Medical Practice as a Professional Service

R Paul L. Shillam, Controller at Pacific Medical Centers in Seattle wrote in to say:

"I just read your article published in Consulting (Nov/Dec 2008). Each time I read your views on professional consultants, accountants or legal firms, it easily translates to the practice of medicine. In a medical practice, there is a group of professionals trained in problem solving and decision making, and then dispensing recommendations to their clients. Clients can either choose to implement their recommendations or not. The medical consultant's success depends a great deal on the relationship between the client and consultant. I could go on with the parallels.

"I think you miss a great opportunity to contribute to the changes needed in health care by limiting your practice to 'service firms'. Isn't the practice of medicine a service anyway? I would be interested in translating much of what you say about the 'trusted advisor' and 'relationships' in professional service firms to the practice of medicine. There is a huge push to change the way medicine is delivered in this country and the common sense approaches your offer to service firms have applicability in the practice of medicine.

"Here's an idea, do a survey of some of your physician acquaintances to see how they react to your ideas ... just a thought."

***

What's the reaction of the rest of you? Do any of you have experience applying professional service firm lessons to medical practitioners? How easy or difficult is it to make the "translation"? How receptive is the medical community?

New Business Thinkers

Are there any business thinkers that you are paying attention to that have not been "around" and well-known for years already? Who, if anyone, is an emerging business thinker worth paying attention to?

Digital Marketing for Professional Firms

David Koopmans, Director of Mokum Marketing in Melbourne, Australia wrote in by email to raise the topic of how professional services firms can use the web in their marketing strategy and what the specific benefits are.

He points out that among some types of professional firm there is often resistance to the concept of marketing in general, and the digital space in particular.

If you were advising a professional firm about web marketing, what would you stress?

I'm not sure how much hard evidence there really is about the benefits of the web in marketing professional services. I suspect that key decision-makers and buyers are not spending much time on the net. Their staff subordinates (HR people, marketing directors, strategy people etc.,) may use it more, and you may be found that way, but I doubt that there is much of a direct executive audience.

I would probably point out that the old adage "demonstrate don't assert" remains the key to effective use of web technology, and that websites need to have voluminous amounts of easy to search and easy to find content, so that you can you can prove that you have something to offer (and are generous and professional enough to share it.) The ease of use of your digital marketing gives you an opportunity to show your ability to put yourself in the shoes of the client / purchaser and understand things from their perspective, rather than saying "let us tell you about us."

I'd also stress that you need to be well advised by people who understand search engine optimisation, so that if there are buyers who don't know you, you are found when they begin searching.

It's still early days for blogging, podcasting and videocasting, but I'd have to guess that, for most professional service firms, these are not high return activities -- again, because I'm not sure that the "high-level" buyers are listening and watching.

I've had a lot of fun and success with my own activities (which I reported on last year in an article called "Adventures in Modern Marketing") but it's very hard to unbundled the incremental marketing benefit that being active on the web has brought. I'm not sure what I would advise a client to do in this area, nor how much of their marketing budget to devote to web activities.

What do the rest of you think? What advice would you give to a professional firm about digital marketing? What have we learned?

Meeting Rules

We all know meetings are a curse.

Here are some of the rules I would offer to help make them more productive.

1. Do not call meetings when some other form of information sharing is possible.
2. Since most people can read ten times faster than a presenter can speak, send material ahead.
3. Meetings need to have concrete goals (a purpose for what must be accomplished), not just an agenda.
4. Select speciifc start and stop times and stick to them
5. Restrict attendance to only those who must be there
6. Appoint a reporter at the beginning of the meeting, charged with recording the discussion, writing it up, and circulating the meeting notes within 24 hours

***

Those are just some of the rules I would offer. What meeting rules would you propose?

Reputations

Consistency, dependability and regularity work: occasional peaks of excellence don't.

For example, always meet your deadlines.

If you are asked to do something, make sure you know exactly what it is and when it is due.

If you have doubts about your ability to complete on time or about the task's priority or importance, raise your concern with your manager or client immediately.

It is OK to need more time as long as you ask for it ahead of time. It is OK to struggle and ask for help.

It is not OK to break your commitments. The fastest and surest way to fail is to break your word.

The Rule of St. Benedict

At a seminar I conducted last Friday, the topic of enforcing standards came up -- as it always does. And, again as always, I made the point that the courage to enforce standards by asking otherwise productive people to leave is both essential and scarce. We also discussed the charcateristics of an effective manager of professionals.

Over the weekend, I heard from Adam Simon, Managing Director of Business Optimisation Services at PRG-Schultz Europe. He wrote:

Many thanks for your words of inspiration at last Friday's seminar. Before going into business 25 years ago I spent some time as a Benedictine monk and have often tried to draw on that experience in my business life.

As you were leaving, I asked if you had read the rule of St Benedict and you said no. I think you will love parts of it, especially two chapters that I draw your attention to for a starter: Chapter 2 what type of man the Abbot should be. I do not think that in all management writing, pace Drucker, Peters and all the gurus, there is a better description of what a good manager should be. Chapter 28, Of Those Who Having Often Been Corrected Do Not Amend, which follows your principle that people have to be pulling in the same direction or leave. Whilst many of the specifics in the rule have no relevance, the spirit is totally modern with its understanding of human frailty and the difficulties of living with others.

Here is a link to a translation of the rule into English (slightly old fashioned language, better modern translations do exist but I could not find them on the web).

CHAPTER II

What Kind of Man the Abbot Ought to Be

The Abbot who is worthy to be over a monastery ought always to be mindful of what he is called, and make his works square with his name of Superior. For he is believed to hold the place of Christ in the monastery, when he is called by his name, according to the saying of the Apostle: "You have received the spirit of adoption of sons, whereby we cry Abba (Father)" (Rom 8:15). Therefore, the Abbot should never teach, prescribe, or command (which God forbid) anything contrary to the laws of the Lord; but his commands and teaching should be instilled like a leaven of divine justice into the minds of his disciples.

