Dennis Winsten & Associates, Inc. : How To Improve Your Image with Physicians

DENNIS WINSTEN & ASSOCIATES, INC

8835 E Speedway Blvd. Tucson, AZ 85710 (520) 885-3416

Healthcare Systems Consultants Specializing In Clinical Information Systems

HOW TO IMPROVE YOUR IMAGE WITH PHYSICIANS

Lew Riggs, Ed.D., and Dennis Winsten, M.S.

SUMMARY STATEMENT: Differentiating your laboratory to your physician clients.

Lew Riggs, Ed.D.
Executive Director, Tucson Osteopathic Medical Foundation
4280 North Campbell Avenue, Tucson, Arizona 85718
(520) 299-4545
Dr. Riggs is Chief Executive Officer of a $10 million medical foundation concerned with post-graduate education and marketing of physicians.

Dennis Winsten, M.S.
President, Dennis Winsten & Associates, Inc.
8835 East Speedway Boulevard, Suite D, Tucson, Arizona 85710
(520/885-3416)
Mr. Winsten is President of Dennis Winsten & Associates, Inc., healthcare systems consultants specializing in clinical information systems. Recent focus of activities has been on the effective and efficient delivery of laboratory information to physicians and other healthcare providers in a managed care setting.

ABSTRACT

With the advent of managed care, the importance of physicians has not diminished, as even they, themselves, sometimes believe, but is actually increasing. A collaborative image on the part of the laboratory is more important than ever, which means addressing the five major complaints physicians have regarding the laboratory within the context of six key characteristics of doctors. The complaints concern: timeliness of information, completeness, accessibility, providing information in a suitable form, and making it understandable to time-pressed physicians. Working effectively with physicians to achieve an immaculate image means understanding why they tend toward control, have difficulty with conceptual presentations, and are quick to stereotype. It also means understanding how to capitalize on their tendency to respect expertise and reward it with loyalty. Establishing a favorable image has less to do with manipulation than it does with creating a perception of cooperative pro-activity based on sensitive performance.

HOW TO IMPROVE YOUR IMAGE WITH PHYSICIANS

It is tempting to assume that managed care is rapidly nullifying the troublesome egos of physicians by regimenting their role to that of simply one member of the team. If that were the case, working on improving one's image with doctors would not be high priority.

There are, indeed, forces at work to make team members out of what once were free-wheeling entrepreneurs. As Eidus and Warburton (cited in Vogel, 1993) somewhat delicately put it, physicians who hope to succeed in an increasingly managed care dominated environment "must have a service orientation which includes good communication skills, accessibility, availability, and the ability to work with others. In addition, they must be comfortable working within an organization...and have good team skills." (1) Montague less delicately states that "Many physicians shake their heads in disgust at what's become of their profession. Physicians are now ensnared by second-guessing, denials of care, de-selections, declining incomes and mounting regulations." (2)

All of these things are true. With physicians being the fatalists that they are, it is not difficult to find more than one who foresees the profession's relegation to clerical status. But that is not how it is working out.

The Growing Importance of the Physician
The new economics of medicine is maturing and, with it, the notion that the doctor is more than ever the linchpin in the system. Not to be ignored or subordinated, doctors are the drivers. One system executive echoes the conviction of many others that "The ability to manage and control delivery costs is crucial under managed care. Our viewpoint is that physicians control and direct approximately 85 percent of health care expenditures, so organizing a physician-driven system is what ultimately gives you the best opportunity to manage and control delivery costs." (3)

That view is becoming more widespread as the results of integrated delivery systems come in. "A typical community hospital consists of a number of vital parts. One of the most important is the medical staff. Physician participation is crucial to the hospital's survival. Because physicians control more than 80 percent of the decisions affecting health costs, they drive virtually every aspect of care from admission to discharge. Further, physicians hold the highest degree of control over resource consumption, more so than nursing or hospital administrators. Medical doctors have significant influence in the areas of ancillary costs and direct nursing costs." (4)

The fact is that while physician practice patterns are changing, their role and, in truth, autonomy in the system are increasing. The good news is that the changes, particularly those which have affected the economics of medical practice, have made them more amenable to being part of the team. With proper understanding, therefore, on the part of the other team members of how physicians are trained and work, the opportunity to bring them on as part of the laboratory team was never greater.

