Balance

Business Week features a piece on Starbuck’s CEO Howard Schulz and how he is leading the company through the business landscape that has changed. Dunk’ in Donuts and McDonalds have taken business away as they focus on selling coffee, while Starbucks has always been in the business of creating a destination place. Riding a fast growth curve, Schulz was able to eschew more traditional business management practices for informal operating systems and practices.

But practices that rely completely on individual discretion and action are not always a good idea – for anyone. In the story, Starbucks found that the baristas were throwing out a small fortune of excess milk that had been heated for the lattes, etc. The solution? Etch fill lines on the milk cups for each size of drink. We have measuring cups for a reason - some people (I’ve known a few) can cook and bake without them, but most people need the measures. In addition, throwing away excess is simply waste, and is just wrong.

In a medical practice, there is a balance between standardized procedures and leaving it to providers to do deal with situations as though each patient and situation is new and different. We use forms, such as lab and imaging order forms, prescription pads and encounter forms, as they reflect pretty much what would be useful in almost all cases. There is always the option to customize what is ordered or recorded.

As Schulz learned, there is a balance. You don’t want to lock everything into standardized procedure, otherwise you might as well be McDonalds. On the other hand, every latte, and every patient, is not unique, and what can be standardized should be. Every barista need not figure out the fastest way to make the “perfect” latte, no more than every physician needs to figure out for themselves the fastest way to get to complete a productive exam. In their training, physicians learn how to do a physical exam and the process of information gathering and decision making. As they gain experience, they will adapt the process to what works for them.

Physician practices have very limited options to improve profit margins. The best way is to make changes – sometimes major changes – in the patient visit process. As I’ve long advocated, walk through the process, looking for places where a form could be discarded, multiple forms collapsed into one, steps eliminated, and where standardization would benefit the patient. Look to your staff to redesign how you do things – they are likely to have more ideas, and are less invested in how things have been done. This is where you will cut down on the “dead” time and improve the number of patients you can handle without adding stress to the physician – it’s the physician-patient time that needs to be preserved.

Business discipline can add value to a practice and your care for your patients. The guiding principle, as with so many things, however, is “balance.”