There has been a lot of discussion and focus on the "triple aim" of good patient care which translates to access, cost, and quality. Which factor is most important? It depends upon who is talking, but more importantly it depends upon who your customer is.
In a medical practice there are many customers, with patients coming first and foremost, followed by referring providers, staff members, and other business partners. In order to meet the needs of the customer, I believe that quality is the most important factor, or as some may remember from the Ford Motor Company, "Quality is job one!"
One way to achieve quality is to create a quality management system (QMS). A QMS focuses on the quality of the desired outcome, as applied to patient care. The premise here is that quality outcomes will ensure good patient access and also control costs — therefore the focus for any business must be on the quality of services provided.
Creating a quality system
Here are four basic requirements to create a system:
• A system is a coordinated approach to deliver services to meet the needs of the customer — patients, referring physicians, staff members.
• A system does not succeed without a focus, so your practice's purpose (mission statement) stated simply could be: provide quality patient care, efficiently and effectively, to meet customers' needs.
• A system requires resources, machines, processes, supplies/equipment, and people.
• A system requires the efficient use of these resources — the role of management is to coordinate activities, ensure there is not waste, and ensure the practice is achieving its goal of quality patient care.
The patients come to your practice with a set of expectations. The question that should be asked every day is, "Did we meet our patients' expectations?" The best way to answer "yes" to that question is using a coordinated approach to all aspects of your practice's operations. One that will lead to long-term survival and success.
Barriers to quality
Too often we find ourselves creating "silos," where staff members say, "My job is to do only this, and I don't care what others do." Physicians may say, "I want to do things my way, because that works for me, and that is what I think is best for the practice."
A systematic and coordinated approach to patient care, on the other hand, suggests that these silos be removed. For example: Look at the basic patient flow in your office. The five steps are: check in, triage, the physician/patient encounter, follow up, and check out. If the medical assistant does not consider the role of the receptionist and only focuses on what she does, there will be problems at some point in the patient visit. Focusing on a single role will lead to delays, barriers, and inefficiency in the delivery of patient care.
A systematic approach also takes advantage of the strengths of the physicians as a whole, standardizing operations as much as possible. This is the tough one, as physician training involves independent thinking and decision making. The idea of having to change "my" approach to care to meet some administrator's idea of making things better is foreign and difficult to achieve.
This is where the discussion must occur about the effective use of resources by physicians. Reviewing what works best to achieve the practice's overall mission is a good start. Comparing physician metrics through appropriate reporting and positive peer pressure will assist in changing behavior to a more systematic approach.
What's the key point of all of this? Your practice should focus on the quality of care it provides and the quality of relationships it has with customers, in a systematic fashion. If this is accomplished, your practice will flourish and meet the expectations of each of its customers.