Episode 32: Training to Address the Shifting Business of Healthcare

Healthcare’s rapid changes demand continual training for everyone – not just CME. In this episode, Scott, Michael, and Jared take a deeper dive into different ways to train leadership and staff in the face of evolving business needs – not just to get better at our current jobs, but to gain new skills to keep up with what’s coming next. From today’s students and workers to tomorrow’s leaders, these principles apply to everyone.

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Full Transcript

Announcer: It’s time to think differently about healthcare. But how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together. And here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your “Paradigm Shift.”

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts with my co-host, Jared Johnson and Scott Zeitzer. On today’s episode, we’re talking about continuing to train leadership and staff in the face of evolving business needs and healthcare. You know, one reason that companies, health systems, and hospitals train is to make sure that people can effectively do their job as it’s already been set out. Here are the guidelines, just follow these guidelines.

Another reason that people will train is that the job itself keeps evolving. And this is happening rapidly with healthcare. And people are going to need new skills to keep up. So let’s start today’s conversation with training students in universities right now. You know, we recently spoke to Britt Berrett from the University of Texas at Dallas. And he talked pretty extensively about training up tomorrow’s health administrators on the business side of things.

Scott: It’s interesting when we talked to Britt about how just conceptually, when he started talking about the need for this, how many people said, “Huh, we’re really gonna train people on the health side.” And he was like, “Very important, we can’t stop doing that.” That being said, we need to really do a better job of training people on the business side of things. On how well we take care of the patient and not just how quickly we get them in and out.

Which has always been like, we need to do that better, we need to get them in and out faster. It’s like, okay, there’s certainly some plus side to that, there’s a lot of patients that need to be taken care of. But are we taking care of them effectively? How do we get that and achieve that balance? What’s the appropriate balance between customer service? All of these things come into play.

It was fascinating to hear him communicate those things, to talk those up with these students and get them going from the outset rather than going, “Oh, wow, I need to go squeeze this topic in now.”

Michael: Yeah.

Scott: Right, because he was starting it right when they’re starting when they’re newbies.

Michael: It’s so much of why he’s structuring the program that way, in particular, is all about patient expectations leading into this, you know. The reason that we don’t want to just squeeze the patient in and get them out as fast as possible are because of things like the consumerization of healthcare.

Scott: Of healthcare.

Michael: The way that things like patient reviews start to really have an impact on not just that particular appointment, but how all of the patients are gonna expect to interact with the practice or the hospital. So it’s not just, “Hey, I’ve got this idea, we should have sharper business people,” but patients are changing. We have to train people differently in order to interact with that group of patients.

Scott: Yeah, you know, I think of… We had a conversation with an office manager. A very good office manager who’s been out there for a long time up in Ridgewood, Terry, up in Ridgewood Orthopedics and how she’s had to adapt. When she first started, it was really just about how to take care of the docs, how to take care of the office, and then, you know, how to see as many patients as possible. And now she’s all about, you know, how to take great care of these patients, and balance it out with taking care of the doctors as well as the staff. We talk about Cheryl Toth with Karen Zupko & Associates, how she actually helps coach practices. Whether it’s the surgeon or the office manager about how to be more effective at what they do. How to get everybody on the same page. It’s kind of critical, here.

Again, it’s when my parents went to go see somebody, I remember my mother telling me like, “Man, I really don’t like going to see the doctor. I really don’t like going to see this doctor.” And I remember telling my mother like, “Well, why do you go see the doctor?” “Well, that’s the one I was told to go to.” Now, this was when I was younger. And I was in high school, I think when I heard that, and I always think of that, because nowadays, it’s completely flipped around.

To your point, Michael, you know, reputation marketing development isn’t just about taking good care of the first patient. When that patient isn’t taken care of, well, it isn’t that you just lost that patient. You’ve lost potentially a lot of patients, right. So, one, the patient may have walked out the door, in the old days, they would have never even walked out the door they just would have sucked it up. Now, they’ll walk out the door. Not only will they walk out the door, they’re gonna tell everybody else…

Michael: Sure.

Scott: …that they’re walking out the door. And you know what, the patient might have been right. You know, this is where, you know, it’s very interesting when Cheryl was talking to us about how to coach better and how to listen to the patients. How to listen to the people in the practice and how to come up with a solution, where you empower the people in the practice to help come up with those solutions. It’s not just about barking orders. It’s about listening, and cheerleading, and coming up with solutions that make sense for everybody. Again, the consumerism of healthcare, right? It’s gonna force this on you. Don’t ignore it.

