Thursday, September 30, 2021

Advice for physicians when giving negative feedback

Giving negative feedback can be one of the most difficult parts of any job. For most physicians, negative feedback is not part of patient care, but it can be part of working with staff and colleagues. Giving negative feedback is different than discussing a bad prognosis with a patient because negative feedback can be an associated sense of rejection and blame. While few doctors could actually enjoy the process of giving negative feedback, it can be a less dreaded interaction if it’s done with some thoughtful planning.


Establish roles and purpose


When you give negative feedback, the recipient of your assessment might push back by arguing that you are wrong or that you are not qualified to provide an opinion about their work. As a physician, before you provide your feedback in the work setting, it’s important to verify that you are in a position to give this type of appraisal. Whether you are formally supervising other doctors or assessing one of your peers, defining your roles and the need for the critique is a vital first step.

Perhaps your evaluation is scheduled, which can make the process easier. But if you are giving unscheduled feedback to a peer for the purpose of getting fair treatment for yourself, improving the process for your team, or responding to a patient care issue, you need to be clear about several things:

· Why this feedback is important

· Why you are the one who is giving the feedback

· Why feedback is needed at this time

· The overall purpose and desired outcome





The traditional sandwich still works


When it comes to negative feedback, using the 1/3 rule is a tried-and-true strategy, particularly for people who might be highly sensitive to criticism. Opening with praise, then clearly stating the criticism, and then closing with praise is a way to present the matter as being only one aspect of a person’s whole performance.

Sometimes, pointing out the positives can prompt a reassessment. It might lead to organizing assignments so that people can increase the amount of time they spend on tasks they are especially good at. If this is something that you and your whole medical team would consider to be productive, the complement/criticism sandwich might frame the situation for you and others to see how to better apply colleague talents.

Provide suggestions


An important aspect of feedback is giving suggestions for improvement. Sometimes the path to improvement is easy to see and spell out, but other times you might not have an idea of how a

person can improve. If the steps to fixing the problem are not clear, your colleague may need professional help. For example, a physician might benefit from a continuing medical education (CME) program with instructions covering the area of deficit. Or they might need a more comprehensive or personalized program to help them work through problems that are interfering with their work. Suggestions might not be simple, but it is a good idea to discuss actionable steps to remedy the situation at an early stage.



Show realistic belief in improvement


Being criticized can be overwhelming, even for physicians who seem to be confident. If you think your colleague can improve, it helps to directly tell them that you believe they can fix the problem. They might not be able to see their potential until you point it out to them.

Feedback about a deficit is usually about the action, not the person. This is the case most of the time. However, if you and colleagues are concerned that a peer physician or another health care professional might not ever be able to achieve the improvement necessary to provide good patient care, it could be beneficial to use objective measures to make this assessment and to find resources so they can find another path that doesn’t endanger patient safety.


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Wednesday, September 29, 2021

How to build a succession plan for your medical practice

After working for years to build a successful medical practice, are you ready to move on to retirement or something new? To maximize the value of your practice and properly sell or pass it along to the next generation, a succession plan should be in place.


Succession planning can be a slow-moving and difficult process. While many physician owners claim they look forward to days when they can retire, they often fail to create a transition plan. Daily clinical duties and caring for patients take precedent over long-term planning concerns and this pushes succession planning to the back burner often for long periods of time.
Plan ahead

It can be more comforting for the physician owner if the succession planning process starts years before their actual transition. It’s also important because the more time spent shifting the core business responsibilities of the practice away from the current owner, the better.

To facilitate this process, it’s necessary to document the core areas of responsibility. This will help segregate various aspects of the owner’s responsibilities and create a clear vision for which tasks can be allocated to others as potential backups. It also provides clarity when searching for a successor on key tasks they will need to be able to perform. The more that is known about the role, the easier it will be to find a match.


Establish a timeline


Effective succession planning doesn’t happen overnight. It can take many years to understand organizational challenges, identify solutions, and then get all the puzzle pieces to fit. The key is to establish a goal retirement date and then work backwards from there. Since things often change in the healthcare arena, it’s not essential for the date to be an absolute. However, a rather flexible goal date that can change as needed is best.

Planning at least four years in advance will allow for maximum planning time and efficiency. Working with the end in mind is the best way to approach succession planning and allows for the complex process to be broken into smaller pieces. Your succession plan should include a detailed list of circumstances and, if applicable, dates for all major steps in the succession plan. Depending on the situation, your timeline may stretch across many years.


