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Passion, People and Principles

Medical Practice as a Professional Service

post # 478 — December 19, 2007 — a General post

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

“I just read the excerpt from your book 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?


Ed Kless said:

In terms of being knowledge workers and customer service, I can see the jump. However, because of the lack of a true open market (third party billing, restrictions of HMOs, etc.) I think it gets a little sticky.

Two great lessons from the medical field:

  • Don’t prescribe before diagnosing (they call it malpractice, for many PSFs it is standard practice)
  • Don’t bill by the hour (you knew this was coming, I from VeraSage)

posted on December 19, 2007

Shama Hyder said:

Hi David,

Aside from the professional billing rules, I think the gap is very easy to close-at least in terms of marketing. Our company works with professional service firms, including medical practices, and there is no glitch in terms of industry when it comes to applying the principles.

posted on December 19, 2007

Paul Shillam said:

Yes, health care is complex. What the industry needs are some fresh insights to help organizations lead and manage change to achieve their missions. Drawing from your experiences in helping other organizations examine the fundamental strategic assumptions as outlined in Managing the Professional Service Firm. Health care organizations need to develop “a set of actions that will make the firm’s services more valuable to clients than the services of competing firms.”

In addressing this topic, you wrote in True Professionalism that ways for firms to develop more value include:

  • Provide professioinals with the benefit of shared skills and experiences within the practice group.
  • Back up the professional with investments in shared tools, methodologies, templates, research, etc.
  • Facilitate the access of skills of other in different disciplines.
  • Establish procedures to produce well-trained junior professionals.
  • Achieve high level of referrals, cross-selling, and access to clients of other professionals.
  • Provide superior support staff and systems (including technology), to facilitate conduct of the practice.
  • Instill a system of supportive, but challenging, coaching to bring out the best in each professional, senior and junior.
  • Create an emotionally supportive “collegial” environment.
  • Establish a powerful brand name that makes marketing easier.

These work equally well as guidelines for health care interaction of providers (consultants) with their patients (clients). In reviewing the list, all are applicable to health care.

In your other books, you discuss the importance of relationships and developing trust. These are vital to servicing patient needs and health care organizations can lose sight of this.

Those are just a few of my thoughts on how you could engage in this area.

posted on December 19, 2007

Mike DeWitt said:


Aside from the vagaries of the prevailing “alternative billing” practices in the healthcare industry, all of the lessons in “Strategy and the Fat Smoker” apply to medical practices.

I would love to see the industry seriously address the issue of client relations and the expert/advisor issue. Too many current policies and practices are designed to optimize the economics of expert/patient transactions as opposed to advisor/client relationships.

Recent studies in the area of geriontology show that this is particularly painful and costly in the end stages of life, where most of our healthcare money is spent.

The healthcare industry needs you, David!


posted on December 19, 2007

Francis Egenias said:

there is even a view that MDs are the best service marketers.

in his book “The ‘I Hate Selling’ Book” Allan Boress uses a physician as the best role model for a marketer of professional services. he said a physician is often successful in selling additional services to existing patients, without ever sounding, acting or looking like sales people

posted on December 24, 2007

Brian Tingley said:

Others have mentioned the billing issue, but I would pay a fee up front to have email access to my health care provider. If I can get a question answered by a nurse or practitioner, why go through the hassle of a trip to the office? I don’t have the ability to forecast a couple months ahead for an appointment. There is an average of 55 days wait time for an appointment in America. I can see my lawyer, accountant and other service providers faster than that – why not my doctor?

The medical profession needs to emulate Toyota’s Lean Production System. The first and primary principle in Lean is to eliminate waste. In the doctor’s office, the appointment backlog is their inventory, and it’s 54 days of waste. Doctors think that things like supply and demand don’t apply to them, but they are no different than any other service provider or manufacturer. They produce a desired outcome for a customer.

posted on December 26, 2007

Barbara Bix said:

Hi David,

It has been my experience that professional service marketing best practices most definitely apply to medical practitioners. In fact, I recently wrote an article entitled “Why Marketing 101 Lessons Still Prevail: A Case Study that discusses how a hospital-based subspecialty practice used professional service marketing best practices to increase referrals from surgeons by 25% in 6 months (read it at http://www.bbmarketingplus.com/articles/RT_3-2007.htm) That said, as another commenter notes, not every medical practice wants/needs to/can increase its business. The “translation” works and the doctors may be receptive but receptivity may not be the relevant issue. One of the key differences between physicians and other health care service providers is that their billing rates are fixed. Most can only bill as much as they have hours in the day and many practices are at capacity. Here are a couple of exceptions: practices that can use technology to leverage their time and/or practices that can get patients to pay out of pocket for their services (such as reproductive endocrinologists and plastic surgeons). In addition to using professional service best practices to increase referrals, I’ve also used them to recruit new physicians to a group practice or to target patients interested in particular services.

posted on January 4, 2008

david (Maister) said:

Thanks, Barbara

posted on January 4, 2008

Ambulance Nurse said:

It’s a pity but I haven’t such experience. But I find out lot of curious details from previous comments.

posted on January 10, 2008

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posted on June 11, 2008