Case Study: Results with Maximum Change

DocBy Dr. Philip A. Foster

A premier interventional pain management and ambulatory surgery center in middle Tennessee focused on helping adults with musculoskeletal or neuropathic conditions regain strength, mobility, and function while avoiding narcotics or major surgery. This highly regulated medical practice (the practice) is headed by an acclaimed physician and leader in the field of interventional pain management.

The practice was in process of becoming an accredited surgery center. With the expansion, the stakeholders were seeking additional surgeons to join the practice. During disclosure it was determined the practice was losing on average $110,000 a month in revenue and this would limit interest by investing physicians to join.

We focused on four main areas of concern: Front-office mismanagement, workplace conflict, disengagement of the stakeholder/leader, and back-office mismanagement.

Front-office (intake) mismanagement included customer service, scheduling, purchasing, intake (pre-authorizations), pre-billing, co-payment, proper paperwork and compliance.

Customer Service: Reception is the first experience patients have with the practice. Going to a doctor, specifically for chronic pain is not a pleasant experience to have. It is important that reception work to ease tensions and to be a friendly reassuring face of the practice. At the time of the review, the practice had a front desk staff that was lacking in the area of customer service. Some areas of concern include: long wait-times for patients, improper interactions with patients, phone etiquette was rough and sometimes even costic. Some patients were turned away because they arrived without the proper documentation or referrals.

Compliance issues: HIPAA violations were observed. Specifically the positioning of computer monitors and conversations overheard from the waiting room.

Scheduling conflicts: Patients sat in the waiting area for extended periods of time and on occasion some may have been turned away altogether. No front office manager or practice manager who can delegate work and maintain workflow. Very little accountability of time, resources, scheduling, etc on a regular basis.

Expenses: Reception oversaw the purchasing and expenses within the organization. There was no inventory control over oversight and expenses were out of control.

Workplace conflict is not uncommon as it typically involves differences of opinion, style, or approach that are not easily resolved. In the case of this practice, there were layers of conflict. There were conflicts between co-workers as well as conflicts between the stakeholders and employees. The greatest level of workplace conflict in the practice was between the stakeholders and employees in that there were proper ways to do the work and then there was the way the employees wanted to do the work.

Disengaged leadership is a challenge that many organizations face today. What we know about leadership is that it is a participation sport. An engaged leader is about being visible, present, and connected with the employees. Engagement requires strategy and the ability for a leader to recognize their personality and how that plays out in the office setting and among their followers. Disengagement of leadership does not necessarily note a lack of skills or ability.

Leadership engagement takes a lot of time an energy – something many leaders feel takes away from their core responsibilities. In the case of this practice – engagement of the physician requires time that the doctor feels is better spent with patients.

Back-office: Billing issues. Medical billing is in constant fluctuation and is based on a complex set of variables. The billing department was missing opportunities to bill and thereby left a great deal of money outstanding.

Treatment Plan
To begin the process, we conducted several days of in-person observations over a one month period. Some of the observations were done without the knowledge of the staff. The first day of observations, Dr. Foster arrived and sat in the waiting area to casually observe the interaction between staff and patients. On another occasion staff was directly observed. One observation was made in secret. Dr. Foster entered from the back door and sat in a back office down the hallway from reception so that he could audibly observe what was going on in the office.

Dr. Foster met directly with a compliance consultant and the physician/stakeholder of the practice to get input from both parties as to the problems at hand. The compliance consultant was spot on in their observation. The physician focused concerns on what they believed the issues were. Physician felt as if their position within the organization was taken for granted. Physician felts as if the staff was running the show and not him.

An organizational culture assessment was conducted to determine the culture of the organization. The assessment was conducted by use of a questionnaire which requires individuals to respond to six questions. The purpose of the OCAI is to assess six key dimensions of your organization’s culture. Each of the six key dimensions has four alternatives and two columns for each alternative marked now and preferred which indicates how we think it should be in five years in order to be successful as an organization. The OCAI is based on a theoretical model known as the Competitive Values Framework which is used to interpret a wide variety of organizational phenomena such as the organizations core values, assumptions, interpretations, and approaches that characterize the organization. Overall, the survey results indicate:
Respondents would like to continue to develop sense of a team. Continued training, team-building and coaching is recommended.

Respondents would prefer less adaptability, flexibility, and creativity. Organization must determine the level of adhocracy desired and develop plans to train and equip the staff in areas where uncertainty, ambiguity, and information overload is possible.

Respondents would prefer a greater focus internally and less externally. Appropriate balance between external and internal focus is required. Given that the organization relies on referrals and relationships external to the organization. A fitting policy and procedure for handing external interaction is recommended.

