Article

September 1, 2016

Due diligence can mean difference between good plan, bad plan

When developing a new plan for a medical practice, explore solutions and barriers from all possible angles (including an escape route) before implementing the endeavor.

Putting It In View By Dianna E. Graves, COMT, BS Ed

“A plan that can’t be changed is a bad plan.”

Herm Edwards was not only a coach in the NFL for the Kansas City Chiefs, he also played professional football with the Philadelphia Eagles, LA Rams, and the Atlanta Falcons. Currently, he is a football analyst for ESPN.

He is also known for his “Herman-isms.” To say he is a passionate speaker, and vocalizer of his thoughts, is an understatement.

I was listening to my favorite sports station the other day-while thinking of some of the conundrums I was having to figure out-when all of a sudden Herm shouted through the radio speaker with the above Herman-ism.

During the commercial break, my mind raced to a conversation I had with the chief of the clinic: How could we increase visual fields in our seven sites to decrease waiting times for patient appointments-without buying more visual field machines or increasing staff?

Though his idea had merit, it wasn’t going to be as easy as he made it seem. It was going to involve flipping the diagnostic flow, as well as clinic flow, upside down to some degree. Each plan to make it work had merit, but definitely had pitfalls attached as well.

I have always lived by the motto: “If this, then that.”

Some have said this method of planning is an easy way out if you don’t want to continue with the plan, or want an excuse not to do the plan. I side with Herm and say: Every plan needs an escape route so you can get out of a failed plan and ensure there is minimal damage. If you do not have this contingency plan, you will be roped into a failed endeavor that will sink all those around you.

'Make it happen'

‘Make it happen’

As managers, we have all had a physician come to us with an idea and these fatal words: “Make it happen.”

It is very hard to tell a physician that while his or her plan appears to have merit on the surface, it might not benefit the entire group, or may have consequences not initially foreseen down the road. It is a poor career choice not to at least investigate the plan and try and make it work!

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Listening to the chief’s plans for the visual fields, it was hard not to jump ahead in my brain and mentally list the reasons it wouldn’t work. There were many. But, career in mind, I smiled and listened, and then waited for him to leave the office so I could finish the schedule I was working on.

At 2:45 a.m., I sat bolt upright in bed and took out a pad of paper, drawing a line down the middle for the “goods” and “bads” of the idea to increase visual fields on a shoestring budget. Writing reasons for both at a fevered pace, I vindictively hoped his night of sleep was equally as poor as mine.

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Soon I had six reasons why we did not want to do this, and why we could not achieve the goal.

Knowing that I did not want to present a skewed view, I forced myself to concentrate on how could we make this happen. Lastly, I made another column and followed Herm’s words. What was the escape plan if it all went South?

Making a case

At 6 a.m., pad of paper in hand, I headed into the meeting with the idea of how we were going to make this happen. And then I waited for the explosion.

They picked it apart and did everything I had done, and then decreed: “No issue-we can make this happen.” Actually, they even uttered we should get it going soon.

In shock, I departed the meeting and thought: “You’ve lost it. You’ve gone to the pessimism side and can’t climb out.”

Ten minutes later, the first lead called with concerns they didn’t want to vocalize publicly. And then the next, and the next.

We hadn’t discuss what would happen if it went poorly.

So, the next morning we reconvened to discuss the escape route to get out of it if it failed. That was more tortuous. In order to make this work, we would need to:

· Change the schedule templates.

· Get 48 technicians in the mind frame of how to make it work.

· Change the front desk way of scheduling patients.

· Ensure the leads had a system in place for each clinic so physicians would

know where to go with add-on fields.

· Ensure there was no internal sabotage that could occur.

Then, I spoke with the manager of the front desk, sent a cheerful e-mail to the front desk and technicians that this was a great idea and how it was bound for success with their help, and rolled out how we would get it rolled out.

Most people agreed we could make it happen. A few panicked because it was change. Some brought up ancient history, as this was how they did visual fields 15 years ago and it had been a small disaster. I reminded them that was “BD” (“before Diane”) and we would do it differently to ensure success.

So, we are ready to implement and will do so within the next 3 weeks.

What's the escape plan?

What’s the escape plan?

That was easy to draft up and present.

I invoked their pride and professionalism, and advised them that there is no reason this will not work swimmingly. I have not told them that there is no escape plan because we have analyzed it front to back and it will work. An escape plan here would be admitting we didn’t put our best effort forward, and we allowed a negative mind set to sink us. We were not going to have that happen on our watch.

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You may be thinking, but Herm said a plan that can’t be changed is a bad plan.

True. And we have analyzed what the contingency plan would be if it failed miserably. So, there would be a plan in place: Returning to the original (which is poor as well) would be plan No. 1. Another machine and body to run it is a plan-but budget wise, not very good. And then we would have the age-old problem of no space for it.

Having a change (“an out”) in case of problems is crucial-as long as it is tucked away in a small area of your brain to ensure it is not the first thing you grab when you are having an implosion day in the beginning of the endeavor.

By the way, Herm also said: "This is what's great about sports. This is what the greatest thing about sports is. You play to win the game. Hello? You play to win the game. You don't play it to just play it.”

Get your game face on, and hit the field! You’ll never win the game on the sidelines.

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Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.