Jared: I think one of the things that caught my interest when we were talking with Britt was the types of classes that are part of the program. And it’s not just strictly narrow healthcare admin courses. There are straight up general business and finance courses as well, which told me that even right off the bat, he’s helping them understand the breadth and the depth of their knowledge base and their skill base to be successful. And I think that’s a lesson that a lot of us have learned, either in the field or by advising those in the field is that, realize we’ve needed to kind of be awakened to how different things were than when we set out to start, whatever the organization or whatever the business is, right? All these changes around us have caused us to think about them differently. And we’ve had to expand our own knowledge.

And Michael, when you started off even saying, I love the distinction between talking about continuing our education to get better at our current job as well as understanding how we need to evolve and do something different, do something new. Because it is the combination of those two things. You can see how if we only focus on doing the evolving parts, and we don’t get better at the stuff that’s still…we’re involved in day-to-day, then we’re missing the point there as well.

And then likewise, I do, I catch myself almost too often focusing just on those who are resisting anything that’s coming and resisting any kind of change, where that’s easy enough. I think it’s easy to see the fault in that how we can just box ourselves in. We can pin ourselves into a corner and then we wonder, “How did I get here?” And it’s because we didn’t ever evolve at all.

So I think just even realizing that we have to address both of those, the current, you know, the present and the future, we have to address both in our training and our education. And don’t let that feel like it’s biting off more than we can chew. Just focus on one or the other at a time and recognize that we need both.

Michael: What I really liked about Britt’s conversation in particular, I went back and I was reading the show notes before our episode today. He was talking about just trying to figure out like, what a hip replacement cost, you know. And having to…he would instruct his students to go figure out how much a hip replacement cost. And the number of places that they would have to call the number of…you know, even starting to call internationally and, you know, doing everything they could to find like what just a hip replacement cost. And the crazy differences in prices that they would get if they actually got the pricing.

You know, talking about the changes that a lot of people are resisting, a lot of people that don’t want to deal with it. This price transparency thing is coming more and more, and it’s starting to be a reality. And, you know, he jumped into like, “Hey, here are groups that are doing it, that are getting out there and that are talking about this and being very upfront with it.” You know, not looking at it from a surgical side but jumping back to Walmart Health, you know, here are the prices to go and do this.

Jared: Right.

Michael: And if you have bad insurance, or if you have no insurance or like whatever that is. Or even if you have great insurance and you just want to know, like, “Hey, I might want to pay for this in a different way.” Like knowing what those options are and being able to see that. Those are changes that are coming in. People aren’t necessarily trained up on dealing with that patient yet. That’s not something that’s really commonplace yet. And so there’s still a lot of opportunity for students. But then you also look at the practice side of things for the people that are already in healthcare. We had the chance to talk to two different consultants. You mentioned one of them, Cheryl Toth. And then we also got a chance to talk to, I got the chance to talk to “DJ” Mitsch.

Jared: That’s right.

Michael: That was the one that I get to do on my own. You know, I talked to “DJ” from the Pyramid Resource Group about the way that that she and her team, they’re coaching healthcare system executives to really become leaders. To really be able to navigate major changes that come up and to guide their organization through that. And she was talking specifically about how much of a change that may be for physicians, because with your medical training, here is the right answer. There aren’t, you know, “Tell me how you feel about it.” There are not like a lot of soft answers when it comes to some of this kind of stuff. And so one of the big things that they do focus on is dealing with uncertainty, when there isn’t exactly a right answer, when there isn’t exactly a right diagnosis. Being able to deal with that, being able to work with soft skills more, being able to engage your employees well.

And then we did talk with Cheryl and she does work with KarenZupko & Associates, also does some work on her own. And she talked to about the value of getting that administrative team to think like coaches. And that’s a big shift from just being a manager where you go, “No, you did this wrong.” And instead, really enabling people and really guiding people and training people in that kind of capacity.

So both of these folks talk about how coaching is important. And we see this so many times because just engaged healthcare professionals deliver better care. If they feel more fulfilled at their job, they’re going to do a better job. It’s just part of it. So, you know, let’s talk about rather than just kind of recapping the stuff that they said, I’d like to focus on some of the specifics that coaches within organizations can help healthcare adapt to. So we’re seeing all these changes. We’re seeing consumerism of healthcare, you know, what is it that these groups can do to start getting ahead of these things? You know, we had an episode where we talked about all of these different business models that are coming out and how people need to think differently about that. That doesn’t happen by accident. What can coaches within these healthcare organizations do to lead their teams?