Respondents desire greater emphasis on hierarchy. Developing policies, procedures, and clear lines of authority and duties would be helpful to the members of the organization.

What was revealed
Insurance calls by reception should not be conducted during busy times of the day. Insurance calls should be conducted by someone who will not be continually interrupted.

For HIPAA compliance, front desk computer screen should be positioned so that it cannot be seen by anyone standing at the reception window.

Pre-screening of patients should be conducted via a checklist and that no patient should be given an appointment without proper paperwork submitted. Specifically, referrals and pre-authorizations from insurance should be completed prior to patient arrival as to limit the patients stay in reception waiting.

Pain patients should not be left waiting for a doctor because the doctor is stuck speaking with a drug representative. Drug rep visits should be handled by the practice administrator and any specific meetings required of the doctor should be set at “non-busy” times of the day.

Patients seem to wait a long time – practice should track check in time against wait time.

There is a strong need for weekly intense coaching and mentoring on customer service, time management and even practical computer and office skills.

Front office should have a day-to-day office manager or practice manager that can delegate work and maintain workflow. There appears to be very little accountability of time, resources, scheduling, etc on a regular basis.

Job descriptions should be developed and tied heavily to performance. Such performance measures should be: patient wait time, efficiencies, demeanor, and number of compliments or complaints – just to name a few. Currently raises and bonuses in general are not tied to any such performance metrics.

Practice should have front office staff that is cross-trained in the event of vacation, sick day, etc.

Numerous complaints from referring colleagues. Such complaints can be tied to performance. It would be helpful to poll referring agencies at least once a year asking one or two simple questions to make sure that we are hitting the mark on customer service, etc.

Tracking wait time and scheduling are keys to the overall performance of the practice. The practice is losing money due to inefficiencies in use of physicians time, scheduling and wait times.

Bonuses should not be an expectation of any position – however, if bonuses are to continue they should only be tied to performance as based on the positions job description and performance ratings.

Based on observations, discussions with the stakeholders and the organizational culture assessment, we developed an intense coaching plan for the staff as well as the practice leadership. Weekly coaching for employees was focused on workflow, time management and customer service.

Ultimately, It was noted that the position and the practice outgrew one of the staff members capabilities. This particular staff member had been with the practice for many years. After intensive coaching and little improvement, the staff member was ultimately released with a generous severance package.

At our recommendation, two staff trainings were conducted over a one year period. The first training was focused on Customer Service and all staff members with the exception of the physician were in attendance. The second training, held after several changes in staffing, was team building. Again all staff were present with the exception of the physician. The team building process would have been much more powerful if the stakeholders had been present.

After training, coaching and changes in staff, practice went from a loss of $110,000 a month to a 45% increase a month in revenue within 7 weeks. Additionally, expenses went down by 18% with the recommended changes.

For more information on Maximum Change Coaching and Consulting, please visit our website at

Why You Need A Coach


I hear this question a lot: “Why does any one need a coach?” The answer is quite simple.

Research shows that individuals who engage in coaching are more satisfied with life, have better relationships and are more successful professionally. More specifically, studies show that working with a coach:
Improved work performance/productivity by 90%
Improved Business Management by 61%
Improved Team effectiveness by 51%
Increase well-being and life satisfaction over 52%
Help cope and grow from life experiences
Provide average return on investment of over 500%
Improved self-confidences by 80%
Improved communication skills by 72%

Over 95% of people who use coaching continuing working with a coach well into the future. 86% of companies who hire a coach say they made their return on investment.

Benefits of Coaching:
Improve your overall life satisfaction
Create definable and measurable goals
Develop a road map and action plan to generate results
Achieve your goals and develop personally
Identify self-sabotaging patterns and behaviors
Generate power, velocity, confidence and inspiration
Take action to create real change in spite of any fear
Find creative new ways to solve problems
Become more accountable
Save time and get faster results
Save money
Less stress and frustration than going-it-alone
Insights into yourself
Increased self-confidence
Develop communication and leadership skills
Improve well-being

Coaching is a unique conversation; a way to reflect on your own life. It is a way to figure out what is getting in your way of you living life to it fullest.

What is Business Coaching?
Business coaching is a process used to take a business from where it is now to where the business owner wants it to be. A business coach will assist and guide the business owner in growing their business by helping them clarify the vision of their business and how it fits in with their personal goals.

Why Dr. Foster?

Dr. Foster has coached thousands of Individuals, Business Owners & Leaders around the world to develop clear and concise goals, make executable plans, and adapt those plans, to achieve the success they desire. Dr. Foster collaborates with his clients and engages an honest, open-minded, positive and inspirational approach to navigating life, health, business and relationships.

