Best Practices

Striving for collaboration

Examining the role culture plays in a group practice

By Bruce Maller

Legislative and regulatory changes to the US health-care system are likely to have a profound effect on the management and financial performance of ophthalmology practices over the next decade. In anticipation, many ophthalmologists have formed or joined large, group practices. While a lot of practitioners believe “bigger is better,” large group practices frequently struggle with issues of culture, leadership and compensation.

This column examines the role culture plays in a group practice.

Of culture and collaboration

We’ll define culture as a comprehensive or shared understanding of guidelines, principles, social mores and communication styles, resulting in commonly held assumptions and views among leadership and staff. In ophthalmology group practices there are unique dynamics related to sharing staff, investment in infrastructure and providing ancillary services. This need for sharing practice resources, though, often conflicts with how groups make decisions, as well as practice patterns of income and expense allocation. Although successful group practices demand a “group-think” mentality and cooperative culture, often many factors run in contravention with this approach.

Collaboration is a process through which people who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own limited vision. For ophthalmology groups, adopting this mindset can prove challenging.

In the Harvard Business Review article “Building a Collaborative Enterprise,” the authors list four key areas for developing a culture based on trust and teamwork:

• A shared purpose

• An ethic of contribution

• The institution of independent processes

• The creation of a collaborative infrastructure.

Getting there

One of the most important factors in developing a sustainable business model is for groups to invest the time and resources in creating a common identity with a shared mission, vision and values. In the case of groups contemplating a merger, these discussions should take place prior to going through the time, trouble and expense of completing the transaction.

In the case of existing groups, we recommend that the board and leadership team set aside the time to invest in this process. It is one that can prove difficult, as discussions may uncover strained relations between key stakeholders. Thus, having a proper forum to discuss these issues with the “volume in the room” lowered, is critical. This may require the assistance of a third-party facilitator skilled in these matters. Although this adds a layer of expense to the process, it is most often worth the investment.

While many practices invest significant time and expense in developing business strategy and associated tactics, this investment may not yield expected results if the culture of the organization is not healthy or strong. OM

Bruce Maller is president and CEO of BSM Consulting, an internationally recognized health care consulting firm headquartered in Incline Village, Nev. and Scottsdale, Ariz. For more information about the author, BSM Consulting, or content/resources discussed in this article, please visit www.BSMconsulting.com