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    James R. Zeman, PhD, FACMPE, CPA

    Lewis Carroll’s “Alice in Wonderland” books caution us: If you don’t know where you want to be, you might just get there. I plan my day, and I live by OKRs (objectives and key results). As a certified public accountant, I do not cheat and I do not distort financials: The numbers are the numbers.

    In January 2015, a cardiology group hired me as their practice manager/administrator/CEO. Despite more than 25 years of experience in multispecialty groups, I had limited exposure to cardiology. Nevertheless, the doctors saw something in me that convinced them that I could help take them to the next level.

    At the time, the group was a merger of two very strong cardiology groups that had been open for more than 20 years. The merged group’s main competition was with university medicine; it served a nine-county area, most of it rural. It consisted of a dyad style of management and, due to the seasoned partners having a say at the board level, maintained a true group mentality. The group operated out of a publicly traded, for-profit hospital chain.

    During the interview process, it became clear the group had the following mantras:

    1. High quality care will never be compromised.
    2. Treating people right — all people (patients, their families, visitors, staff, referring physicians) — was of the utmost importance.
    3. The group will remain a cohesive, proactive, and physician-owned team of providers and staff.
    4. The cost of hospital healthcare was out of line, focused on profit rather than patient care.
    5. Once the first three items are met, financials are very important.

    The first 90 days on the job for a new practice administrator typically follow a familiar path:

    • Interview the individual physicians in the group.
    • Interview the management team.
    • Do an employee satisfaction survey to gauge morale and mores.
    • Review financials and corporate paperwork. If it is not available, develop several spreadsheets that show key financial data over a five-year period.
    • Go to the chamber of commerce and the county planning board to get their take on the communities and nature of healthcare.
    • After reviewing and studying the above, develop a “preliminary vision” for the next five years.

     I did all the items above within the first four months. If a written vision is not readily apparent (which it wasn’t), one should be created.

    During individual partner interviews, I was impressed with the fact that they followed the previously mentioned mantras: High quality care. Take care of all people who interact with us. Maintain group mentality. Ensure good financial management, but not at the expense of the other three items mentioned. I was provided some excellent ideas as to where they thought the group should be going over the next five years.

    While I was not able to pick my management team, I was lucky to have a team primarily composed of long-term employees who worked very hard and lived and breathed the partners’ mantras. I learned quickly to appreciate my good fortune.

    Armed with an abundance of data after about four months, I asked the management team to have a one-day, off-site breakaway meeting with me to talk about the direction of the organization during the next five years and set goals for our first year.

    This was their first experience with this type of meeting, which was well received by the management team, who generally came away invigorated and very encouraged.

    From that meeting came the following vision:
    By 2020, in keeping with our core values, we will be regionally recognized as:

    1. The best place to receive care
    2. The best place to practice medicine
    3. The best place to work.

    With this vision, we used these three items as part of our objectives for our first year of operation. We decided to obtain a data source for each objective and determine a baseline.

    The best place to receive care

    For the first baseline, we decided to use patient satisfaction scores. We had engaged Press Ganey, an outside patient satisfaction survey company, to develop a patient satisfaction survey for our patients. From Press Ganey’s detailed summary reporting system, we focused on two main ratings:

    1. Overall patient satisfaction
    2. Likelihood patients would refer us to their friends.

    These detailed summary reports also provided time frames for the month, quarter and year-to-date percentages, which easily allowed us to measure progress as the year(s) went by.

    We also wanted to ensure we were taking care of our referring physicians. The group’s outstanding marketing director already visited referring physician offices on a regular basis. She always returned with the same news: Our doctors are wonderful, we get our reports back into the hands of the primary care doctors promptly and succinctly, and they hear from their patients that our staff are outstanding. If there were any concerns that came out of a visit, she immediately focused on helping to correct them and responded to the referring physician’s office on solutions.