To do that means taking a trick or two from successful marketers. According to Phil Knight, President of Nike, there came a time when they wanted markets beyond running shoes. "When we started making shoes for basketball, tennis, and football, we did the same thing we did in running. We got to know the players at the top of the game and did everything we could to understand what they needed, both from a technological and a design perspective. Our engineers and designers spent a lot of time talking to the athletes about what they needed both functionally and aesthetically." (5)

That meant listening to criticisms through focus groups and from consumers. Once the main problems from consumers were identified, it was possible to push forward. It is the same with physicians. There appear to be five main criticisms of the laboratory which, if recognized and remedied by the lab, will improve the laboratory's image considerably and result in a more compliant physician customer.

The Five Complaints
The product of the laboratory is information. Information regarding the clinical condition of a patient based on measured physiological parameters is of critical importance in the diagnostic and therapeutic process. If there are criticisms of the laboratory by physicians, they typically fall into five categories: timeliness, completeness or continuity, accessibility, specificity or suitability for purpose, and understandability.

Timeliness. Timely Laboratory information is often very important for diagnostic and/or therapeutic decisions. Certainly one expects stat orders to be completed and reported as quickly as possible. However, other laboratory results, if provided in time for the physician to see them before leaving the hospital, may permit patient care decisions to be made then rather than a day later during the physician s rounds. There is an intrinsic "time value of information" that can, potentially, reduce patient stay and associated costs in a managed care environment.
Completeness and/or Continuity. Continuity/completeness of information particularly in our currently fragmented healthcare system, is difficult to obtain. Trends to more integrated delivery systems in a managed care environment will increase the need for access to more complete laboratory data regardless of where the data was originally generated. Ironically, our systems of reporting on a departmental basis require physicians to mentally correlate data from various reports derived from various departmental forms or systems. Unless one has access to the evolving physician s workstation, there are no comprehensive reporting mechanisms that summarize, combine and correlate clinical findings from various areas into a single source. Even within the domain of the laboratory, physicians may not have ready access to patient laboratory data obtained during other encounters, inpatient or outpatient, or at other locations within or outside of the patient's current healthcare providing institution.
Accessibility. Information must be delivered to or accessible at the right place. Physicians are mobile; depending on the day of week or time of day, they may be in their office, at a clinic, or doing rounds at the hospital. Laboratory information distribution is often based on a fixed location, usually related to ordering location. Distribution should be based on multiple factors including priority, criticality of the result, physician location and physician preference. It might be desirable to distribute data to multiple locations. It should be easy for a physician to re-route results to associates and/or consultants; e.g., via an information network. Laboratories often do not provide sufficient guidance to clinicians on how to most easily access laboratory information; e.g., via computer terminals at the hospital or in their offices. Labs need to be more proactive in establishing information networks (including hospitals, clinics, and physician s offices) and in educating physicians and their staff about utilization of the information facilities available.
Specificity or Suitability for Purpose. Information should be provided in a form that is suited to the physician's decision making process. A question often asked is "What does the medical staff want?" The question pre-supposes (erroneously) that the medical staff is homogeneous. The type, format, and structure of laboratory information desired by the surgeon may differ radically from the internist. Different specialties will have different needs for information presentation. Further, those needs may vary depending on factors such as patient s diagnosis and/or condition. A laboratory information system manual or automated must be flexible enough to recognize both the physician's specialty and the current context of the patient s care situation and format and present data accordingly. Laboratories could initiate and sponsor physician's forums in which the spectrum of informational needs across medical specialties can be discussed and action plans established to meet reasonable expectations.
Understandability. Quickly understandable information incorporated in laboratory reports, particularly in an inpatient setting, can be in a form that is difficult to understand or interpret readily. Reports tend to be cluttered with data that is, at best, peripherally relevant to the physician s analytical and thought processes. Further, in cumulative reports it is often difficult to quickly find the lab results of interest.

Most physicians are interested in viewing the most recent lab results in a concise form not poring over a thick sheaf of papers in order to dig out the essentials.

Effective image creation depends on how artfully the knowledge gained from customer criticisms is translated into solutions the customer perceives to be on target. Perception is the key word. Our experience has taught us that physicians perceive the world through the lenses of their training and the way they must perform their work. Knowing the characteristics that these elements produce is crucial to working with them.

