How to handle unreceptive medical personnel?

Question

I work with many fields of study at my organization establishing manning and balancing processes. My methodologies are very sound and proven mathematical approaches: queueing theory, line balancing, takt time analysis, etc. Most fields are very receptive and can follow the math/analysis and either agree or state understandable issues with the analysis. In short, most all fields at least have a desire to understand and improve their processes.

It seems through my experience, when dealing with medical personnel I cannot even get them to listen to any recommendations much less implement them. I have had several friends in the medical field tell me flat out that no one is going to listen to me because I'm not a doctor. This is very frustrating for my job. It also looks poorly on me because whether or not they implement the suggestions, if there is no improvement then I did not accomplish what was tasked of me. Even if I point out their reluctance, I am still on the defensive which is not a strong position to be holding. It is also a large blow to morale and ends up wasting much of my time.

Are there any tactics to deal with unreceptive people in general when they will not even attempt to rationalize or work with you?

Answer 1

I work in healthcare performance improvement. My team analyzes scheduling templates, call center metrics, no-show rates, copay collections. . . The list goes on.

We've been able to institute change at every level in our organization, but by far the most stubborn group is the providers. Providers do often think they know best, and it certainly comes across as crass. Changing their workflow, or the workflow of their nurses, takes time to adapt to- And they simply don't feel they have the time. I have providers who stay up until 3AM charting.

They're stressed, and change, though it may be for the better, is a hassle.

But, here's the thing - Providers care about their patients. Managers care about provider burnout. Directors care about quality scores.

Depending on what change you're looking to implement, you need to draw a clear connection with how the change improves what your target cares about.

When it comes to scheduling templates, our providers had previously set them up as best as they know how- But they don't have the analytics insights we do as to how their templates affect their ability to give care where it's needed. You have to sit down, converse, and get them on board.

Sure, your 30 minute-blocked open schedule allows you to see as many folks as possible, but how are you fitting in same-days for your long-paneled sick patients? Are you allocating space for new visits to grow your panel, or is it crowded with yearly follow-ups (non-sick) that maybe could've been pushed out a week?

Block some time out on their schedule, and meet with the Provider and the clinic manager. You're going to have to build some reputation here. It took a couple of years before our visits shifted from "dread" to "relief".

Be transparent. Be candid. How does this change help them to give better care to their patients? How does it increase their MGMA scores? How will this help them use their EMR more efficiently, reducing burnout? Will this put more cash in their pocket? Will it allow them to see more patients? Will those patients be happier?

Personally, I bring everything back to Quality. Our providers rarely argue if that term is in the conversation.

Closing your charts in a timely manner allows patients to be billed in the window they expect. Refill requests need to go out within 48 hours. Collecting a copay at the front desk, where the patient expects to pay it, will save them the hassle of dealing with a paper bill.

Answer 2

Here's the thing about doctors: When an administrative assistant changes a process, if they are wrong, the business might lose a few thousand dollars. That can be recovered by reversing the process change, sure it sucks but it's not a big deal. In medicine, if a doctor changes a process or approves a process change, people can literally die. Therefore, such decisions really ought to only be made, or ought to at least have significant input, from medical professionals, which you are not. Therefore, if you come down from on high and start trying to "fix" things, the doctors have a responsibility to tell you to shut up, because if you make a mistake, people can die, and it's literally their job to make sure that doesn't happen.

Now, this isn't particularly helpful to you, because you also have a job to do, which you are being paid for. So, here's what you can do: You need to get buy-in from management. Someone hired you to do this job, and that person presumably has authority over the doctors who are being belligerent. It's that person's job to oversee that what you are saying is what's happening, and/or to give you feedback as to what you're doing wrong. If you are trying to implement a process that might kill people, it's not only that person's job to tell you to stop, it's also that person's job to tell you why you shouldn't be doing what you're doing. Furthermore, it is also in that person's best interest to step in here, because they hired you, and you're being paid, and you're doing your work, but nobody is cooperating. Which means you're effectively being paid to not contribute anything in terms of results. Which is bad for the company that hired you because they're flushing money down the toilet.

So here's what you do: You explain to your onsite manager that you're trying to implement some procedures (and explain what the procedures are), but nobody is cooperating. Explain your methodology that you used to come up with these procedures, how you've vetted them for safety, and so on, and once you've explained the plan, ask them for feedback and if they can help with the implementation. Explain to them that you're doing your best to contribute, but as these are processes that need implementing, you can't proceed without other people's buy in as well.

If your onsite manager refuses to help you, then you're on your own; without expertise in medicine yourself, as you said, doctors aren't going to listen to you, because you don't have the expertise required to make sure you're not going to kill people, and so you can't do your job. At this point, you may want to limit your services provided to exclude the medical industry if this is an ongoing problem with all medical institutions.

Answer 3

Are there any tactics to deal with unreceptive people in general when they will not even attempt to rationalize or work with you?

Enlist help from someone with sufficient credentials that the client will listen.

In this case, recruit a medical professional to work with you. Perhaps a doctor. Perhaps a university professor who teaches medicine.