Case Study: Results with Maximum Change

DocBy Dr. Philip A. Foster

Background
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.

Diagnosis
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.

Results
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 http://www.maximumchange.com

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Proceed with caution when rolling back programs like work-from-home

Removing programs designed to foster openness can be tricky—even destructive.

by Dr. Philip A. Foster

Proceed with caution when rolling back programs like work-from-home
Image by : opensource.com

As an evangelist for open organizations and an ambassador for open principles, I am fully aware of the challenges organizations go through when they’re trying to effect lasting change. Changing deep-rooted organizational culture should not be taken lightly. It’s something people should weigh very carefully, debate fully, and then embrace wholly.

Once your organization “steps through the gate” and adopts an open mindset, reversing the flow of power that’s unleashed is difficult. Organizations that embrace openness shift their attention from costs to the value side of doing business. In other words, they begin seeing employees as assets capable of delivering value to the organization rather than as cost centers that must be strictly managed.

Because open organizations are built on trust, accountability, transparency, and empowerment, actually reversing course and creating closed environments can be detrimental to an organization’s long-term success. Certainly, in the short-run, we know that up-ending an open ecosystem diminishes morale, trust, and (even more so) productivity. As a result, organizations that tighten their workers’ freedoms ultimately lose market share—and their best employees.

Take, for instance, the 2013 case of Yahoo ending their work-from-home policy for more than 500 employees. Public fallout and ridicule from the decision was deafening. While the number of employees who ultimately left Yahoo as a result of the decision is a bit sketchy, we know that many were not very happy with the decision. We can also look toward noted remote-work pioneer IBM, who recently announced to more than 5,500 marketing employees that it was moving away from remote-work and had decided to “co-locate” its U.S. marketing department of about 2,600 people to one of six different locations: Boston, New York, Raleigh, Atlanta, Austin, and San Francisco. This means that individuals who normally worked remotely or from another office must now move closer to one of the six offices—or resign. This move has many employees furious. They’re abandoning work on long-term projects and looking for others jobs.

No take-backs

In my book, The Open Organization, 2nd Edition, I write about leadership intervention within the confines of an open organization. We know that in the context of an open ecosystem when leadership intervenes in decisions made by their followers, they begin to erode the spirit of openness and thereby create anger and diminish trust. This is not to say that leadership intervention is unwarranted or should be avoided at all costs. This means that when a leader intervenes or holds veto over a group decision, that it should be done sparingly and the leaders must be prepared to fully explain the reason for their override. Leadership’s role in the context of an open system is protecting its First Principles and the governance models that define its openness.

When we “walk back” freedoms we give to people, we begin to break down the morale of the organization. This affects productivity and the overall happiness of the workers. As we have seen with IBM, many employees noted that they stopped focusing on long-term projects, as they were concerned with their job stability. When we remove these freedoms from our workers—when we’re clearly focused on costs rather than value—we end up creating an exodus.

We saw this happen when Zappos adopted holacracy. We watched it happen when Yahoo ended work-from-home and we are beginning to watch valuable and talented employees leave IBM.

Sending the wrong message

When we move an organization from the freedom of open to a more rigid, inflexible structure, we send the wrong message to our employees.

In the case of the work-from-home policies being taken away, we’re really communicating that we are not going to trust employees to do their work unless they’re located some place where we can monitor them. While I readily admit that working from home is not for everyone, for those who thrive in this environment, taking it away is tantamount to a demotion.

Fix what’s really broken

When I read about organizations that are walking back their work-from-home policies, I can’t help but think that it was their policies and not their people that were broken.

Stay the course. Fix real problems. Trust your employees to do the right thing.

While I understand that Yahoo and IBM are ending work-from-home policies in an effort to increase productivity, collaboration, and innovation, the resulting effect appears too frequently to be the opposite of what they set out to do. In the end, it is not the collaboration or even innovation that is broken. What we are really experiencing is an organization with ineffective processes and policies for remote work. Bringing employees back into the office will not fix the problems these organizations are experiencing. While there are many reasons why a work-from-home policy might fail, here are few of the more common ones:

Organizations fail to properly onboard individuals for remote work. Working from home is not for everyone. It requires focus, organization and technological skills among others. Organizations that properly onboard remote workers will make sure that the new hire understands the organization’s missions, vision, and processes. They communicate these often.

There is a lack of connectivity between the remote worker and the organization. Staying connected is extremely important. Communication should be conducted via video conferencing (face-to-face), and in person at on-site meetings. Companies offering work-from-home policies should remain purposeful in their desire to keep connected with their distributed workforce. Out of sight should not be out of mind.