Six Characteristics of Physicians
Blanton has identified a profile of physicians. He notes that "The physician is trained to act independently and spontaneously, is oriented to the present, tolerates little delay between diagnosis and action, and is best in one-on-one situations." (6) Doctors are a hybrid of entrepreneur and healer, with emphasis on the latter. They value personal rather than written communication because that is how they spend their day, one-on-one with patients, and they will create barriers if any kind of communication is unclear or ambiguous. Working with them requires understanding of at least six very important characteristics of physicians.

Control. Consensus-oriented hospital people find this irritating, but it is a legitimate part of the doctor's makeup. It is legitimate because logic dictates that when one can be personally sued for a substantial sum over a single slip in judgment, one tends to be controlling. Reliable information is crucial to avoiding slips in judgment. That is why specificity is so important.

Conceptual myopia. It is also crucial when it is considered that doctors are, for the most part, not trained to be broad thinkers; they are trained to be fixers. Their seven years plus of education and their daily routine has conditioned them to seek quick, deft solutions to immediate problems presented in rapid succession. They are pragmatists. They are procedure, process oriented individuals because they have to be. That is why they appreciate communications that are simple, clear, concise and easily verifiable.

Respectful of expertise. Physicians value expertise of all kinds if they perceive it to be valid. They value credentials, knowledge, and earned position. Laboratories which proactively demonstrate their expertise by providing guidance to physicians on the best ways to access laboratory information are capitalizing on this characteristic. Physicians will often test an individual in an unflattering way until they are assured that the individual is an expert at what they do, but once convinced of a laboratorian's sincere desire to help, they will often grant colleague status, making the laboratory's job infinitely easier. Establishing personal credibility, therefore, is the first task of anyone seeking full cooperation from physicians.

Loyalty. Once perceived expertise is accepted by a physician, the doctor will exhibit loyalty almost unknown in any other profession for a very long period of time, even after it is no longer merited. The physician's loyalty can be won by demonstrating a complete grasp of the technical fundamentals of one's own area of expertise. It is mandatory to the maintenance of an effective image with physicians. The previously mentioned information network is an excellent means to garner physician loyalty.

Quick to stereotype. Sickness does not wait. Physicians are trained to make decisions quickly and that extends to their decisions about others on the team. Patients are either compliant or non-compliant, administrators are either dumb or smart; and communication is either important or worthless. Lack of time is endemic to the doctor's day, resulting in a mind-set that does not permit much contemplation. First impressions, therefore, are often lasting ones with physicians. Because the laboratory is perceived by physicians as part of the firing line rather than as an administrative modality, the laboratory that is action oriented and reaches out will be likely stereotyped favorably. That is where timeliness comes in. Results provided before the physician leaves the hospital and permitting timely patient care decision, will result in an instant image of unquestioned competence.

Visible results. Quick, understandable results will feed neatly into one of the prime characteristics of physicians. Doctors place high value on results they can see at a glance. They have little appreciation for anything other than conclusions presented in an eye-catching manner. They often will, in fact, accept less quality as a tradeoff for a quickly provided conclusion that is easy to assimilate. Uncluttered reports that seem to pierce the veil of ambiguity will add lustre to the image of an entire department and all the people in it.

Let's not be fooled by the term "image"; it is not something one does, it is something one has. Every organization, department, and individual has an image. Put simply, it is the set of beliefs people have about an individual or an organization. That set of beliefs is based on how actions are perceived. If physicians perceive that the laboratory understands the immutable forces that comprise the doctor's milieu and shares a desire to work within that framework as a partner with the physician, the image will be that of a colleague; and the payoff for the laboratory and laboratorians will be measurably significant.

REFERENCES

1. Vogel, David E. The Physician and Managed Care. Chicago; American Medical
Association, 1993; p. 33.
2. Montague, Jim. Old Traditions, New Realities. Hospitals and Health Networks,
December 4, 1994; p. 22.
3. Townsend, Douglas. Empowering Physicians. Hospitals and Health Networks,
June 5, 1995; p. 36.
4. O'Connor, Kristen. Management Implications of Physician Practice Patterns:
Strategies for Managers. Hospital and Health Services Administration, Winter, 1993; p.
572.
5. Willigan, Geraldine E. High-Performance Marketing: An Interview with Nike's
Phil Knight. Harvard Business Review, July-August, 1992; p. 94.
6. Bergin, James J. Change and Patient Advocacy. Persuading Physicians,
Rockville, MD, Aspen Systems, Robert Rubright (ed.), 1984; p. 283.

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Updated 9/6/00