ADVISORY e-ALERT     July 29, 2010
Advisory Law Group, a Professional Corporation
It's likely that you're familiar with the term "glass ceiling," used to describe the situation in which systemic factors within an organization hold down women and minority group employees from advancing beyond a certain level. 
Diagramed, a glass ceiling looks like this:
The Glass Ceiling
The Glass Ceiling

There's a far lesser known, but equally invidious, braking mechanism being applied to success - self applied - within many medical groups.  This mechanism manifests itself both at the group and at the physician level.  I call it The Stall™; it's the complacency that often comes from thinking that you've "arrived."
The Stall
On the medical group level, consider the case of Community Group, not its real name, a physician group with an exclusive contract for hospital-based specialty services.
Community Group had recently signed the fourth consecutive three year renewal of its exclusive contract with Memorial Hospital.  Income was good; in fact, the group's physicians placed within the top percentiles on national and regional compensation surveys.  The group's leaders were content not to expand the scope of the group's services beyond that one facility.  In general, they believed that there was little for them to do in terms of management.  After all, they thought, they had built up a very profitable practice over the course of more than a decade, all in conjunction with their excellent relationship with Memorial.  As a result, the group leaders devoted their attention chiefly to patient care concerns alongside the rank and file members of the group.
Six months before the end of the renewal term, Community Group's leaders were completely stunned to learn that the hospital had chosen not to renew the deal.  The administrator announced that he would issue an RFP and that a group providing services at another local hospital had announced its intention to obtain the agreement.
Shifting to the individual level, The Stall manifests itself in several different ways.  One particularly common example is that of the physician who joined the group as an employee or subcontractor several years ago and who worked hard to become a partner or shareholder.  Once having attained an ownership position, he now believes that he deserves his position - in his mind, partnership does not involve a continuing obligation to deliver; rather, it is an entitlement position providing a cornucopia of rewards.
Like the glass ceiling imposed by others, the self-imposed plateau of The Stall prevents its victim, group or individual, from making further progress.  The solution is to find a way to break though that ceiling:
Avoiding The Stall
Avoiding The Stall
Avoiding The Stall
In broad terms, avoiding the stall requires close attention to the mindset that no single point on the progression from here to there represents the point of final destination.  The final destination is like the horizon - an idea (or an ideal) that is itself not accomplishable.  Accordingly, no matter what the accomplishment (the first contract with the hospital or the 10th renewal term, expansion to serve five facilities, board certification, partnership, $1 million annual income, etc.) it's but one stop on the way to a bigger envisioned future.
Business, for the group, and career, for the group physician, must be seen as a continuous process, not as a finite series of steps to completion.
For the Group
On the group level, this means that operating your business requires a continuous process of examining and resetting your strategic goals in synch with your changing observations of the competitive landscape, and then aligning tactics to accomplish those goals, only to then continue the process, reexamining and resetting strategy and realigning tactics.
In a sense, this is an expansion of Col. John Boyd's OODA loop (Observe, Orient, Decide, Act), with your evolving strategy used as a filter within the loop.  In Boyd's battle, the competitor who can consistently and effectively cycle through the loop faster gains an ever-increasing advantage each cycle.  The slower competitor falls farther and farther behind and becomes increasingly unable to cope with the deteriorating situation.  Each cycle, the slower competitor's actions become less relevant to the true situation.
Conversely, and as the impact of The Stall, unless your group continuously evolves quicker through the strategic operation of this process, your competitor (for this purpose defined as an actual competitor providing the same service, the hospital itself, or any other third party, depending on the circumstances) will get "inside your loop" - that is, in the original context of Boyd's thinking, the aerial dogfight, in a position to shoot you down.
For the Group Physician
There are Stall avoidance tools for the individual physicians within the group, both at the personal and at the medical group level.
Theoretically, at the personal level, a physician should adopt the never ending journey mindset in which each achievement is not a destination, but is a stepping stone in the direction toward the unreachable ideal.
That said, it is usually more effective for the group to impose tools on the individual physician than it is for the physician to police his or her own outlook.  For example:
Groups must develop a culture that drives home for each physician member the importance of a process of continual improvement at both the group and the individual levels.  This involves both intragroup education and training as well as "hands on" experience.
Groups can adopt seniority structures other than non-owner/owner.  For example, they can employ an equity model incorporating multiple levels of partnership class.
Groups can incorporate more physicians, both promising candidates for partnership and recently admitted partners, into the group's strategic planning process to infuse them with the sense that the group, and therefore they, must continue to make progress.
Groups can include partnership track employees/subcontractors as well as newer partners on the entity's other administrative committees to enforce this same, constant goal seeking mentality.
In addition to outsmarting your competitors, in order for your medical group to thrive, you need to release it from the impact of the internal brakes, The Stall, placed on its success from within, both at the group and the individual physician levels.
For information on how Advisory Law Group's process, The Strategic Group Process™, can help you accomplish this, contact Mark F. Weiss now. 


Accountable Care Organizations:  Accountable to Whom?, published on on June 10, 2010.


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