Companies don’t properly and consistently instill their culture in their workforce. The organization must continually instill cultural values in their employees. They can do this by clearly articulating the company purpose, values, and mission.

Organizations do not give the employees the autonomy and empowerment they need to get their work done efficiently. This inhibits productivity and certainly gives the impression that the employees are goofing.

Proceed with caution

Organizations that are contemplating ending open organization programs (such as work-from-home, flexible hours, and others) should proceed with caution. The moment the organization empowers employees, they open a Pandora’s Box that’s difficult to close without damaging the fabric of the organization. Open ecosystems are extremely rewarding, and, when done right, are effective and innovative. Moving an organization to an open ecosystem is not to be taken lightly. For those that operate in an open modality, going backward is not always the right thing to do.

Stay the course. Fix real problems. Trust your employees to do the right thing.

This article originally published on OpenSource.com. Republished under Creative Commons License. 


cropped-img_0100-001Dr. Philip A. Foster is a Thought Leader focused on the Future of Work and the 21st Century Workplace. He is a prolific writer, International Lecturer and Best Selling Author of “The Open Organization” – now available on Amazon. He is an Ambassador to the OpenSource.com community and holds a Doctorate in Strategic Leadership with emphasis in Strategic Foresight from Regent University, Virginia. You can contact him at http://www.maximumchange.com

4 Steps to Organizational Success | STEP 3: Process Improvement

4_Steps_to_Org_SuccessNo one knows your business better than you, right? This is a trick question because, while you and your team know your business, if your methodology is flawed then the way you do business is broken. This is why the organizational analysis in STEP 1 becomes so important. Case in point: I recently spoke to an organization that requested I conduct a survey of their customers to reveal a predetermined outcome. While it is always a good idea to get feedback from customers in STEP 1, it is only part of the equation. It is liken to changing the oil in your car in hopes it will fix the broken radiator. If you don’t look at the whole picture and address the actual problems that exist, your organization will flounder and perhaps fail. STEP 2 becomes a painful outcome of a failing organization because change is not easy on any day. Add to this a heightened level of dysfunction and you’re in for a treat. STEP 2 is about changing beliefs and broken actions. As I’ve written previously, change takes time and the process of change cannot be rushed. Once your organization has moved through the first two steps of the Organizational Success Model, you are now ready for STEP 3: Process Improvement. As a result of the analysis and alignment process, the organization’s best practices and deficits are now clearly exposed. We are then able to begin considering the “How” of what organizations do and develop scalable processes and best practices to generate positive outcomes. The key to this step rests in the idea of scalable. Scalable is when a process can grow and contract with the organizations life cycle. Unfortunately many organizations are still using systems and processes that are out of date and have not kept up with the organizations growth, changes in laws or even technology. Process Improvement requires someone with an unbiased view of the organization to observe and report those areas that appear to be in deficit. Process Improvement also requires speaking with the individuals in the company who actually do the work and asking them questions like, “what would you do to improve this process” or “what would you change in this process to create efficiencies?” Unfortunately what I’ve discovered is that many leaders believe they know better than their followers on how things are done. The key to success in STEP 3 is locked in the engagement of the followers. When you include them in the change process, they are more apt and able to assimilate the changes required to achieve success. Effective leadership is really in the empowerment of your followers to do their job. It means getting out of their way and letting them do what they do best. If you believe your organization would benefit from an honest assessment of your operations, we are ready to help! Our team has over 60 years of leadership, management and organizational development experience. If you believe your organization could benefit from our 4-step process, please contact us today for a FREE consult.

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Dr. Philip A. Foster is considered a Thought Leader in Business Operations, Organization and Strategic PIC3Leadership. He is a prolific writer, published author and lectures internationally. His most recent book “The Open Organization” is now available through Ashgate Publishing.  Philip is certified in both Leadership and coaching and serves as Adjunct professor at Middle Tennessee State University, Murfreesboro, TN. He is the Founder and CEO of Maximum Change Leadership and Business Consulting, serving clients from around the world. He is a Doctor of Strategic Leadership with emphasis in Strategic Foresight and holds a Master of Art in Organizational Leadership, both from Regent University, Virginia. He can be reached at philip@maximumchange.com or (615) 216-5667.

