The Hierarchy of Values within a Medical Practice

August 26, 2015

We’re all willing to sacrifice one principle for another. As a practice leader, you must develop a framework to choose between competing values.

A recent, highly publicized incident reminded me that it is as important for medical office staff to know the hierarchy of practice values, as it is for them to know what those values are. 

In early August, a Lowe's customer in Danville, Va. specifically requested that a black person not deliver her order.  The store manager complied anda firestorm ensued.  It was a perfect case of competing values, and a lack of clarity as to their relative importance.

The store manager was operating under an imperative to make the customer happy, a core value in most retail and service enterprises.  Unfortunately, he ran afoul of what Lowe's says is a higher value for the company:  "Zero tolerance for discrimination of any kind."  It isn't clear how much harm the incident did to Lowe's.  It is clear the manager lost his job.

In light of this, here are some lessons for medical practices leaders:

Acknowledge that values are relative.

It can be unsettling to consciously acknowledge that, in a given situation, we are willing to sacrifice one principle in service of another.  The reality is that each of us does it every day, most often without realizing the tradeoffs.  Most individuals do it automatically because they ideally have coherent internal value systems.

The relativism is more problematic when we must rely upon other people, e.g., medical staff, to execute those tradeoffs for us.  Unless the leader acknowledges that tradeoffs are sometimes necessary, the staff will be far less likely to consider competing values and far more likely to respond consistently with the most often repeated mantra.  The Lowe's manager made that point.

Give staff a framework for choosing between competing values, according to the practice's value system.

Once the leader has articulated her values, she needs to do a pair-wise comparison to determine their relative value. 

For example, assume a physician's top three values are patient safety, patient satisfaction, and getting home on time.  If patient safety and patient satisfaction conflict, what wins?  What about patient safety and getting home on time?  Patient satisfaction and getting home on time?

If staff members are clear about what's important and what is more important, they can perform consistently within the practice's values.  It is not too much to post these, discreetly, at workstations so that employees have a ready guide whenever confronted with a situation.

Provide staff for explicit guidelines to identify tradeoffs that must be reserved to the physician.

Part of being comfortable in making a decision is clarity about the decisions that need to be delegated up.  It is not effective for the physician to be a part of handling every single patient phone call.  It is not safe for the physician to leave the management of all phone calls to staff. 

A set of bright lines will give staff the confidence to operate relatively autonomously, because the bright lines will tell them when to call for help.  It will also give the physician confidence that he will be involved appropriately.

It is essential to articulate the values of a medical practice.  The necessary next step is to acknowledge their relative value, and provide clear guidelines on when the physician's judgment is required to resolve value conflicts.  From there, all three must be clearly and consistently communicated to medical staff members.