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3 more fixes that will boost your bottom line

February 13th, 2013

by Kenneth H. Cohn

In my last post, I mentioned four tips for engaging physicians where you work to improve clinical and financial outcomes, as well as create a more satisfying practice environment.

Here are three more recommendations:

1. Any time you hear someone moan, "Getting doctors to do anything is like herding cats," reframe the discussion to stimulate healthy competition.

Take, for example, a cardiac catheterization lab director who inspired his colleagues to decrease clinical variation and cut costs by showing them their data in a blinded fashion, and letting them know that if they did not achieve progress within six months, he would put each cardiologist's data in the cath lab lounge for everyone to see and comment on.1

Within four months, procedure times and outcomes for the entire six-person group were within one standard deviation, and they had decreased their vendors to two and cut costs substantially, all while improving outcomes, as I described in "Collaborative Competition."


As one of the cardiologists explained, "None of us wanted to be an outlier, except on the positive side."

2. Work with front-line physicians and nurses to decrease readmissions.

Activities like calling patients within 24 hours of discharge are low-cost, high-impact measures that improve performance, as I described in "Collaborative Handoffs."

Similarly, asking patients with congestive heart failure (CHF) and their caregivers to restate instructions in their own words (teach back) allowed St. Luke's Hospital in Iowa to decrease their CHF readmission rate from 12 percent down to 3 percent - 9 percent. The variation resulted from patients who were near the end of life but not yet willing to engage in palliative care options, as discussed in part one of this blog post.

3. Work with your providers to improve the safety culture.

As I wrote in Getting It Done, four steps that organizations can take to build and sustain a healthcare safety culture include:

  • Conduct a baseline survey of adverse events and near misses over the past year
  • Look for patterns and common causes that suggest recurring systems issues
  • Gather employees and medical staff to review the data and brainstorm improvement strategies; have physicians present data to the medical staff
  • Discuss and evaluate what behavior-based expectations might decrease adverse events and near misses

Improved communication and collaboration brings about a virtuous cycle of increased revenue, lower expenses, and most importantly, improved clinical outcomes.

1 Cohn KH, Lambert M. (2005) "Engaging Physicians in Hospital Operations." Better Communication for Better Care: Mastering Physician-Administrator Collaboration, Chicago: Health Administration Press, 47-48.

Ken is a practicing general surgeon/MBA and CEO of, who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance.


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