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.

Mentoring

There's an interesting discussion this month in the print version of CONSULTING magazine about mentoring programs in consulting firms. What's notable is how diverse the programs are. Some are highly structured, while others are based on encouraging mentees to seek out their own mentors among the senior staff.

One common element is the claim that senior people are evaluated on how well they develop their mentees. I wonder how real this is, and how much is just paying lip-service. I'm sure it's on the list, but I don't know how much weight is actually given to it. After all, senior people have lots of other things they are evaluated on.

Do any of you have experience being effectively mentored inside your firm? What were the key elements that made the mentoring program work well in your organisation?

Technical Excelllence

In many professional businesses, high technical excellence is taken for granted -- we assume that having it is "table stakes" for competing.

However, it's not a trivial issue to ask whether and how a firm goes about ensuring that its employees in fact meet high standards of technical expertise, especially in a world where companies tend to signal that revenue generation is a more pressing (if not more important) topic.

Who is best positioned in a professional organisation to judge an employee's technical quality? I assume that it might be that person's supervisor, but there could be some built-in conflicts: what if the supervisor is under economic pressure to meet group goals and hence compromise (a little) degrees of technical excellence?

I'm curious about your experience as to how your firm or company goes about ensuring technical excellence. Is it some combination of:

1. Training
2. On-the-job supervision
3. Peer Review Processes at the Job Level
4. Annual Performance Appraisals
5. Reward schemes

Or something else?

Believer or Sceptic?

When working with clients on change initiatives, I notice that they have two widely different strategies for appointing the internal person to lead the project. In some cases, they appoint a "true believer" who really wants to see the change happen. In other cases, firms go out of their way to appoint a sceptic, so that only proposals that can overcome the scepticism emerge from the study task-force, and proposals are not made that will not be implemented.

As a consultant, it's easier initially to work with a true believer, but the implementation success may be higher if a sceptic is appointed.

Does anyone have experience with this? if you were a company manager, who would you appoint to lead the charge on new strategic change intiatives?

Another reader question

My question to you and all your website contributors;

What have been people's experiences with the strategy of targeting only working with one client per industry sector and deliberately broadcasting to the market that that is your "modus operandi"? It's a bit clumsy, but, for example -- "We guarantee our clients that we will not work for their competitors, thereby preserving exclusively for our clients, the commercial advantage of partnering with us"

I know the applicability may vary with the type of services one offers, but do others have any thoughts on this approach?

Implementing a Client Service Strategy

One of the most common topics I am asked to advise on is achieving distinctively high levels of client service. I find that many firms underestimate how tough a diet and exercise program (see STRATEGY AND THE FAT SMOKER) it would really take to pull this off.

Among the changes that most firms would need to make are:

1. Adopting a culture that no longer allows people to "opt out" on the topic of client service excellence on the grounds that their skills lie elsewhere. A firm can't get a reputation for something that not everyone does.
2. Finding some way to monitor client feedback in real time (not just once a year) and make it credible to everyone that there will be a follow up for anything less than excellence.
3. Providing training in client counselling skills
4. Providing research support from the marketing department to help service delivery people stay current on client industries
5. Enable sharing of experiences (workshops and workbooks) among practitioners on an ongoing basis to establish a continuous improvement approach to client satisfaction.
6. Implement disciplined project management systems, including mandatory processes for communications strategies with clients mid-process.
7. A systematic program of senior officer visits to clients to "role model" the firm's commitment.

None of these approaches are new or innovative. (I first wrote about them in the 1990s, and I wasn't the originator then.) However, it is still my experience that firms are less than systematic in implementing a client service strategy.

What systems do you think are need to pull this strategy off? What else needs to be in the "change package?"

Managing Professionals in Not-For-Profits

A friend called recently and asked whether I thought the principles of managing professional service organisations applied in the not-for-profit sector.

It's a complex question. Let's start below the level of the organisation and ask whether the principles of managing professionals (not the organisation, but the people) differs between for-profit and not for profit.

I suspect that while the principles are the same (manage people through the opportunity for meaningful, challenging work) the actual practices are very different. The monetary dimension in the for-profit sector is both a blessing and a curse.

The blessing is that the availability of money allows generous rewards to be used to attract, motivate and retain talent. The curse is that financial rewards come to be used exclusively as the means to attract, motivate and retain talent.

In the for-profit sector, managers can "get away" with being poor managers, using money to cover up the absence of hands-on managerial skill. In the not-for-profit sector, the need for people management skills is unavoidable.

That's only one dimension of the not-for-profit difference, but before carrying on with my analysis, let me get yours.

