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How to become a patient-centered practice and improve your profitability

What do old-school electric typewriter manufacturers and medical practices have in common? More than you might think.

Ron Howrigon, president and CEO of Fulcrum Strategies, a healthcare consulting firm, tells the story of two of highly competitive typewriter manufacturers, one of which adapted to change and thrived and another which kept manufacturing typewriters right up to the time it went out of business.

The successful firm, IBM, realized that its future survival lay in personal computers, and began moving away from typewriters and manufacturing products to meet that need.

Howrigon says medical practices are at a similar crossroads today, adding “Healthcare is a service industry and we need to act like one.”

He says that given recent changes in healthcare, medical practices are now faced with the challenge of having to compete for the ‘right’ patients.

“The right patient is someone with a good job and good health insurance and with so many choices available, the services you offer and the patients’ overall experience will keep them coming back.”

There is a shift occurring toward more patient responsibility in the financing of healthcare.

According to Howrigon, patients are increasingly seeking not only good quality of care from their physicians, but also good quality of service.

He says that in the past, if you were a good physician, patients would come to you, but that’s no longer the case.

“Consumers (patients) are saying, “What more can you do for me? How can you be more efficient? How can you make my experience better?'”

What’s the difference?

Medical practices have traditionally been doctor-centered.

“What I mean by that,” says Howrigon, “is that most practices are built around what’s good for the doctor in a work environment, not what’s good for the patient. Most practices I deal with have limited hours. Some doctors don’t even want to start their (work) day until 9 o’clock and some want to leave at 4:30 (p.m.).”

Most doctor-centered practices have complex scheduling rules; long waiting times for appointments; long delays in waiting rooms; and limited online capabilities to serve their patients.

Other problems include doctors canceling scheduled appointments without a valid reason, poor telephone service, poor customer service, unsatisfactory problem resolution, excessive forms (paperwork), and poor patient follow-up.

On the point of follow-up, Howrigon says a patient might undergo an MRI or laboratory tests and then not receive a follow-up call when the results come in.

Mediocre service might be tolerated by patients who are either unemployed or retired, but Howrigon says people who are busy and who have good medical plans won’t put up with shoddy customer service for long.

What a patient-centered medical practice looks like

In comparison, patient-centered medical practices offer:

  • Extended hours of operation and same-day service.
  • Innovation and automation.
  • Better use of technology.
  • Excellence in phone and customer service. Examples include same-day specialty clinics, iPad check-in, onsite integrated pharmacies, weekend and evening hours, the choice for patients to see who they want to see, and patient portals that allow them to access their medical information electronically.
  • Better employee training.
  • Policies that ensure more effective follow-through with patients.
  • Elimination of the traditional waiting room, so patients can move directly from check-in to an examination room.

In a nutshell, they “provide what the customer wants, not what you want to provide,” according to Howrigon.

How to make the change

Howrigon says there are seven essential elements for moving toward a patient-centered focus. These include:

  1. Doctor buy-in.
  2. A demonstrated commitment from administrative leaders.
  3. An understanding by front-line managers of why change is necessary.
  4. Tools which managers can access to transition toward change, including training and adequate staffing.
  5. Education of front-line staff as to why changes are needed.
  6. Providing everyone with the tools and training they need in order to succeed.
  7. A clear understanding that everyone must listen to the patient, whether it’s the doctor, the CEO, the director of operations or the check-in person.

It’s critical to identify and remove barriers to change, including resistance from doctors and staff, passive/aggressive behavior or financial doubts.

Where to begin

“The patients will tell you what they want. They will tell you when you are succeeding and they will tell you when you are not,” says Howrigon. “You need to be open-minded. You need to listen to the patients and make sure that those comments, both the good and the bad, are expressed throughout the organization.”

In deciding where to begin, start with your biggest area of dissatisfaction. You might, for example, be frustrated that patients who are tired of being placed on hold are hanging up their phones.

Asking patients to fill out surveys can also give you a clear picture of areas of dissatisfaction and what you need to be doing to improve your level of service.


“Celebrate your successes and take time to remind people how far you have come. Keep moving. Change is not easy. (Maintaining the) status quo is easy. When you are going through hell, don’t stop. Once you get through it you’ll be much better,” says Howrigon.

And so will your practice’s bottom line. A move toward patient-centered care will improve your medical practice’s profitability by attracting better-paying, insured patients.

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