AAOS Bulletin - August, 2006

Developing a positive office culture

Physicians, patients, payers and staff all benefit

By Al Campagna

Whether you realize it or not—and no matter how large or small your practice is—you already have an office culture. And that culture—for better or worse—is affecting your practice and your patients. By taking a look at your current office culture, and actively taking steps to foster specific aspects of that culture, you can improve your life at work, increase your referrals, reduce staff turnover and create a practice where people want to practice and patients want to come.

What is culture? For centuries, the word culture has been interpreted many different ways. For the purposes of this article, culture can be defined as:

• the observable differences in the activities and expressions of people and organizations

• the parameters, behaviors and values that an organization expresses externally and internally

• a learned and shared way of interacting with both internal and external customers

Organizational cultures

Two opposite styles of organizational culture exist: a positive culture and a toxic culture. A positive culture inspires internal customers, helps performance under pressure, assists in resolving conflict and offers uncompromising service. A toxic culture operates on rumors instead of information, includes bias, uses innuendo as the method of communication, is filled with suspicion and mistrust and practices discrimination among customers.

What can you anticipate resulting from a toxic culture? High costs, poor morale and a high turnover among staff are among many adverse outcomes. But the most destructive result of a toxic culture is that patients will sense it the minute they walk through your door.

What can result from having a positive culture? A positive culture improves teamwork; generates a shared vision, synergy and excitement across your practice; creates a whole that’s greater than the sum of its parts; and results in a more successful organization.

What does a positive culture lead to? Internal and external customer satisfaction, which naturally increases referrals.

Why you need a positive culture

The entire health care environment is changing. Patients are more informed—and better informed—than ever before, and they are more proactive in making decisions about their own care. The Internet has made it easy for patients to shop around, explore treatments and even diagnose themselves. Patients are aware of the multiple costs and options available to them. Mainstream magazines feature articles on “How to find ‘Dr. Right.’”

Yet despite—or perhaps because of—this plethora of information and their own good intentions, patients are often misguided. Thus, they need their doctor’s decisiveness and expertise more than ever. This means that doctors need to communicate better both directly with patients and through their support staff.

Employers, payers and patients are demanding more value for fewer dollars. With rising health care costs and decreasing reimbursement, there is more competition among practices. Increased competition drives practices to find ways to differentiate themselves, with varying degrees of success.

Another reason for fostering a positive culture in your practice is the growing movement to evaluate doctors through surveys that gauge their patients’ satisfaction and measure more than just clinical expertise. There is a direct correlation among patient satisfaction, future referrals and a practice’s financial health.

The outlook is for these trends to continue and even accelerate. What can you do? You can cut costs—or you can compete more effectively. For an orthopaedic practice, this means taking a good, honest look at your practice culture.

The impact of a positive culture

A positive culture will help deliver:

• Positive ratings from patients. By providing prompt, affordable and friendly service, you show that you value your patients’ time. They will, in turn, rate you highly.

• Positive ratings from referring physicians. Referring physicians appreciate it when their patients are scheduled and seen promptly, and when they receive feedback as quickly as possible.

• Positive ratings from payers. Payers appreciate a cost-effective business operation and may provide financial incentives that positively affect your bottom line.

• Increased staff morale. A positive culture results in reduced sick time, increased employee loyalty and retention, and staff who are motivated to work together toward a common goal.

It’s all about respect

Aretha Franklin put it so well when she sang about R-E-S-P-E-C-T. Use this mnemonic to help create a positive culture in your practice:

R = resourceful. Use the resources you have in a way that creates value to your external and internal customers.

E = effective. Get the anticipated results from your efforts.

S = service-focused. Provide excellent service to referring physicians, patients, payers and staff. This enables you to deliver your services in a focused, effective and streamlined workflow. The physicians and staff communicate pride and confidence in their team as well as in their own abilities, which will be positively reflected in your customers’ experiences.

P = professional. Build a practice that treats everyone as a professional, just like yourself. Staff who are treated as professionals will be dedicated to their roles, whether they are answering the phones or taking an X-ray.

E = efficient. Minimize redoing work. Complete each task that is started. Ensure that everything that can be done for a patient is done by the conclusion of the visit.

C = customer-centric. Do everything with the customer in mind—whether the customer is the patient, a payer or a referring provider.

T = team-based. Ensure your service is delivered by a team whose common goal is greater than the sum of its individual objectives. If your team is less than excellent, how can the excellence customers require and deserve be guaranteed?

Building a positive culture

Specific steps to build a positive culture in your office include:

• Define your practice offerings to eliminate internal competition. Offer services that complement your practice strengths in a way that responds to your customers’ needs. Consider establishing schedule protocols—templates that allow you to respond to urgent appointment requests.

• Define the different tiers of customers you need to service. Remember that your staff is an important customer and must be treated as a valued commodity!

• Break down any barriers between you and referring providers and be sure to provide referring providers with prompt, efficient feedback.

• Teach your staff specific skills, such as managing workflows, efficient message taking, effective communication, problem solving rather than blame placing, personality assessments and, most important, how to work supportively.

• Create a brand image and communicate that brand. Your practice and culture will be embodied and reflected in that brand image. In other words, make your culture a brand.

• Use multiple ways of communicating with your customers—phones, e-mail, automatic call distribution centers and a Web site that customers clearly understand and that enhances their interaction with your practice.

• Develop forms that are easy to read, complete and process.

• Plan your office environment so it is easy to access, enter, move around inside and exit.

• Adopt a modern but understated clinical look and feel to your office. This could include practice apparel, which embodies your brand and helps to communicate the notion of a unified staff.

• Involve your staff and customers in defining and developing your culture through staff retreats, surveys, focus groups and nominal group techniques.

• Never skimp on training; allocate a defined number of hours per year to staff training and development.

• Keep yourself receptive to innovative technologies and paradigms. Look at the same problem but in a new or different way. Most important, take pride in a job well done.

Expect results

Once you’ve established a positive culture, you’ll be delighted with the results. Among the benefits are the ability to attract and retain talented staff, efficient staff-to-provider ratios, premium contracting opportunities, the potential for payer gainsharing opportunities, high quantifiable customer satisfaction, sustainable growth in provider referrals and high self-esteem among staff.

Al Campagna is the business manager for Greater Rochester Orthopaedics, P.C., in Rochester, N.Y. He can be reached at ACAlberto@aol.com

Ten things you need to know

1. Make sure the physicians in your practice understand what is going on at all times.

2. Get a feel for your marketplace. A gap in your market is not necessarily the same gap in another’s market

3. View your patients as customers. Treat them as though your practice depends on it because it does!

4. Remember that a customer with a problem is not a problem customer.

5. Resolve the issue, instead of winning the argument. Respect the experience of your customers. They are the reason your practice exists!

6. Some doctors like to see long waiting lists. Most patients don’t.

7. Create a culture of openness. Each doctor knows the progress of all the others.

8. Empower your staff, but set boundaries. You want to protect your culture while allowing staff enthusiasm to flourish.

9. Make your practice a culture and your culture a brand. Your standing in the community and consistency in all practice communications give staff a sense of pride among their peers.

10. Show your customers R-E-S-P-E-C-T.

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