Scott: One thing that was common from Britt, as well as Cheryl, and I did listen to DJ, it was a good podcast, it was all about listening. I’m a great talker. Anybody who listened to these podcasts like, certainly talk quite a bit. I hope I’m doing better at listening. You know, that old axiom. What is it? Two ears, one mouth, how about listening, like, it’s not just about telling you how to do it. It’s like what’s working for you? What’s not working for you? When we work with Doctor.com, and the professionals over there about good reputation marketing development, one of the cornerstones that they are big about is, “Hey, you got to listen to your patients, everybody.” It’s not just about getting better numbers. It’s you get better numbers by actually listening to your patients and taking good care of them, etc.

And when we spoke to Cheryl, Cheryl was all about like, “Hey, if you’re getting a lot of complaints about a particular way that you’re talking with someone, rather than just say, ‘Stop talking like that.’” It’s like, “Well, how is this coming to be? Talk to me a little bit about the pressures that you’re having? How can we make this better for you?” When you do have a tough day and you had to go see 60 patients instead of your normal 50 patients in an afternoon. You know, one of the things that Cheryl coached the office manager and the doctor about was like, “Why don’t you give everybody a pat on the back? They worked hard.” You know, “Good job, everybody.” You know, it does take a team effort. So I think listening is a big component. Jared, do you agree with that?

Jared: I really did go to that as the first thing when Michael asked, “What are some of those changes that we need to pay the most attention to?” It is listening. And you think about listening to patients and consumers in general, that that was not part of the medical education process for decades, maybe for more than a century. And so understanding that there is now this democratized version of medicine in the first place, that may be the single most difficult hurdle for a clinician to overcome, in my mind. Just from anywhere I’ve seen, not just from a business or a marketing side or a practice management side, just overall, that is such a mind shift that it is a challenge.

And luckily, those who have overcome that either just weren’t as entrenched in it in the first place, or they have seen the benefits of it. Because instead of just, you know, digging your heels in and saying, “Well, it’s not me, it’s them.” All of those who have taken any effort to better understand why people are saying that. Why they’re not giving you a five star review, why they had some other feedback. It’s a basic understanding of how to deal with feedback. I suppose that that isn’t always the easiest for a lot of folks, and especially when you have been taught, when you have been brought up in all of your education. You are the smartest in the room. You’re the one that they are here for. You are the one that has…the only one here who’s got the skills to help this person and they’re gonna thank you for it. It is just that mind shift itself.

There’s so much wrapped up in that. I think we’ve seen those who have been able to shift and to understand better about the benefits of it. But I still think if there was one single thing, that’d be the thing I’d still point to as the biggest hurdle to overcome.

Michael: I was doing some reading before today’s episode, and just taking a look at some of the different like human resource elements that are out there talking about how engaged or not engaged people are with their jobs. So getting beyond just healthcare, thinking about, you know, all the different industries that are out there. And, you know, the numbers, they get pretty depressing pretty quickly because, you know, so many people just show up, it’s just a paycheck, that sort of thing. The companies where this really stood out, where people were more likely to be engaged were with the companies that were very clear about their mission. Very clear about what it was that they delivered, very clear about how they were going to help their customers.

You know, I think about this, even more so from the standpoint of healthcare. Everybody knows that, yeah, we’re gonna go and try to take care of our patients. That’s sort of that like, basic thing. But it’s so easy when that’s like sort of the given to fall into this rut and to fall into resistance to change, to fall into all of these like, ways of behavior that are going to just stand in the way. You know, whether it’s the healthcare administrator, whether it’s the doctor, whether it’s the executive team, like whomever that is. There has to be very strong and very clear leadership about this is the direction that we’re going as a group, this is what we’re about.

And we can be flexible with some of the implementation on this. We can come up with different ways to make these things work. And we have to be, if changes are gonna keep rolling our way, we’re gonna have to be able to adapt, have to be able to be flexible in order to keep moving forward. But if there’s a clear vision, a clear through line, then it’s easier for people to latch on to that and to be more fulfilled and to be able to deal with those changes.

Scott: Yeah, you know, training the staff, with the overarching goal of the business, the practice, the group, etc., critical, right? When we hire people, we talk about just some basic ways that we communicate with people and the basic goals that we have. And then we make sure that we empower our new employees with the information that they need so that they don’t feel that they are just drudging through it, you know. And I always think about the multitude of times that I’ve walked into a practice and, you know, the very first person that everybody talks to is the person that slides the glass door open, right?

Michael: Yeah.

Scott: And probably a lower level person very often. You know, it’s someone who’s just taking a name and entering it into the system, letting, etc. And you think like, “Well, why would I need, you know, to train this person? Why does that person need to have any really big information?” Well, that’s the first person smiling, it’s the first person talking that’s…

Michael: Hopefully smiling.

