Improving Quality in the Group Practice

Leif C. Beck, JD, CHBC, for HealthLeaders Media , October 30, 2008

Physicians in group practice are concerned about profitability. Indeed, their compensation formulas focus heavily—often totally—on producing revenue. This focus encourages the current work effort to offset declining reimbursement patterns and increasing expense outlays. To a large extent, cash is king.

But that's not why most doctors entered the profession. They want to support themselves and their families well, of course, but they also care deeply about that amorphous factor, quality.

Quality factors
Quality is an important factor for doctors in several areas, such as:

  • Clinical excellence (e.g., when confronting difficult diagnostic problems)
  • Personal characteristics (e.g., whether in handling patients and staff members or in simply being a compatible partner)
  • Commitment level (e.g., the willingness to assume full or even greater responsibilities for the benefit of the group)

Quality features like these affect a group's profitability as well but, unfortunately, they are more remote and longer term than producing current revenue.

Your group's legal documents likely make no more than casual reference to quality standards. Still, it's important to encourage standards and, more importantly, to discourage your members from violating them. Traditional protests such as, “No one can tell me how to do my work,” simply don't cut it any more. A partner's shortcomings or weaknesses cannot go unchecked indefinitely.

Performance evaluation
One way to handle this concern is to subject your physician-partners to the same type of test that, ideally, your office manager uses for your nonphysician staff: the annual performance evaluation.

Since critiquing colleagues and being reviewed by them may rankle doctors, establishing the idea calls for careful leadership. It is best to have such a program in place before a serious partner problem crops up, but sometimes groups adopt it almost specifically (although unstated) because of one member's bad characteristics.

A good physician-leader or executive committee might start by building up the partners' willingness to undertake the process. Consider installing a performance evaluation routine for one or more newly or soon-to-be hired doctors as a good first step.

Those younger physicians probably encountered enough evaluations in their training to be comfortable with—or at least accepting of—performance reviews. Even at the young-doctor level, involve all your members by seeking their input into setting up performance reviews. Rather than simply presenting a review format, ask them to consider which factors are most important for further group success. People respond better to a new idea when they are involved in deciding how it will work.

Group input
After getting preliminary group approval, distribute a questionnaire listing different performance attributes, asking your members to grade them as to importance. For example, the criteria might include purely clinical abilities, personality features, and levels of personal commitment to group success.

Upon receiving the replies, you or an outside source can draft a proposed evaluation form based on what you and your partners deem important standards. Present it to your partners for approval and also recommend a format for receiving, reviewing, distilling, and reporting the results.

The process should proceed to a private meeting between each evaluated doctor and the group's leader. With careful leadership in guiding your partners to approve the process, you should be able to handle quality issues, as well as immediate profitability.

Leif Beck advises on top-level group practice matters. Contact him at Leif C. Beck Consulting at 610/355-0797 or e-mail at This column originally ran in the October issue of The Doctor's Office, a HealthLeaders Media publication.
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