American Association for Physician Leadership

Problem Solving

Lessons I Learned from a Bonsai Plant About Practice Management

Neil Baum, MD

February 8, 2018


Abstract:

It is not easy to raise and care for a bonsai plant, just as it is not easy to start, grow, and maintain a medical practice. If we can successfully nurture a bonsai plant—and it is not easy—then we can also manage to care for and nurture a medical practice. The endeavors are similar in many ways.




I never thought a small-scale tree could teach me lessons about running a medical practice. I have always been fascinated with the beauty of bonsai plants, which are miniature full-grown trees, and my appreciation only increased when I tried to raise a bonsai cypress tree by carefully tending and pruning the plant only to have it suffer an early demise. I took good care of the plant, providing it with sunshine and shade as directed, carefully watering and misting it according to the instructions provided with the plant. Then, for some reason, its foliage started drying out and dropping—slowly at first, and then accelerating, until the plant was a goner. I was so disappointed when the leaves started drooping and then turned brown and finally dropped into the pot, thus highlighting my failure as a horticulturist. This article compares nurturing bonsai plants with the care and feeding of a medical practice.

Routine Tending and Careful Observation are Essential

Bonsai plants often have problems that emerge when the routine is changed. Just like a dog doesn’t like to go to the vet or even the “spa” when the master goes on vacation, bonsai plants don’t take kindly to changes in their water or exposure to light routines. The same holds true in your practice. The practice doesn’t run smoothly when you deviate from the routine or the schedule. If the doctors are to arrive at 8:45 and start seeing patients at 9:00, the staff is prepared, the patients are in the rooms, the phone is taken off of the answering service, and everyone seems to be on the same page. If the doctor decides to arrive at 9:30, check e-mails, return a few phone calls, and then begin to see patients at 9:45 or 10:00, there will be mayhem in the office. Patients become surly, the staff are agitated, and no amount of hurrying up can get the practice back on schedule.

The same applies to hospital operating rooms (ORs). If the OR expects the doctor at 7:30, and he or she shows up at 8:00, the entire OR schedule is now delayed, and other doctors, patients, and OR staff will be upset. This will have a trickle-down effect on everyone involved.

Rarely, if ever, should you deviate from the routine you and your staff have agreed upon.

Let the bonsai plant provide you with a lesson on having a routine—rarely, if ever, should you deviate from the routine you and your staff have agreed upon.

Pruning and Practice Management

Your bonsai is not a weed and will not grow and take care of itself without careful attention and even coddling, much like that which is required caring for a child. Pruning is the art of retarding the growth of the tree to keep its miniature status and size. To have a fuller, lower-growing plant, it is necessary to trim back the branches at certain defined angles.

How often do you review your balance sheet looking at your assets and liabilities? How often do you look at your EOBs or your denials of claims submitted to the insurance companies or to the CMS? A successful practice does not run on autopilot. It is imperative that you review the key performance indicators, the most important metrics that indicate the growth or the decline of your practice. When you identify problems, that is the time to consider pruning what isn’t working, such as dropping low-paying payers and look to new sources of revenue, such as offering early morning hours, evening hours, same-day appointments, or Saturday morning appointments. Another example of pruning is to look at revenue cycle management,(1) and make sure that nothing is falling through the cracks. This process also ensures that you are going to be paid what you deserve. Pruning is a necessity for a healthy bonsai plant and a necessity for a healthy practice.

Using the Right Tools at the Right Time

The absolute essentials for caring for a bonsai plant are a mister, measuring cups, and small pruning shears. But if you really want to provide outstanding care of your bonsai plant, the experts recommend a soil moisture tester. You must have the right tools to provide optimum care for your plant.

Make every effort to provide your employees with the skills and technology to let them do great work and be the most productive.

You can enhance the efficiency and productivity of your practice if you make certain that the staff has the right tools, including the right technology. For example, is your website offering your patients the ability to make an appointment online? Does the website offer the demographic forms and the health questionnaire for patients to complete before they come to the office for their first appointment? This single feature can make the practice more efficient, and your patients will appreciate being seen on time instead of spending 20 to 30 minutes completing forms in the reception area prior to being seen by the staff and the doctor. You can also enhance the efficiency of your staff if the scheduler or receptionist can verify the patients’ insurance online before their appointment.

As with bonsai plants, resources and tools can make all the difference in the world! Make every effort to provide your employees with the skills and technology to let them do great work and be their most productive.

The Right Environment Helps

Attention to careful potting of the plant to ensure that the soil drains quickly and keeping a moisture tray underneath it will allow the plant to believe that it is growing in the exact same conditions as its natural habitat.