Transferring ownership


A critical component to successful succession planning is determining a successor. Although every situation is unique, there are three primary methods of ownership transfer:
  • Selling the practice: If you are a co-owner, you could sell your interests back to the practice. If you are the sole owner of a medical practice, you may sell your practice to an outside party (e.g., another physician group, MSO, or hospital).
  • Transfer to an existing partner: Rather than selling ownership interests back to the practice, you may sell your share or interests directly to an existing partner.
  • Pass the practice along: You may choose to pass ownership interests along to a physician currently employed within your practice.

Once you have determined which transfer option is best for your specific situation, a succession plan can be crafted.


Identify a successor


Although you may have a single successor in mind, it is best to list multiple options organized by order of consideration. If you are not planning to transition soon and do not have a set successor list in mind, begin by listing qualifications, skills, and/or personality traits you would like to find in a future successor.

It’s important to identify a successor as early in the planning process as possible. Without an identified successor, much of the work of succession planning is quite limited. Beyond this, the job of most physician owners is so complex that it may require a great deal of time to conduct training, introduce them into relationships, and coach them through transition. Start the training processes as soon as reasonably possible. This will ensure a maximum amount of time to transfer organizational and business knowledge.


Empower the successor


Once a successor has been identified, there will be opportunity to share tasks or responsibilities. It’s not uncommon to see a successor approach a task or tackle a challenge in a way the current owner may not. Don’t be alarmed, it’s important to be open to the new ideas, processes, and ways of doing business that a successor can bring to the table. Open the door for them by allowing them to manage some existing responsibilities and make them part of the decision-making process quickly.


Is your practice sellable?


If you plan to sell your medical practice to an outside party, determine how appealing your practice may be:
  • Does your practice have a history of profitability? Of course, a financially stable medical practice with a history of consistent profitability will be more attractive to potential buyers than a struggling practice.
  • Where is your practice located? Is it in a highly desirable area based on the type of specialty you are in? Do you have a consistent patient base and loyal referring physicians? Positive answers to these questions point towards long-term profitability and higher medical practice value.
  • Are your assets in good condition? Assets with market value and remaining useful life assist in increasing practice value and potential buyer attraction.
  • Do you have a strong balance sheet? Medical practices that appear worth purchasing usually have good retained earnings, great net worth, and low or nonexistent debt.
  • Have you done a valuation? If you had a valuation performed on your practice more than one year ago, it is definitely outdated.

Planning for succession well in advance of a transition is extraordinarily helpful for increasing the practice’s marketability. Succession planning offers peace of mind for any physician owner, regardless of retirement timetable, but it is no small task. These are emotional decisions which require structured thought and time to contemplate. You may want to consider consulting professional advisors to assist in the tasks outlined in this article and to work with you to develop a comprehensive strategy.

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Tuesday, September 28, 2021

ONC: App integration with EHR on the rise

The Office of the National Coordinator for Health Information Technology (ONC) says that more apps are integrating with EHRs.


According to a blog post from ONC, the entity has released research analyzing apps that were discoverable in app galleries managed by EHR developers such as Allscripts, athenahealth, Cerner Corporation, and Epic Systems Corporation as well as the SMART App Gallery. It found that there has been a 20 percent rise in the number of apps which integrate EHRs as the healthcare industry continues to adopt the digital tools.

The goal of the research was to understand growth in the app market, the various app functions, how they connect to EHRs, and if they Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standard prior to finalization and implementation of the ONC Cures Act final rule, according to the post.

The total number of unique apps saw an increase during 2020 with administrative apps which handled scheduling, check-in, and billing making up 42 percent of available apps. Other common apps include clinical apps with 38 percent, care management apps with 31 percent, patient engagement apps with 20 percent, and research with 5 percent, the post says.

Meanwhile the number of FHIR-enabled apps has remained near constant despite more apps supporting FHIR as there has not been a statistically significant increase in the proportion of FHIR-enabled apps among all apps.

The post says that the modest growth may be tied to the prevalence of administrative apps which typically do not support FHIR as well as the fact that FHIR apps are typically developed around specific use cases.

“In this study, the data showed that there is still room for growth and variation in the apps available,” the post says. “Updates to the ONC Health IT Certification Program resulting from the ONC Cures Act Final Rule are intended to support a more robust ecosystem of third-party apps. By the end of 2022 many certified health IT developers will be required to support FHIR-based, standardized APIs for patient and population level services and they will need to abide by new API ‘Conditions and Maintenance of Certification’ requirements to promote transparent and competitive business practices.”


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