Scott: Hopefully smiling. There you go. It’s the first person talking, it’s the person answering the phone. I have a friend of mine who wanted to get a procedure done, I forgot what it was, and had some questions. And she called a practice and started asking questions, and the person had no idea what that procedure was, whether or not the doctors did the procedure. By the way, it was on the website and the person calling knew exactly what procedure she wanted, who the doctor was. That person had to tell the person answering the phone, “No, no, it’s Dr. X that does that, and I some specific questions.” And the person who I was talking to actually said like, “I don’t know who I felt worse for, you know, me who’s not getting any information whatsoever, or the poor person on the phone who obviously had no training, no idea.” She felt terrible. She felt disconnected.

You know, these are the things that need to happen. And it’s why I do go back to it. And again, I’m a little biased. I know Cheryl, and we’ve spoken to Cheryl and I didn’t get a chance to talk to DJ. So, you know, you’ve got DJ, I’ve got Cheryl, but over them talked about, “Hey, how do we empower them with better information? How do we listen to them to find out what’s troubling them in terms of getting that point across?” It’s not so easy doing everybody’s job. We do. We tend to just kind of, “Well, if I’m not doing it, it’s not that important.” It’s like “Well, that’s not true,” right. We oversimplify.

Michael: Yeah, absolutely. One of the things that I really liked that DJ brought up, and I’d like to include in this episode show notes as well, was this concept of moving, you know, from this level of uncertainty and this level of chaos and trying to move through to, you know, actually having a plan of action.

Scott: Sure.

Michael: And everybody always hopes it’s that, you know, straight ascending line or it’s that like hockey stick that just, “Here’s how all the progress we made it was woohoo.” But the line that she draws is, you know, pretty much like a New Orleans road, you know, where it just goes around, and around, and around, you can’t figure out how to get through it. And that’s what change actually is. That’s what navigating uncertainty actually looks like, and people aren’t comfortable with that.

Scott: No.

Michael: It’s not innate for us to just go like, “Oh, I’d love to have more of that in my life.” And so, again, coming back to this concept of like being very clear about who we are, as a group, being very clear about who healthcare groups are, what they’re trying to accomplish. This helps offset some of that, it still requires a lot of strength and leadership itself, and in the strength of the team itself, and clear communication with that team, and all of those sorts of things. But it’s not an easy thing to do. I don’t think that’s…I think that’s the rut that whether you work specifically like in a provider organization or you work around healthcare, like, it’s not just going to happen just because. Like there has to be a very, very strong level of intention and a level of training around that. I think that’s kind of like the big through line that I keep seeing with all this is like, we have to plan for uncertainty. We have to train for uncertainty and be able to have critical fingers at all stages along this process.

Scott: Yeah, I think that’s one of the most important things. I think that when Britt was talking about training his students, you know, a lot of it was about not just training them on specific issues, but training them how to learn, how to listen, how to comprehend the problem, and tools to attack that problem, because it’s gonna keep changing.

One of my favorite stories, and I’m sure I’ve said it on another podcast, was about a practice where an orthopedic surgeon who was a sports medicine fellow was running out the door to go take care of another patient that was in the ER. And he could not figure out for the life of him why it was taking so long to get more sports medicine patients. And as he was running out the door, the person answering the phone said, “No, sir, we’re orthopedic surgeons, we don’t do sports medicine, we do surgery.” And he was horrified, you know, and indignant about it.

And I remember telling him like, “Well, two things. One, we need to get the word out on your site and through your online marketing that, yes, indeed, you’re a sports medicine specialist. But have you taken time to train your staff? What sports medicine is in relation to orthopedic surgery? You know, that it’s actually a fellowship you can take and this is what it’s all about. And this is what we do. And this is how we take care of patients. And this is…?”And he was like, “Yeah, you know what, shame on me,” right. So at first he was indignant. Like, “How could she not know” and it’s like, “Well, who took the time to talk to her?”

So when you’re budgeting, time and money for training, it’s not just for the care provider, the surgeon, the nurse, the PA, etc., right. It’s about the staff. It’s so critical. And it’s not that hard when you put together a plan. It’s part of what I like. And then when they are better trained, not just on orthopedic surgery because I don’t think you need to get into like the, “This is what a chamfer cut is and why it’s important, and the total knee replacements.” It’s like, no, there’s good basic information that can go out there. But then you’re better prepared, like, “This is what our goals are as a practice,” and you’re better prepared for those changes because the core goals are set. So it’s like when that new curveball comes, it’s like, “Okay, what do we do?” “Well, this is what we’re about.”

Michael: Absolutely. Jared, do you have anything else to add before we wrap up?

