Transforming a practice need not be a headache, consultant says

September 15, 2008

Change in the practice setting can affect acquired skill sets, physician expectations and, perhaps most significantly, delivery of patient care. Major sources of change in ophthalmic practices include: technology, personnel, compensation, workload, patient mix, and payers.

Key Points

Change, although inevitable in every aspect of life, in reality is not always so easy to implement in ophthalmic practices, according to Shawn J. Khan, MD, MBA, FRCSC, a consultant of ophthalmic practices, who is currently in private practice in south Florida. He recently spoke on "Mastering Change: Framework for Successfully Implementing Changes in Your Practice."

What's needed to implement surefire changes in a practice is the framework needed to manage transformation, he advised. Change in the practice setting can affect acquired skill sets, physician expectations, and, perhaps most significantly, delivery of patient care, pointed out Dr. Khan, who was on the University of Michigan faculty for 3 years.

Major sources of change in ophthalmic practices include: technology, personnel, compensation, workload, patient mix, and payers.

Dr. Khan quizzed his audience with some questions to determine the type of values they employ when confronting change.

Following are his questions:

1) The most important features of a successful practice are (select one set): a) communications and teamwork; b) innovation and vision; c) efficiency and quality; or d) being competitive and being profitable?

2) What are the most important characteristics for a successful practice manager/physician owner to be: a) a facilitator/teambuilder; b) entrepreneur/visionary; c) coordinator/planner/organizer; or d) competitor/producer?

3) Practices ought to strive for: a) communication, commitment, and development; b) innovative outputs and vision; c) efficiency and timeliness; or d) market share, goal achievement, and profitability?

4) In short, a practice must: a) do things together; b) do things first; c) do things in an organized manner; or d) do things fast?

5) The keys to a successful practice are: a) human development and collaboration; b) innovativeness and change; c) control and efficiency; or d) compensation and customer/patient focus?

The audience was asked to tally up their responses and then Dr. Khan outlined the framework for each letter. The goal was to determine the type of culture that each practice embodied. Culture, according to Dr. Khan, is based on collective assumptions, expectations, and values that reflect the rules determining how people behave.

Culture types

For those who were mostly "As," the culture type is built on collaboration; "Bs" are known as the adhocracy culture with an orientation to create; "Cs" adhere to a hierarchy culture that seeks to control; "Ds" fall into the market culture type where the orientation is to compete.

In the framework he spelled out, the "A" group is also classified as the "yellow" group, and is focused internally on long-term development. Examples of "yellow" organizations outside of ophthalmology include, Southwest Airlines, many major colleges, and Harley-Davidson.

"These folks believe in collaboration -they feel your job as a leader is to be a facilitator, a mentor, a teambuilder," Dr. Khan said. "Communication, commitment, and development are important. Their theory of effectiveness is that human development and high commitment produces effectiveness."

The "B" group is known as the "green" group, who believe in creating things and doing things first. Business examples to illustrate this category include Pixar and Schwab. "These folks are focused externally. What's everyone else doing?" Dr. Khan noted.

"The green group's value drivers are 'Let's get some innovative outputs, some transformation. Let's be agile,' Dr. Khan commented. "Their theory of effectiveness is: innovativeness, vision, and constant change produce effectiveness."

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