What do the rest of you think? What has your experience been?

Screening for Relationship Attitudes and Skills?

Yesterday's post was about whether relationship skills must be "found" by firms in their hiring process or whether they can be developed.

As I reported, about one-third of a conference of leading management consulting firms felt that these values, attitudes and/or skills are mostly "hired in" rather than developed once people have reached the age and stage of being hired by consulting firms.

Which raises these questions:

1. How can firms screen for and identify relationship values, attitudes and skills?
2. How, in fact, do they screen for them?
3. Do formal testing approaches work?
4. What about "behavioural interviewing" (I'm still not sure what that is!)
5. Do you have to rely on the "take them out for a beer" test?

Developing Relationship Skills

At a conference of leading management consulting firms last week, I led a discussion about the barriers to developing strong, deep relationships with clients -- a "fat smoker" strategy in the sense that we all know we should be good at it, but few of us are.

As we explored the topic, I took a poll on how many people thought relationship skills were "born" and how many thought they could be "made" (i.e. developed.)

(Only) two-thirds of the audience thought they could be developed. However, very few firms said they had formal programs to help their people develop the interpersonal, social, political and emotional skills necessary to be good at relationships. As a rule, they depended either upon people developing these skills for themselves, or (if you were lucky) learning on the job by observing those ahead of you who were good at it.

The challenge was made even more difficult when it was pointed out that -- ultimately -- relationship skills are about values and attitudes, not personality characteristics and skills. If the discussion is about values, then it really is challenging to address the key questions:

1. Are these born or can firms develop them in their people?
2. If they can be developed by the organisation, how?
3. How did you learn to develop your relationship skills?
4. Were you ever given any formal training that helped?
5. What would you advise others that wanted to work at developing these skills?

Firing unprofitable clients

Hi Richard,

I had a question I wondered whether you or your blog readers had any opinions on.

Many companies have unprofitable customers. This situation may arise for many reaons including:

• Poor pricing controls -- offering large and multiple discounts
• Historic over-servicing and under-charging long-term customers
• Lack of understanding of the true cost to serve

Nonetheless, whatever the reason, when companies do find unprofitable customers they need to manage them. They can be made profitable or they can be "fired".

Do you have any ideas or strategies for actually firing customers? Does anyone have any examples of how their companies (or others) have done this and what the results were?

Regards. Daryn, Sydney, Australia

***

Well, gang, what say thee?

Bob Sutton wins Quill Award for "No Asshole Rule"

Bob Sutton was awarded the Quill award for "best business book of the year" for "The No-Asshole Rule."

Way to go, Bob! As I said on his blog, we all look forward to the movie of the book!

Consultant Seeks Advice

A consultant sent me this emaial, soliciting advice:

Last week I spent a couple of days with group within my client's organisation. The group was all male with one female. I was appalled by the pre-pubescent behaviour of the males towards the female. I'm a former Marine, played football in college, I'm not unfamiliar with male environments. Their behaviour towards their own female staff made me uncomfortable. My test is that I don't want to put our employees in an environment in which I would be uncomfortable putting my wife or daughter.

But, it's a really big client. And, my desire to back away from this client is being challenged by others.

Our first, agreed-upon principle is that our employees come first. Great employees, who are truly experts in their area, are harder to come by I think than clients. This is an interesting test of our application of our principles.

Any suggestions about how best to handle this would be appreciated.

Books by Consultants

Here's a great piece by Jonathan Copulsky, (a consultant at Deloitte in Chicago) published in the October 22, 2007 issue of Brandweek.

Smells Like The Publishing Spirit

While any self-respecting management consultant strives to achieve stellar results for his clients, there's one desire that often seems to permeate both body and soul more than any other: He dreams of being the author of a bestselling book.

Don't believe me? Browse the business section (or even, at times, the center-aisle tables) of the nearest mega bookstore, and count the number of books with the grinning guy in a suit on the dust jacket.

Naturally, he wants to demonstrate his in-depth knowledge and experience, share his insights, purvey his skills -- and earn your respect. Perhaps I should say "we," however, because the siren song of publishing oft tempts me -- a veteran marketing and sales consultant -- too. Only the fear of being unable to make my book truly stand out from the stack has kept me from succumbing to the temptation.

Until now, perhaps. Last week, you see, I finally found my inspiration -- the talisman sure to set my book apart from the rest. A newspaper story informed me that, when it comes to business books, animals are "in." The article cited Spencer Johnson's mice tale, Who Moved My Cheese? which has topped bestseller lists for almost a decade. More recently, John Kotter recast his 1996 organisational change bestseller as a fable about a penguin who mobilises his colony against the threat of its melting iceberg. Our Iceberg is Melting sold more than a quarter of a million copies.

