High-Performance Work Practices and the Patient Experience

Your practice is being reviewed on Yelp, and it appears that you might need to think about the patient experience in a more meaningful way. Patients are taking a more active role in the decision-making process and sharing this with the world through physician review portals. Those reviews provide direct insight into how satisfied or dissatisfied patients are with you and your practice. Patients are not necessarily empowered by all the ready data—they are overwhelmed.(1) Help your patients by keeping it simple.

Keep it simple—what is that? A modern physician is beleaguered by medical advances, cascading research, and figuring out how to run their business on a shoestring budget with downward pressure on revenue. To keep it simple, start with what you can control. You cannot control patient satisfaction, but you can control what the patient experiences with your practice. There is a strong link between employee well-being and customer satisfaction.(2) It just might be that improving the patient experience begins by improving the experience of your employees.

Start with a Self-Assessment

The first step to becoming a destination employer—a place where people want to work and current employees do not want to leave—is to perform a serious self-assessment. Drucker argues that we all have to learn to manage and develop ourselves so that we can make the greatest contribution.(3) Success will come to those who know themselves and how they can use their endowments most effectively. You have to explore these critical questions articulated by Drucker:

• What are my strengths? Most people don’t know what they are good at, and many of those who think they do are wrong. You cannot assess your strengths without feedback, and getting useful feedback can be difficult. People tell us what we want to hear, not what we need to know. Getting to know your strengths is simple, but hard.

• How do I perform? You need to know how you get things done and realize that everyone gets things done differently. One size does not fit all—we all learn differently. How do you manage stress? What type of environment best suits you?

• What are my values? This is not your ethical orientation, but your core values beyond ethics. Ethics are essential and necessary to build character. Values refers to characteristics such as authenticity, loyalty, authority, boldness, community, and fairness.

• Where do I belong? Everyone is a on a journey to find where they belong. Physicians usually decide on their careers early, but they wanted to be doctors, not run a business. Success cannot be planned; you can only be prepared and hope to bump into opportunity.

• What should I contribute? Value creation is more than a buzzword. It is a critical construct. The idea of value creation is profound because it starts with the customer or patient. If you start with the premise that you hope to create value, that provides clues about how to contribute.

Start with the intention to help yourself grow and be open to where the process takes you. This is a problem-solving process that can help you move toward excellence. Stop trying to control what is beyond your grasp and take account of what is. Taking personal stock is difficult, uncomfortable, and time consuming—that is why so many people don’t do it. Be different and have a good talk with yourself—you might just like what you hear!

Are You a Good Investment?

Many physicians have gone back to school to get an MBA in hopes that will help them learn how to navigate the business of healthcare successfully. Management cannot be taught in formal programs, however; it must be learned by the experience of managing.(4) Until a managerial aspirant is taught to learn from their own experience, they will not improve as a manager. That MBA teaches secondhand information, whereas good managers require first person experience.

First-person experience is critical, because it is the best way to learn what to focus on and how to invest your energy. Financial ratios provide a useful way to understand payback and performance. Return on management (ROM) measures the payback of a manager’s time and attention.(5) The demands on a doctor’s time and attention are intense and can get in the way of their good intentions. ROM can help determine focus. The concept is summarized in Table 1.

The usefulness of the measure is enhanced if you know exactly what you are trying to accomplish, and you have communicated that to your team. Management is not a solo sport, and getting a great team ready can only happen if the coach has his or her own house in order.

What Affects the Patient Journey?

When patients write a review of their experience with your practice, they evaluate the whole experience as a cohesive event. The best way to reduce the risk of negative reviews is to skillfully manage the entire patient experience. You need to take the patient experience seriously, because that is the primary shaper of people’s perception of your practice and the quality of what you offer.(6) Patients expect good service, and when they have a negative experience, they are increasingly vocal about it. Negative reviews are opportunities.

Failure is guaranteed if you do not involve your whole team in the process of identifying and improving the patient experience.

Your patient spends more time with your staff and navigating your processes and procedures than with you, which is why paying attention to your staff is the critical factor in improving the patient experience. One of the factors that contributes to patient satisfaction (or dissatisfaction) and goes unnoticed is the cumulative experience.(7) It wasn’t that the patients were dissatisfied with any one experience; it was the cumulative total of their experiences with your practice. This is why you cannot just fix individual problems but must address the entirety of the patient experience.