I have observed that happy doctors and happy office managers create a milieu that makes for a happy staff, who, in turn, give patients a positive experience. Sometimes, obtaining this atmosphere is as simple as changing the verbiage or language that is used. For example, if you call the area that patients enter when they open the door to the practice as the waiting room, you are almost creating a self-fulfilling prophecy that the patients will be waiting before they will be seen. However, if you change the term to reception area, you create the aura that is where patients are to be received and that they will be seen and processed very quickly. Changing this one term makes patients feel appreciated and that they are doing the doctor a favor by being part of the practice rather than the other way around—that is, that the patient is the one who is making the effort rather than that the doctor is doing the patient a favor by providing healthcare.

Another method of ensuring the right environment is to have regular staff meetings to identify problems and also use this time to compliment staff members for going the extra mile on behalf of patients. I refer to these as ABCD awards, or Above and Beyond the Call of Duty. It is the actions of staff that aren’t necessarily in the employee manual that you want to reward, at least verbally, so that the behavior is repeated and that the staff know that their actions are recognized and appreciated.

Getting Advice

Unless you are a bonsai authority you will need to periodically ask for advice on your beloved plant. You can’t possibly know it all, and you will probably have to consult with a bonsai doctor when your plant exhibits signs of failing to thrive. Likewise, your practice will, on occasion, need to consult with an expert to solve employment problems, establishing a sexual harassment policy, or advice on taxes and investments. As with the bonsai plant, it’s not a sin to ask for help. It just may save your bonsai and your practice.

Bonsai Plants are Delicate

Too much or too little water will cause your plant to wither on the vine. The same applies to a doctor’s reputation. Physicians spend their entire lives building and protecting their reputation. We know that the majority of our patients have a favorable impression of the doctor and the practice. An angry patient with a bad experience can wreak havoc on a medical practice. Today, a patient who posts negative comments about the doctor and the practice can have their invective seen by thousands of viewers with just a click of a mouse. Therefore, it is imperative that physicians take an active role in protecting their reputations. The best way to do this is to capture compliments from happy patients the moment they utter their accolades. This can be done with online surveys, or right after the patient’s visit, before he or she even leaves the exam room. I use a kiosk from Context Media that allows me to create a patient satisfaction survey that the patient completes in the exam room. It takes the patient less than two minutes to complete the survey and adds to the glowing compliments about my practice that have afforded me 4.5 stars!

Giving Your Bonsai a Checkup

The bonsai experts suggest that even if your plant is doing well, it might be a good idea to have another pair of eyes, fingers, and soil testers to look in on your plant periodically. The best bonsai authorities will make housecalls without being asked and give your plant a periodic checkup.

The most effective office managers and managing partners practice MBWA—management by walking around. They visit with the schedulers, receptionists, and scanners and see how they are doing. These leaders find out about their issues and concerns and serve as the eyes and ears of the practice.

You can’t have an effective practice if you are moving from one crisis to the next and stamping out forest fires as they occur. You can be much more effective if you conduct regular staff meetings. The success of any medical practice begins and ends with the staff. A well-motivated, excited, and enthusiastic staff is the key to giving patients a positive experience every time they interact with the practice.

I suggest that you perform a regular performance review, perhaps every six months. I believe employees like to know where they stand and how they can improve performance on the job. Motivated staff members want feedback on their progress—even if there is a lack of progress. The best way to furnish this feedback is with periodic performance reviews.

Begin by asking employees what they like best about their work, what they like least, one or two areas that they would like to improve, and what you as office manager or physician can do to assist them in their professional growth and development. I suggest you provide the employee with a worksheet with these questions and request that they complete the worksheet before the performance review. I like to make sure that I end the performance review on a positive note. I tell the employees how valued they are and how much of an asset they are to the practice.

Bonsais and practices need fine tuning. Don’t be complacent with your plant or your practice.

Bottom Line: Lessons for practice management are available not only in books and in MBA schools but also in the flora and fauna of our hobbies and desktops . . . if that’s where you keep your treasured bonsai plant. My children are grown, and I am proud of their accomplishments. Now I’d like to try raising a bonsai plant . . . one more time!

Reference

  1. Dowling R, Baum M. The urology practice revenue cycle: how to track and manage it. Urology Times; October 30, 2011. http://urologytimes.modernmedicine.com/urology-times/news/modernmedicine/modern-medicine-now/urology-practice-revenue-cycle-how-track-and-m .

Neil Baum, MD

Neil Baum, MD, is a professor of clinical urology at Tulane Medical School, New Orleans, Louisiana.

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