More about scale: Shared appointments and Passion

A few weeks ago I posed the question of how to scale operations in health care. This topic came from reading In the Plex by Steven Levy, a book about Google and their history of managing the scale of operations to support their vision of searching the internet. Since then I have continued to toss around the question to friends and colleagues. How do you take an operation that is sequential, one patient after another and methodical within the visit with the patient, and scale it so it retains quality and personalization? Right now I still don’t have the answer. However I have two concepts that might contribute to an answer. These concepts are shared medical appointments and passion.

Shared medical appointments (SMA) is a model being used by Harvard Vanguard where a group of patients are seen at the same time by the same doctor. They are applying the concept to groups that are homogeneous (have the same medical condition) and heterogeneous. Preliminary research results indicate higher quality and patient satisfaction with lower cost (Noffsinger). From the perspective of face validity this makes a lot of sense. One big challenge for medical practices is having the space for the SMA. Medical offices are cut up into small rooms designed for the sequential individual visits. Where can you hold a SMA for 25 people? If you move too far from the exam room space you can’t reach the equipment needed for some individual care and testing. We need more flexible space in medical offices, like what you find in hotel meeting rooms. Movable panels that can rearrange space quickly to flex with the demand.

Another concept became evident today when I was reading the RSS feed from FastCompany. The article was on a new concept for a nail salon. Why it caught my eye I can’t be sure. However in reading the article the owner of MiniLuxe was asked about scaling franchise operation that retains the quality in the vision of the organization. Sue Thirlwall, the owner,  responded by saying that the key is to find a franchise operator who will embrace and have a passion for the business in the same manner as she does. Maybe this is part of the answer. Scaling the operation requires a passion for the vision. It is passion that carries the work forward despite obstacles. What is work without passion anyway?

Getting the new ideas flowing

What is it that makes new ideas emerge when you are talking with colleagues? I have read a number of books about neuroscience and the researchers in this area are beginning to unlock the secrets of innovation and creativity. We are still a long way from completely understanding these processes, yet we personally experience them acutely and profoundly. Last week I attending a meeting of large ophthalmology practice business leaders, a wonderful gathering in Charlotte from around the country. Typically we see each other twice a year, with emails in between visits. The trust and collegiality is high, allowing for bantering, brainstorming, and openness. Brain synapses were firing, causing thoughts to come together that would otherwise not connect. It is amazing.

I love that feeling of something new emerging. It raises my energy and lifts my well being. It seems so easy at this meeting, but hard to replicate back in the office with our management team. Imagine the value of getting the energy and new ideas flowing on a regular basis. That is not to say it never happens, just not consistently as it does with this meeting. We need more creativity in health care; new and innovative ideas, energy to make changes, and connection of disparate operations. I am grateful to my colleagues in ophthalmology for their support and engagement. Meeting with them fills my reservoir to carry forward into something new.

Weaving and pivoting

One aspect of wisdom is knowing when to abandon a project. In my leisure time I work with fiber arts; knitting, spinning, weaving, and sewing. Recently I was working on a weaving project with a beautiful yarn. The project was going to be a lace scarf; light weight and in a deep teal color. It takes time to set up the loom and start weaving. After many hours of planning and set up I was finally creating the cloth. The pattern was turning out just as I imagined, except the yarn kept breaking. I would repair it and keep going, but it kept breaking over and over. Finally I abandoned the project. I was sad to see all that yarn wasted. I knew early in the project it wasn’t going well, but stayed with it anyway.

We also do this as leaders. A new idea is launched, project started. We have great hopes and plans for the project. Resources are applied and everything is put into place. At some point we understand that it can’t be as we envisioned. We have to pull the plug. It is hard to pull the plug, yet necessary. The challenge is to do it sooner. I know the team has learned some valuable information from the failure, we can take the information forward into the next project. However, I don’t want to go beyond the lessons and waste resources. The expertise is in stopping at the right time and moving to another project.

Recently I read a FastCompany article on Eric Reis who has received credit for the term pivot in the business literature. Stopping a project and using what you learned to make a change without losing the vision is what Reis calls pivoting. In health care we have to get better at pivoting, even if it means some really beautiful yarn gets pulled off the loom.

Supporting facts, not just an opinion

One of my assignments this week is to prepare a presentation on strategic planning, in collaboration with another medical practice executive. While putting this presentation together I have once again been impressed by the tools available through the internet. When talking to a group, I care about having my facts supported and empirical evidence brought forward in the material. If I am presenting an opinion I try to make that clear. There are many resources to help in this process. I want to share a few to help with your next project.

When I was in graduate school I had access to the school library, a compilation of databases with a PDF of the original articles. This was a fast and easy  way to find lot of articles. Not all of the articles were relevant, so it takes some work to get the query refined to what you want. The school librarians are genius at this type of problem. As an alumni I still have access to the library, but in a smaller number of databases. Helpful, but not as robust.

My national professional association has a set of databases available to members. When I am logged onto the website I can execute a search and the database portal becomes available. Like with the graduate school library the query provides a PDF of the article available for download. One trick I learned is the use of Google Scholar. It is available in the “more” and then “even more” category on Google. You can search through Google Scholar to find academic articles and you can set your preferences to the libraries and databases where you have access. Google Scholar will let you know in the query if your library has the source. Very helpful and uses the power of Google.

Another amazing resource is WorldCat on the Internet. (www.worldcat.org) This library catalog will search for books and articles, letting you know where they are available. Through your community library and affiliated systems you can request articles and books. I found this especially helpful when I was tracking down an original source. Though my community library the books were requested from college libraries from around the state and sent to my local library. There is a little time in the delivery, but the convenience and cost can’t be better.

If you have other ways of finding facts, let me know.