With these zoological precedents in mind, I have decided the world is now ready for Who's Buying Our Guano?

A book about guano can't miss. A prime ingredient for both fertiliser and gunpowder, guano is rich in history, nitrates and adorable animals. Produced by birds, bats and even baby seals, it can be found throughout the world, from tropical islands to dank caverns. Guano's geopolitical influence also has been profound.

Peru, Bolivia and Chile waged war over guano 150 years ago. Perhaps it fueled their cannons, as well as their feud. Long before the world worried about weapons of mass destruction, Congress authorised the takeover of islands rich in guano deposits and even empowered the president to use the armed forces to protect our newfound national guano interests. Bats, seals, birds, war and American imperialism; that, friends, is an unbeatable combination.

Who's Buying Our Guano? will be set in an impoverished but guano-rich bat colony. Mobilised by one of its wiser and more experienced members, Sollie (short for Solomon), the colony wakes up to the commercial value of its deposits. Sollie convinces his fellow bats that they need a robust marketing and sales strategy, as well as a premium product, to achieve results in the lucrative but highly competitive global guano market.

Under Sollie's leadership, the colony quickly creates a multitiered distribution structure that includes exclusive agreements with the top-tier organic retail gardening chains. The bats' brand of guano immediately achieves market acceptance and generates an impressive rate of return. Less than 12 months after the bats launch their branded line, however, they come under fire from the seals. Although the seals' brand of guano is lower in quality in terms of its fertilising value, they promote it heavily with coupons and bulk-purchase discounts.

Our bat-marketer is, of course, baffled and disheartened. Despite their clearly superior product, the bats are losing market share. The ensuing crisis of confidence prompts Sollie to proffer his resignation. Fortunately, the CEO and the board rally behind him. Re-invigorated by this show of support, Sollie leads the attack on the guano sector by identifying value-added guano services, launching a boutique series of guano varietals and creating a series of beautiful complementary products for the home, including an ergonomic guano spreader available in six colors.

All of these innovations put the bats back on top of the guano pile. Determined to stay there this time, Sollie launches an in-depth study of the bats' target demographic. Following a thorough analysis, Sollie is shocked to discover that the bats' guano brand is failing to make a profit on nearly 15% of its customers. He concludes that the colony is literally giving away services, ranging from expedited shipping to custom packaging. Sollie convinces the board to introduce a menu-based pricing scheme. The result? Profitability increases by more than 500 basis points.

As just these little teasers prove, Who's Buying Our Guano? has all the ingredients of a blockbuster. Although bats may strike some as icky, just think of cute bats, like Jannell Cannon's Stellaluna or Fu-Fu from the PBS cartoon Sagwa.

Trust me, after my title hits the shelves, the business publishing sector will never be the same. As Sollie and his talented marketers teach us, when it comes to marketing and sales books, there's always more guano to buy.

***

Thanks, Jonathan, for permission to reproduce this.

So Young and So Jaded

I was giving a presentation to a group of young people (mid to late 20s) newly promoted to their first supervisory position.

As always, I was making what I thought were obvious points -- that the best means to get productivity and quality from those you manage is to help them find the meaning, the purpose, the excitement in what they have to do.

The reactions were amazingly cynical. "Have you ever worked in a professional service firm?" asked one young man.

A young woman asked, "But how do you motivate people to do the unexciting tasks that have to get done?" (I told her that she was unlikely to get much commitment, productivity and quality by delegating with an air of "We all know this is boring, but someone's got to do it, so I chose you!")

Obviously, these young people had not (yet) been managed in a style that elicited their enthusiasms. Even though their firm (like all others) had grand statements about its commitment to developing its people, they had already learned (or so they thought) that the world did not really work that way.

I said that I hoped they would not just pass on to the next generation the poor way they had been managed, but I didn't leave the room with much hope.

Sad, sad, sad.

Summary Proverb -- new careers videocast & audiocast

In the 25th and final episode of this series, we will close with a proverb that I use to conclude many of my seminars. It illustrates that what most businesses need is not clarification on what the right thing to do is, but the courage to not give in to short term gratification.

Audio Timeline

00:39 -- Introduction
01:00 -- Summary Proverb
01:21 -- Conclusion

You can download Summary Proverb or sign up to receive new videos automatically with iTunes or other video players. (Click here for step-by-step instructions on how to subscribe.) My seminars are always available for download at no cost.