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This chain of events likely led to SO much more fear and uncertainty, followed by distrust and discontent, than it needed to. Though the crisis lends itself to an ever-changing protocol when it comes to clinical management (I think most of us can attest to this!), the way the decisions were being made, and those who were directly affected and responsible for implementing said decisions were being informed is simply poor management. What I have learned from living through this crisis as a PRN urgent care physician, is that those IN the clinic: the providers, the MAs, the administrative staff, are the only ones who truly know how things function normally. In this situation, time was/is of the essence, so governance by committee may not be a viable option. However, the people making the decisions need to be those who are directly involved in implementing the changes. This gives ownership of the protocol to the right people and reduces discontent, distrust, uncretainty and fear.
I recently left a hospital-owned practice, of which I had been a part since 2014. Originally, we were owned by a community hospital, where the leadership was by physicians and by committee. A large university system acquired the community hospital, and therefore, our practice, 18 months ago. The leadership style of the new system was top-down and largely administrative/executive rather than physician-led. The new hospital immediately implemented major changes into the highly profitable, highly functional neighborhood practice we had built from the ground up such as removing all incoming calls to the office and filtering them through a poorly functioning call center that serviced the entire hospital system. Our patients were furious, as they could no longer reach the familiar people of the office AND had to be scheduled by the call center, who struggled to understand the difference between urgent (same day), chronic disease management and preventative visits. They often got replies to their request for sick visits like “Dr. Humphries can see you in 3 weeks for this”. As you can imagine, this was infuriating for patients. My partners and I went directly to the top of the leadership board and pleaded with them to take our advice and allow the practice to go back to some old ways that had been developed specifically for the community in which the practice existed and with the community members in mind. The answer was repeatedly “no” and “there will always be new patients, so don’t worry about the old ones”. After getting nowhere, and taking on an enormous amount of intense patient complaints and poor internet reviews, all three of us decided to leave the practice together. At no point did the leadership make any effort to meet with us, to understand our needs and the needs of the patients to whom WE were providing direct care for quite a long time.
This leadership style simply did NOT work for a small, neighborhood primary care practice. The previous leadership, given their community focus and management by a primary care physician, believed that each practice in the physician group required slight differences in operations. We met monthly with the VP (a primary care physician), the financial team, and our elected physician leader to discuss practice management. Our voices were all that mattered as they believed we spoke for the patients (demonstrated by the fact that we had an extremely profitable PC practice—a rare entity in the hospital-owned practice world). We had a striking percentage of new patients on a monthly basis and these new patients were acquired by word of mouth from our current patients. Our VP said every single time that the practice existed to serve the community, and that, as members of the community ourselves, we knew better than anyone else. They listened to the needs and recommendations of our staff and our retention rate was 100% for 4+ years. We knew who was in charge and who made decisions, but we also knew that these decisions were being made 1) on behalf of us and our staff and 2) to benefit our patients. Perhaps it just takes a primary care physician to understand proper leadership and management of a primary care practice, but this inclusive and empathetic leadership-style worked so much better than the top-down governance style of the new hospital system.