    After considering all the work she put into these visits and the fact that we serve a nine-county area with more than 100 physician offices, it was decided that each time she visited a physician’s office, she would put together a report and we would provide this information to the partners in an email called “Marketing Report on Site Visit.” Furthermore, we developed an annual referring physician newsletter —a four-page glossy of our group, outlining our new equipment, any additions to our physicians or advanced practice providers (APPs), and any upcoming events or areas that may be of concern to them. 

    The best place to practice medicine

    For the next objective, we decided to use a physician satisfaction survey. One of my goals was to have a weekend planning retreat for the partners to develop a three- to five-year strategic plan. To ensure non-bias in this data-gathering process, the partners were gracious enough to allow me to bring in an outside consulting firm to assist in developing a baseline for physician satisfaction and develop several agenda items for the strategic planning retreat. The outside consulting firm had a very experienced practicing cardiologist as a consultant, and he proved to be extremely crucial to the fact-finding process. His summary report was very eye-opening and contained great baseline data for physician satisfaction. The overriding theme was that to ensure long-term, high-quality care for our communities, the partners must finally build an ambulatory surgery center — a goal discussed for years and mentioned by nearly every partner in the interview process. This report solidified the ASC’s importance to the group and led to its inclusion in the strategic plan.

    The best place to work

    For the last objective, we already had a baseline from the initial employee satisfaction survey that was conducted shortly after I joined the group. This survey had already been reviewed by the management team, with most of the key areas presented to the partners’ board of directors. As promised, meetings were conducted over several nights to present the results to staff and, most importantly, our plans to resolve some of their issues. We developed a weekly communication newsletter for all providers and staff that showed the scores for our different patient satisfaction categories for the month and year to date; news blurbs about upcoming information in the group; acknowledging employee anniversaries and birthdays; and a “kudos” section to acknowledged employees for the great things they do on a daily basis, which otherwise may be taken for granted or never publicized. It reflected leadership author Ken Blanchard’s favorite statement, “let’s turn people in for doing things right.”

    Over the next five years, the management team became fanatical about attaining our objectives and making sure that our mission, vision and values were at the forefront of daily operations. Every three to four months, we held “town hall” meetings to provide updates to the staff on how we were doing. At the beginning of each meeting, we reiterated our mission, vision and values and their importance to our daily operational duties. More importantly we cited some of the kudos in previous newsletters as examples of how our staff live our mission, vision and values.


    Our vision in 2015 was that by 2020, in keeping with our core values, we would be regionally recognized as:

    1. The best place to receive care
    2. The best place to practice medicine
    3. The best place to work.

    Our patient satisfaction scores — 4.1 to 4.2 out of 5 in 2015 — reached 4.8 to 4.9 out of 5 in 2021, as rated by an outside marketing company.

    Our physician satisfaction score started at 4 out of 5 in 2015 and rose to 4.5 in 2021, with many more physicians feeling good about the future. While this may not reflect a “regional” recognition, the fact that more of our physicians felt good about the direction of the group was a very positive metric for us.

    In 2015, management received an initial score of 3.2 out of 5 in an employee satisfaction survey. Four years later, we received national certification as a Best Place to Work organization. This award is given by employees, and national certification is not easy to obtain. In fact, if your organization is not committed to taking care of its staff, it is quite unlikely that you will receive this designation. 

    For financials, over those five years we reduced overhead by 11%; increased physician income by more than 34%; built a new, 10,000-square-foot ASC; updated and upgraded most of our ancillary equipment; completely revamped our IT system to include a new PACS system and the ability for providers to have access to patient medical records at the push of a mouse or phone key tab anywhere in the world; substantially reduced the ability of any outside interference into our IT systems; and significantly reduced the financial exposure of our partners to our banks and lending institutions. 


    How important is top physician leadership in all this work? It is absolutely imperative that you have a commitment from your physician leadership to develop and work on your vision. In this organization, the group’s partners were 100% committed to the goals of this vision; although many physicians and groups espouse the ideals of high-quality care and commitment to customers and staff, these partners live by these mantras every day.

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    Written By

    James R. Zeman, PhD, FACMPE, CPA

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