4 Steps to Organizational Success | STEP 2: Alignment

4_Steps_to_Org_SuccessWhen was the last time you checked the alignment of your organization? For many, the answer is likely never! In fact, most probably don’t even know what true organizational alignment consists of. According to Webster’s alignment is an arrangement of groups or forces in relation to one another. In other words, is your organization in alignment with the Mission, Vision and long-range goals of the organization? Most would quickly say yes. But to be honest you really don’t know unless you check the alignment on a regular basis. Most organizations I’ve worked with assume that because the organization is making a profit and nothing has proverbially blown up that their alignment is just fine. As example, we worked with an organization that appeared to be doing great with their alignment. They were profitable and growing. But there was a problem festering under the surface of this wonderful organization. When we conducted the analysis and compared it against the organizations stated values, mission and vision we discovered a problem. There was at least one employee that was very unhappy. The stakeholders in the organization were surprised to find that there was a problem at all. The location was their most profitable and the person that was not happy was their best employee. The organization was out of alignment and it was beginning to spread throughout that location like a virus. Unattended, this could have been the undoing on this particular location. Analysis is the first step in identifying alignment issues. But how do we align the organization? This requires the delicate process of change management. Change management involves proper and effective communication, leadership coaching, and follower training among other things. In some cases, alignment requires a clear definition of what the organization is here for. Alignment takes time and patience. The process can’t be rushed and steps can’t be overlooked. Success comes from a proper alignment and is not always a do-it-yourself project. I know better than to try and do a front-end alignment on my car. I take it to a mechanic who has the tools and expertise to assist me. The same goes for organizational alignment. Don’t go it alone. Most organizations do not have the time or expertise to align their organization. If you’re in that place, we can help.  Our team has over 60 years of leadership, management and organizational development experience. If you believe your organization could benefit from our 4-step process, please contact us today for a FREE consult.

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PIC3Dr. Philip A Foster is considered a Thought Leader in Business Operations, Organization and Strategic Leadership. He is a prolific writer, published author and lectures internationally. His most recent e-book “Organization 3.0 – The Evolution of Leadership and Organizational Theories Toward an Open System for the 21st Century” is available exclusively on Amazon.  Philip is certified in both Leadership and coaching and serves as Adjunct professor at Middle Tennessee State University, Murfreesboro, TN. He is the Founder and CEO of Maximum Change Leadership and Business Consulting, serving clients from around the world. He is a Doctor of Strategic Leadership with emphasis in Strategic Foresight and holds a Master of Art in Organizational Leadership, both from Regent University, Virginia. He can be reached at philip@maximumchange.com or (615)216-5667

4 Steps to Organizational Success | STEP 1: Analysis

4_Steps_to_Org_Success

At the end of each year while many are setting New Year’s Resolutions I spend time thinking about much deeper issues. This past holiday break I began to think about organizations and the subject of change. My experience has been that many organizations want to change, but they just don’t know how. Some begin the process only to discover that they are ill equipped for the journey. At Maximum Change we understand this problem and have developed a 4-step process for change. The first step is all about the analysis of the organization’s current state. We can’t change if we don’t know what it is we are changing to or from. Change for the sake of change is most always a waste of time. Most organizations take little time considering their culture, personalities, leadership, and structure and how they relate to the organizations vision, mission, or even the goals before them. Understanding the organization holistically means that we are better equipped to effect the changes needed. We utilize the process of interview, observation, assessment, training and coaching to develop a clear picture of the organizations current state. Our process considers the organization’s culture, leadership structure and individual personality profiles. This process illuminates the organization to its fullest, so that when we consider the desired changes we are better equipped to make those changes in the current organizational environment. Many organizations spend hours a year developing their yearly, three and five year plans only to abandon them to the shelves of their offices. Strategic planning is only the beginning of the process not the end. What we need to understand is that strategic planning is nothing more than forecasting based only on what we know. We call this lag-thinking. Lag-thinking is the process of making decisions based on what has already happened. Budgets and financial forecasts are typically based on this process of lag-thinking. Lag-thinking renders a plan useless within only a short period of time and must be updated constantly. Strategic plans based only on lag-thinking information are ill-equipped for the year ahead. If you believe your organization could benefit from our 4-step process, please contact us today for a FREE consult.

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PIC3Dr. Philip A Foster is considered a Thought Leader in Business Operations, Organization and Strategic Leadership. He is a prolific writer, published author and lectures internationally. His most recent e-book “Organization 3.0 – The Evolution of Leadership and Organizational Theories Toward an Open System for the 21st Century” is available exclusively on Amazon.  Philip is certified in both Leadership and coaching and serves as Adjunct professor at Middle Tennessee State University, Murfreesboro, TN. He is the Founder and CEO of Maximum Change Leadership and Business Consulting, serving clients from around the world. He is a Doctor of Strategic Leadership with emphasis in Strategic Foresight and holds a Master of Art in Organizational Leadership, both from Regent University, Virginia. He can be reached at philip@maximumchange.com or (615)216-5667