they are welcomed and escorted into the office or lounge area.

Let the staff be aware of any last-minute developments that could affect the daily schedule: for example, the need for a doctor to leave at lunchtime for a meeting, a lecture, or a short case in the operating room. If the staff knows about the time that the doctor has to leave, they will work hard to have patients in the room and ready to be seen in a timely fashion in order for the doctor to depart on time.

The morning huddle motivates the doctor to start on time and stay on time. If the doctor is consistently late, then the day starts out already behind schedule before the first patient is seen. This leads to stress on the part of the staff, and they cannot perform at the highest level when there is stress in the office setting. For the morning huddle to be effective, the doctor has to be part of the process and must be on time. We know that there are urgencies and emergencies that sometimes make it difficult or impossible for the doctor to be on time. But this should be the exception and not the rule for most practices. We can do a far better job to be on time for our patients.

The morning huddle gets the entire staff on the same page and creates a sense of camaraderie and team spirit. The huddle can identify potential problems before they have a chance to wreak havoc with the schedule or create a negative experience for the patient.

The morning huddle takes only a few minutes. It just might be the best two minutes you spend with your staff each day to ensure that every patient has a positive experience with the practice.

The take-home message on the morning huddle: the morning huddle may help you consistently hit the sweet spot in your practice.

Bottom Line: Behind every successful practice lies a powerful strategy that includes the sweet spot. Any strategy statement that cannot explain why patients should avail themselves of your expertise is doomed to failure. Take the time to identify the sweet spot of your practice and make every effort to strike the ball at the sweet spot and you will have a very sweet practice.

References

1. Rukstad DJ, Collis D. Can you say what your strategy is? Harvard Business Review. 2008;86:82-90.

2. Logan D, Loh LC, Huang V. The “triple win” practice: the importance of organizational support for volunteer endeavors undertaken by health care professionals and staff. J Glob Health. 2018;8(1):010305. DOI: 10.7189/jogh.08.010305.

3. Covey S. The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York: Simon and Schuster; 2013.