Let the Abbot always bear in mind that he must give an account in the dread judgment of God of both his own teaching and of the obedience of his disciples. And let the Abbot know that whatever lack of profit the master of the house shall find in the sheep, will be laid to the blame of the shepherd. On the other hand he will be blameless, if he gave all a shepherd's care to his restless and unruly flock, and took all pains to correct their corrupt manners; so that their shepherd, acquitted at the Lord's judgment seat, may say to the Lord with the Prophet: "I have not hid Thy justice within my heart. I have declared Thy truth and Thy salvation" (Ps 39[40]:11). "But they contemning have despised me" (Is 1:2; Ezek 20:27). Then at length eternal death will be the crushing doom of the rebellious sheep under his charge.

When, therefore, anyone taketh the name of Abbot he should govern his disciples by a twofold teaching; namely, he should show them all that is good and holy by his deeds more than by his words; explain the commandments of God to intelligent disciples by words, but show the divine precepts to the dull and simple by his works. And let him show by his actions, that whatever he teacheth his disciples as being contrary to the law of God must not be done, "lest perhaps when he hath preached to others, he himself should become a castaway" (1 Cor 9:27), and he himself committing sin, God one day say to him: "Why dost thou declare My justices, and take My covenant in thy mouth? But thou hast hated discipline, and hast cast My words behind thee" (Ps 49[50]:16-17). And: "Thou who sawest the mote in thy brother's eye, hast not seen the beam in thine own" (Mt 7:3).

Let him make no distinction of persons in the monastery. Let him not love one more than another, unless it be one whom he findeth more exemplary in good works and obedience. Let not a free-born be preferred to a freedman, unless there be some other reasonable cause. But if from a just reason the Abbot deemeth it proper to make such a distinction, he may do so in regard to the rank of anyone whomsoever; otherwise let everyone keep his own place; for whether bond or free, we are all one in Christ (cf Gal 3:28; Eph 6:8), and we all bear an equal burden of servitude under one Lord, "for there is no respect of persons with God" (Rom 2:11). We are distinguished with Him in this respect alone, if we are found to excel others in good works and in humility. Therefore, let him have equal charity for all, and impose a uniform discipline for all according to merit.

For in his teaching the Abbot should always observe that principle of the Apostle in which he saith: "Reprove, entreat, rebuke" (2 Tm 4:2), that is, mingling gentleness with severity, as the occasion may call for, let him show the severity of the master and the loving affection of a father. He must sternly rebuke the undisciplined and restless; but he must exhort the obedient, meek, and patient to advance in virtue. But we charge him to rebuke and punish the negligent and haughty. Let him not shut his eyes to the sins of evil-doers; but on their first appearance let him do his utmost to cut them out from the root at once, mindful of the fate of Heli, the priest of Silo (cf 1 Sam 2:11-4:18). The well-disposed and those of good understanding, let him correct at the first and second admonition only with words; but let him chastise the wicked and the hard of heart, and the proud and disobedient at the very first offense with stripes and other bodily punishments, knowing that it is written: "The fool is not corrected with words" (Prov 29:19). And again: "Strike thy son with the rod, and thou shalt deliver his soul from death" (Prov 23:14).

The Abbot ought always to remember what he is and what he is called, and to know that to whom much hath been entrusted, from him much will be required; and let him understand what a difficult and arduous task he assumeth in governing souls and accommodating himself to a variety of characters. Let him so adjust and adapt himself to everyone -- to one gentleness of speech, to another by reproofs, and to still another by entreaties, to each one according to his bent and understanding -- that he not only suffer no loss in his flock, but may rejoice in the increase of a worthy fold.

Above all things, that the Abbot may not neglect or undervalue the welfare of the souls entrusted to him, let him not have too great a concern about fleeting, earthly, perishable things; but let him always consider that he hath undertaken the government of souls, of which he must give an account. And that he may not perhaps complain of the want of earthly means, let him remember what is written: "Seek ye first the kingdom of God and His justice, and all these things shall be added unto you" (Mt 6:33). And again: "There is no want to them that fear Him" (Ps 33[34]:10). And let him know that he who undertaketh the government of souls must prepare himself to give an account for them; and whatever the number of brethren he hath under his charge, let him be sure that on judgment day he will, without doubt, have to give an account to the Lord for all these souls, in addition to that of his own. And thus, whilst he is in constant fear of the Shepherd's future examination about the sheep entrusted to him, and is watchful of his account for others, he is made solicitous also on his own account; and whilst by his admonitions he had administered correction to others, he is freed from his own failings.

CHAPTER XXVIII

Of Those Who Having Often Been Corrected Do Not Amend

If a brother hath often been corrected and hath even been excommunicated for a fault and doth not amend, let a more severe correction be applied to him, namely, proceed against him with corporal punishment.

But if even then he doth not reform, or puffed up with pride, should perhaps, which God forbid, even defend his actions, then let the Abbot act like a prudent physician. After he hath applied soothing lotions, ointments of admonitions, medicaments of the Holy Scriptures, and if, as a last resource, he hath employed the caustic of excommunication and the blows of the lash, and seeth that even then his pains are of no avail, let him apply for that brother also what is more potent than all these measures: his own prayer and that of the brethren, that the Lord who is all-powerful may work a cure in that brother.

But if he is not healed even in this way, then finally let the Abbot dismiss him from the community, as the Apostle saith: "Put away the evil one from among you" (1 Cor 5:13); and again: "If the faithless depart, let him depart" (1 Cor 7:15); lest one diseased sheep infect the whole flock.