Louis Costa

I just wanted to share a personal note.  Your comment makes me think back to when I finished my residency and was stationed at Ft. Hood, a very busy military practice in Texas.  300 – 400 deliveries per month/8 docs.  Carla Hawley my chief resident when I was a PG2, took me under her wing and for two years, guiding my early development.  The deg…[Read more]

This is from Rubeen,

I did not have any formal mentoring but looking back I had to 2 senior physicians during my office hours- I used to bounce cases off them and then I started asking them business questions as well.  I still fondly remember those interactions and only now realize how important they were in my development.  10 yrs into my pvt p…[Read more]

Nice, the biggest complaint I hear is IT systems designed by non caregivers.  The result is that the system works best for the designers, easy to maintain/update, and administrators, easy to grab data, but poorly for those seeing patients and actually interacting with the system daily.  The concept of stakeholders controlling the process of the w…[Read more]

Hey Louis, now that they have you at a certain rate, they clearly do not want to increase it except for the two percent. You have two BATNAs, the two percent or the no call. First, I would complete the homework. You have started it by researching the rates other physicians receive. Who are these guys and why do they get more money? Are there any…[Read more]

This comes in from Louis
Could you send me a digital copy of the negotiation planning instrument. I wish I had this and these courses available during the latter half of my chief resident or fellowship years, great stuff. Unfortunately, (as my better half would admit) I’m not very ’aggressive’ when it comes to negotiation. Mainly for fear of rejec…[Read more]

This comment from Joel.

Valuable teaching points of broad applicability. Impt to know what other side really needs and wants. Prepare an argument for their side and your–like a lawyer would in preparing a case so you can be prepared to counter arguments persuasively but politely. I need to walk in their shoes to effectively negotiate your p…[Read more]

How about I start this one.  Doing your homework is the most important feature.  We were negotiating with another hospital CEO to open a nurse midwife facility in our town in direct competition to our own hospital.  The CEO of the rival hospital came to our office for a 7am meeting and his presence, at that time in our place was a powerful ne…[Read more]

This comment from Katherine,

<span style=”font-size: 13px;”><span style=”color: #32373c; font-family: -apple-system, BlinkMacSystemFont, ‘Segoe UI’, Roboto, Oxygen-Sans, Ubuntu, Cantarell, ‘Helvetica Neue’, sans-serif;”>”I was intrigued by the selection of integrity and candor as the prized characteristics of a leader. How were these selected…[Read more]

Great reply.  I would consider creating a flow chart based on what the patient sees.  Then use that as the foundation for your cause and effect.  It may be quite effective to discovering the root cause of the problem.  We all are so busy, that solving a problem that is not the root cause adds to the inefficiency of our day.  Lot of work, for not…[Read more]

You are right Velma, you were actually the first to reply.

From your post I am figuring that you are talking about discovering the cause of low volumes?  Or are your volumes too high, or not consistent?  Each has a different business approach.  The first is not a process improvement issue.  There are no process problems causing low volumes.  This is really a strategy/marketing issue.  We do not discu…[Read more]

This problem closely parallels the pain control project in the CPI presentation of “Leading Improvement”.  Rather than jump to the first obvious solution, which would have been wrong, our cause and effect work brought us to a rather obscure solution that really produced significant improvement.  It is funny sometimes how our own bias will lead u…[Read more]

I always say the perception is the enemy of reality. As a physician, are we comfortable treating our perceived notion of what is wrong with our patients or should we be more directed toward the real cause of the illness. Of course we are looking for the real cause. Yet in our healthcare delivery process it always seems that perception is good…[Read more]

This came in from Joel.

“In identifying problem, esp. when it is personnel or the manager or his or her traits there is an unwillingness to address the real problem. Sort the “emperor has no clothes” or elephant in room situation.

This came in from Rubeen

In our dialysis clinics, there is the perennial problem of poorly controlled phosphorous. We have two ways of manipulating the phosphorous- diet and using phosphorous binders. I would like to see if we can improve our process in treating this problem. Step 1: understand scope of problem- percent of pts with uncontrolled…[Read more]

Velma, this is an excellent practice improvement problem that would benefit from CPI methodology.  The LQC or metrics to measure would likely be % patients with incorrect pillboxes.  This will help you make sure the problem is frequent enough to merit attention.  Sometimes small volume issues seem more frustrating and time consuming than they re…[Read more]

Janet, your comments are not unlike many comments I have seen from non-military physicians.  Even in the service, somewhere, somehow these financial decisions are being made based on financial information that is collected.  Fact is, they organization you work for has a global budget and revenue in the form of work and expenses are calculated to f…[Read more]

In looking back at my experience in an OB/GYN setting at Ft. Hood in Tx. I had the same dilemma.  You would think that there is no financial consideration.  Resources are allocated on some different basis that financial because there is no billing.  Of course that is naive.

I would start by getting involved in the budgeting.  There is likely a t…[Read more]