Dr. Foster has worked with Individuals, Business Owners, Entrepreneurs and High Profile Public Figures to quickly set and achieve their most important personal, business, and financial goals so that they may realize the visions they have for their life and businesses.

If you are not satisfied with your current situation and are WILLING TO IMPROVE, Dr. Foster can help you realize greater levels of success, discover new ways of approaching life issues, moving past obstacles and accelerating your personal and business growth each step of the way.

If you are truly ready to make the changes needed, sign up for a FREE consultation!

Find A Way: 3 things we need to overcome challenges.

a99193_tree-growth_11-lakeHave you ever found yourself in a difficult place – what we call between a rock and a hard place? Perhaps you find yourself buried by pressures and wonder if you will be able to climb out of the challenge. An analogy of this very issues is that of a tree growing up out of a rock. This is truly an example of a rock and a hard place. Trees don’t choose where they grow – they grow where a viable seed ends up. We, likewise, don’t choose hard places but the conditions around us create these hard spots.

We can either look at challenges as the end of us or we can see challenges as incubators for our character. These difficult places show us what we are really made of. Challenges are not things that should be allowed to overtake us – but things that we overcome.

How do we overcome the very things that are trying to overcome us?

  1. Make a decision that your situation is temporary and that you will work your way out of it.
  2. Be Persistent. Overcoming a difficult situation takes time. You must not ever give up.
  3. Learn along the way and from the difficult challenge.

Like the tree, you can and will grow through your challenges.

Don’t give up… Today is not the day to give in. Keep going and find a way to win.

The Success Coach – Dr. Foster

Power Affirmatons


I Am Amazing
I Will Never Quit
Criticism Has No Effect On Me
Anything Worth Doing is Worth Doing Well
I Will Not Wait
I Will Savor The Journey Today
I Will Leave a Legacy
I Am Focused On The Prize
People Matter
I Am A Winner
I Am Happy
I Am Amazing and Astonishing
I Am Outstanding
I Am Ambitious And Courageous
I Am Free
I Am Succeeding
I Am A Diamond – They Can’t Break Me
I Am Healthy
I Am Strong
I Am Positive
I Am Prepared to Succeed
I Am Powerful and Unlimited
I Am A Leader
I Am The Best In My Field
I Make It Happen
I Can, I Will, I AM!
The Success Coach – Dr. Philip Foster

Where are you headed?


Today’s video was focused on a cute cartoon of Calvin and Hobbes in a wagon barreling down a hill. Calvin looks back to Hobbes and says “The truth is, most of us discover where we are heading when we arrive.” [Video link:]

So true! Most people set out in life with no plan what-so-ever and they only know where they were going when they get there. But what if there was a better way? Well… there is a better way. It is called purposely planning out your life. What if today you made the absolute choice to go somewhere specific? What if you began to develop plans as to what you actually want to be and do in life? It’s true – you can choose what you want your life to be like. Yes, your spidey sense are one target… there is a but! Just because you make a choice does not mean that it happens overnight or exactly the way you planned it. To live in your preferred future – the future you dream about – the future as you imagine it to be, you need three things:

1). You need to make a definitive decision about what you want out of life. What is your goal? What does success look like to you?
2) You need to begin developing a plan to achieve said goal!
3) You need a coach or mentor to help you stay accountable, motivated, and on task.

The life you always wanted is just one decision away and a whole lot of hard work. The hard work is what makes the payoff so much more sweet.

The Success Coach –

The Heart of a Lion

nick_brandt_photogrvphy_magazine_13-1024x614_cThe pursuit of goals and dreams is not for the weak. The journey is hard both physically and mentally. To take this journey you must have the heart of a lion. You must be brave and courageous. You must have mental fortitude… you must be fearless in the face of adversity and uncertainty.

People are going to say things about you on your way to your dreams. They are going to try to stop you because they don’t understand what it is that is burning so deep within you. They don’t understand that your goal is like oxygen to your soul. They don’t understand that you have a fire raging inside of you that only can be satisfied by success. That your goals compel you to work tirelessly day and night.

You must not give up… you must not let fear win. Your journey to success is not about how hard it is… but about how you overcame that difficulty. How you rose above it all and stood tall on the summit of your dreams. The journey is about preparing you for the success you area about to receive.

Today – resolve to have the heart of a lion. Resolve to be courageous in the face of the unknown. Resolve to fearless. Resolve to not give up – not give in – not turn away. You are hungry… you are burdened – you must win.

Don’t give up… EVER!

The Success Coach –