The Strategy for Creating the Best Medical Program or Practice

David Epstein, MD, MS, FAAP discusses the best way to create a successful medical program or practice by creating an organizational system.

The Goal

Hospitals, clinics, individual practitioners, and other types of medical groups strive to create the best practice or program in their area of medicine. These best practices or programs are usually defined by metrics such as satisfaction with care, financial remuneration, as well as the consistency, effectiveness, and efficiency of medical care. The bottom line is that any practice or program aspires to have the best outcome, as defined by the metric of their choosing. But, how does one achieve this lofty goal?

The Solution
Best outcomes can be difficult to attain without a deliberate, well-delineated plan in place.
Humans are the operators of that plan, but they are fallible and inconsistent. As the saying goes, “nobody’s perfect!” So, how do you succeed with imperfect beings? Well, the best strategy is to create a system.
A structured system that accounts for the progression or flow of medical care and most current standard medical practices will help correct for some of the human imperfections and inconsistencies. Creating a standardized medical system is especially helpful with medical decisions and events that are complex, occur infrequently, or require accuracy under extreme pressure. While “practice makes perfect”, some of the most important medical decisions do not come with many opportunities to practice.
So, creating a system that guides medical management will help reduce the variability that can adversely affect the quality treatment that all patients deserve.
The People
Once a system is created, ideally through the collaboration of all involved and responsible parties, people need to be recruited to be a part of the system.
It is ultimately important to find the right people who not only have the skill to perform the required duties of their position in the system, but also have respect for and belief in the medical system itself as well as the mission of the organization. If an individual does not respect or believe in the medical system that has been generated by the group, the effectiveness of the system will be greatly diminished and the desired outcome will not be realized.
Having the right system in place and the right people working within that system is critical to the success of a medical program. Nevertheless, it does not make it inherently sustainable. The sustainability of a program comes with the teaching and training of individuals within a given system to create redundancy of skills and knowledge to prevent a program from collapsing if it loses a key individual or group of individuals. A particular program should not be dependent upon or defined solely by one person.
The Evolution
In addition to training and teaching, empowering individuals to re-evaluate a system and improve upon it is important.
Empowering individuals to effect change and improvements makes individuals feel like their opinion and work matter and, subsequently, creates personal ownership and accountability. In turn, this ownership and accountability will foster an environment that values the critical pivots that are required to stay effective and relevant as science advances or circumstances change. Nobody wants to be the next Blockbuster Video! Systems need to evolve and should not be stagnant or inflexible.
The Result
Establishing a system of operations, obtaining the right people to work in that system, and teaching and empowering individuals to maintain and improve upon a system are crucial elements to creating a self-sustaining and quality medical program (or any program for that matter…medical or otherwise).
Systems are built with people. But, programs flourish with organization, collaboration, ownership, and accountability. When people work together with a common mission and in a coordinated fashion, something small, simple, and fragile will grow into something that is larger and more elaborate, durable, and successful than anyone could have initially imagined. The best medical program or practice outcome is conceived with a vision but realized with a well-constructed system.
What is your experience with systems in medicine? Do you think that systems are an important part of the architecture of a program or practice in medicine?


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