Jared: I was just thinking. I was kinda wrapping my mind around that analogy. I really like that, that thought of just being ready. And I kept thinking, you know, how will I know when I’m fully ready to embrace change? Because I don’t know if anyone really is all the time, but that’d be my question to myself, you know, how do I know that I’m more prepared? You know, especially if I am sitting in, I’m trying to think if I’m a listener and I’m a practice manager, or I am a provider, and I’m interested. And I am feeling like I’m generally open to change. I’m not one of these who’s totally resistant, but, you know, where do I go next? Like, where do I start? Like, how do I start making some movement down this path?

And I think it really does come down to a couple of things that both of you have already reiterated of just the mindset itself and pick a starting point, right. Pick one of these areas that you have seen that you recognize you need a little bit of improvement on and you need to evolve. And I feel like the overwhelming part gets to people and just leads them to resist it more as well. So don’t allow yourself to feel overwhelmed either, just take that first step, whether it is something like listening to this type of program, you know, not trying to plug this at all. But this is a way we hear from people who say like, “This is one thing, listening to your program helps me understand and get trained a little better, helps me do my job better.”

And that’s just another way to do it. So I guess that’s where I was going in terms of like those first steps and kind of any thoughts. And maybe that’s something to throw back at the both of you as we kind of wrap up of kind of that first step that you’d suggest for a listener when they want to start walking down this new road.

Scott: When I started my company 20 some odd years ago, I came up with a core set of principles that I always wanted to bear in mind and then attack it from those core set of principles. For my company, and probably I’ve said it so many times I make people’s eyes roll, but I always say it’s in no particular order, by the way, “Protect the company. Protect the client, no surprises.” And you can alter that for a practice of, you know, protect the patient, protect the practice, no surprises. They all are intertwined, it’s not like one comes first. They’re all intertwined. And as long as you come up with a good way to balance, protect the patient, protect the practice, no surprises, man, it’s a good starting point.

Now, that’s what works for me. It may be something different for each individual practice. But whatever that is that works for you, it’s like, you know, I get it, I probably just made Michael, your eyes roll. And you were very polite and probably kept them in place for me and then when I walk out the door, you may roll those eyes. But in reality, I’ve said it a lot.

And whatever that is for you, as a provider, as the person running the practice, it’s like one of those core principles that you really wanna make sure everybody understands, right, and then go from there. You know, there’s a reason why physicians take the Hippocratic Oath, or the Oath of Maimonides, depending. There’s some good core principles in there, and start with that possibly, and then build accordingly. It’s not easy, but it’s a good place to start. And then find out where you want to go.

Michael: Yeah, it makes me think of that, you know, the conversation, we have with Dr. Smith, about, you know, he did a lot of like polling of his patients in a potential patient.

Jared: That’s right.

Michael: To say, like, “Hey, what are the things that matter most to you?” And, you know, whether you do it in that framework or, you know, you can more easily intuit that kind of information. But building that structure around the patient, I would then balance that with you know, Britt’s concept patient comes second, right? Like, so you got to take care of your stuff, too. So it’s very much along the lines of what you’re saying, protect, protect, but I think with that at the core, changes don’t have to be scary.

Scott: Right.

Michael: I know that my core model of protecting people, of caring for people, of taking care of my staff, of taking care of my patients, that’s gonna be the number one thing. Everything else is…

Scott: Will fall into question.

Michael: …an adaption. Yeah, it is.

Scott: Yeah, everything will fall into place.

Michael: It’s again, it’s work. It’s not just going to happen, but.

Scott: No. No, no, no, I agree with you wholeheartedly. I’ll kind of leave you with this, when my daughter, who just recently got married, the rabbi gave a piece of advice to the two of them. And he said, “It’s gonna be the hardest piece of advice that I can get you to follow.” They both leaned in. And the rabbi said, “Be kind to one another,” I thought it was a great piece of advice. Now, sounds easy, you know, on the day you’re getting married, but, you know, the day you’re coming home very tired and cranky, and you wanna know what’s for dinner, that “Be kind” becomes a little bit harder, you know. And so whatever those core set of goals are, it seems easy.

Michael: Sure.

Scott: But in reality, “Hey, man, a lot harder.” But if you know what they are, and you have told your practice what they are, those conversations are much easier to have. They’re better conversations, where everybody feels like they’re part of the team. They’re empowered to help get to that. Like, “What are we trying to accomplish? Take better care of our patients. Take care of the practice try to be as open as possible. Okay. Now, tell me the problem.”

Michael: Sounds great. Thank you, everybody, for listening.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neural practices. Subscribe on iTunes, Google Play or anywhere you listen to podcasts.