I’m not a big fan of buzz words, but when I ran across this one--intrapreneur—I was intrigued. As organizations have grown larger, intrapreneurs—persons within a company who promote innovation within the organization—have become the new movers and shakers, and company executives are on the hunt for this new type of employee, for people who can lead on important internal issues and, where possible, effect internal change that’s positive and, in many cases, ground-breaking.
In my work with new docs, especially those coming right out of residency or fellowship, I tend to see three distinct types. There’s the new physician that just wants to practice medicine, and not be bothered by operational issues. There’s the new doc that is only interested in those operational matters that have a direct impact on his or her bottom line. Finally, and more rarely, there’s the intrapreueur, the one that looks at a bigger picture of healthcare and is looking analytically at their practice, the group’s practice, and the immediate healthcare environment, finding ways to make very productive changes that benefit their practice, group, patients, and hospital.
As the business of medicine grows more complex, and undergoes rapid change, it’s almost impossible for one physician to cover all the bases. I have always suggested to my clients that they look at their practices as multi-faceted entities, and that they break down the most important pieces—contracting, HR, patient satisfaction, hospital integration, etc.—into silos, assigning responsibility for each. Spread the responsibilities, hopefully matching each silo to the interests of the physician. This helps create strong group leaders. Even the smallest groups should bifurcate responsibilities and set a schedule for reporting meetings as well as a mechanism to deal with urgent matters.
Of course, having a good administrator to help coordinate all of this can be crucial (and should be part of any job description for this position).
What typically happens is the intrapreneurs rise to the occasion. They search for a better way to do things, and do not look at this responsibility as just non-reimbursable burden. These are the folks that will be leaders in your group practice in the years ahead. They are the guys that read the literature, keep up with what’s going on in medicine, and understand the concepts of “Best Practice” as they apply to medical practices. Typically, they often become leaders within their hospitals or surgery centers as well.
I also suggest to my clients that they amend the interview process when hiring new docs. They need to ask questions designed to help identify the intrapreneurs, as well as those new hires who just want to come to work. For those who want to get involved, groups need to find a way to reward them for their extra effort.
Consideration might be made to add a certain level of operational responsibility into the wording of employment agreements—maybe even for all new hires. Group culture should be amended to require all new hires to understand that they are expected to be integrated both clinically and operationally, with tasks in the latter category designed to get them involved in the operations and business. Start small, expand as the talents and interests of the new hire begins to surface. You may have more intrapreneurs in your practice than you know. –Tom Ellis
A few months back I promised to discuss this topic a bit more, discussing the ways affiliations can be built, maintained and expanded in functional medicine practices. Let’s start with a few of the basics.
The primary combination of a good nutritionist and an FM doc is an absolutely “must have” for any functional medicine practice. Nutritionists don’t have to have an FM certification but need to be working in that direction; same with a doc if they don’t have an FM certification.
These two must get comfortable with each other to form an affiliation: More than just sharing referrals, the combination must be part of a clinical practice that is dedicated to expanding the patient experience and overall patient wellness. In my opinion, this is one of the most critical question to ask, and the answer has to be YES.
With this accomplished, the affiliates (I don’t want to use the word “partner” because it has an array of legal meaning) need to talk about their vision for creating this relationship, and discuss in detail their vision for the practice and its patients. Look down the road--Where would you like to be in 12 months? 18? 24??
What’s most important is that you have a frank, open conversation about these topics. Don’t think it will happen in one meeting. Outline everything you can think of that would involve your new “affiliate” And don’t leave any questions unanswered. Write it all down. Diagram it out. Detail it in great depth.
Remember, on top of all of this is that commitment to improving the patient experience. This is always true of any affiliation you build—the patient experience has to be foremost in your mind, with patient satisfaction and wellness a number one priority. FM patients want a holistic, overall assessment of their problems, and the experience they are looking for is very different from that of traditional medicine, which tends to deal only with one clinical problem at a time and can be much more fragmented. The larger, successful FM practices have the vision of a “one stop” shop in many ways, everything a patient can need combined, as much as possible, under one roof.
This planning process is extremely important, because it sets the parameters for budgeting and integration. There are a number of different financial and operational models, but all are based in large part on who contributes what—EHR platform, phone system, clerical staff, billing system, marketing costs, leased space, etc.—and then what needs to be purchased. For example, you should have one EHR system to create complete patient record, and one billing system that can add information to the latter. And you have to look at pricing, taking insurance vs. cash only, etc. This is a more complex problem that I’ll expand upon in a future blog entry. This is where a consultant can be of great value in helping you align the financial and operational aspects of the now, and then further down the road as you reach to complete your vision.
The best FM practices plan for growth, and work to expand the patient experience, in a logical and sustainable way. They are always looking beyond the now, planning for growth, including the costs of growth. They are continuously asking questions about how to help the practice grow and be more comprehensive for the patients.
But as you start this process of affiliating, remember, it’s a medical practice. It’s also a business. Synching these two elements up is critical, with both having equal importance. More on that down the line when I’ll look at one or two specific areas of planning for growth. ---Tom Ellis III