Healthcare is moving away from a sickness model and implementing a wellness model that is more inclusive and holistic. Physicians have to reorient and align their practices to resonate with the new reality. You cannot realign without improving the practice of leadership, increasing employee engagement, and optimizing your workforce. Failure is guaranteed if you do not involve your whole team in the process of identifying and improving the patient experience. A great place to start is by adopting high-performance work practices (HPWP).

HPWPs are ways of organizing work that allow employees to have a real impact on their jobs by participating in decision-making. Adopting these practices requires a commitment to creating a culture that values performance and where achievement is a way of life. The cost of implementing HPWP can be recouped only though enhanced productivity and improved patient outcomes. This philosophy is consistent with the direction of change in healthcare and payments. A coherent set of consistent practices can be a source of competitive advantage and value creation.

Working toward a high-performance culture demands that you pay careful attention to the drivers of human capital management (Table 2). The platitude that “workers are our greatest asset” is often spoken but rarely realized. Improving your hiring practices is essential to make sure you attract and hire people with the capacity to excel in an achievement-oriented culture. All too often, businesses hire great people and immediately shackle them, preventing them from using their abilities. Achievement-oriented people want recognition and compensation. You must align your incentives with your expected outcomes. If you do not believe investing in your employees, HPWP will not work for your practice.

The financial health of your practice and the success of your team will hinge on exceptional human capital management.(8) Your people are the critical asset and determinative of the patient experience. Investing in your people builds your practice, and the revenue should follow. It starts with you knowing what you want to achieve because if you lack clarity your employees will be confused by the conflicting messages you send.

How Do You Get Clarity?

There is no shortage of “how-to” tools, but there is a paucity of “what to do” tools. This reflects the difference between fixing a known issue versus trying to manage an uncertain future. Getting clarity is complicated by the fact that there are no data about the future. We cling to the past and what works because it is known and comfortable, but over time what we do must shift to stay aligned with the present reality. The healthcare system is trying to adapt, but it is not completely clear what to adapt to. The frenetic efforts at change being grasped at across the healthcare field seem helter-skelter.

Drucker argues that you need to have a valid theory of your business to be successful. The theory of the business is your assumptions about the business environment, the mission of the business, and the core competencies necessary to be successful. To get clarity you should address four deceptively simple factors(9):

1. Your assumptions about the mission, environment, and necessary core competence must fit the current reality.

2. The three assumptions should fit with one another.

3. The theory of the business must well known and understood in your practice.

4. The theory of the business must be challenged and tested frequently.

The largest companies lose their way in spite of their resources and analytical reach—they lose their way by failing to focus on what matters. The factors of change rarely are obscured; they are plain to see for all who look. The focus of attention is constantly captured by the pressing urgency of the moment. It is natural to lose your way as things change, and it requires significant effort to correct your course.

Conclusions

Physician review portals are an opportunity—they provide the unfiltered feedback to tell you how you are doing. Your patient doesn’t know if they get good medical care or not; they only know if they feel better and how they were treated. Reviews are about the aspects of the experience your patients can competently comment on, and you should listen. Give patients an experience that deserves a rating of excellence.

Your patient wants an authentic and transparent experience, and they will put up with lots of inconvenience. They put up with inconvenience because they know going to the doctor is serious business. Honor their willingness to endure by getting serious about the business and take the steps to transform to a high-performance practice. You might like what you see on Yelp!

References

1. Spenner P, Freeman K. To keep your customers, keep it simple. Engineering Management Review. 2013;41(3):67-72.

2. Chamberlain A, Zhao D. The key to happy customers? Happy employees. Harv Bus Rev. August 19, 2019. https://hbr.org/2019/08/the-key-to-happy-customers-happy-employees .

3. Drucker PF. Managing oneself. Harv Bus Rev. 1999;77(2):64-74.

4. Livingston JS. Myth of the well-educated manager. Harv Bus Rev. 1971; 49(1):79-89.

5. Simons R, Davila A. How high is your return on management? Harv Bus Rev. 1998;76(1):70-80.

6. Segbers R. Go where the customers are: marketing (and managing) your patient experience with social media. Marketing Health Service. 2010;30(1):22-25.

7. Rawson A, Duncan E, Jones C. The truth about customer experience. Harv Bus Rev. 2013;91(9):90-98.

8. Bassi L, McMurrer D. Maximizing your return on people. Harv Bus Rev. 2007;85(3):115-123.

9. Drucker PF. The theory of the business. Harv Bus Rev. 1994;72​(5):95-105.