Pricing, Cognitive Dissonance, & How To Charge More

Your profits are in your prices. Where are the psychological triggers you can use to raise your prices and charge more?

You'd like to be able to charge a premium for your services and rake in the big bucks, right? Then why are so many physicians and clinics utilizing the slow death spiral of constantly trying to undercut the competition and using discounting coupon services like Groupon. Why are some physicians able to charge 50% more for Botox and others are trying to give it away and scrambling for any new patient. Where's the disconnect?

Guess what. It's psychological.

Look, there are only two things that determine ANY price.  Put these lines on a graph.

1. How much you're willing to sell something for.
2. How much someone's willing to pay for it.

That's it. Just those two things, and the second of those is based on psychological triggers more than anything else. (Of course, those two lines cross at some point or you're pricing yourself out of the market and in big trouble.)

As a physician running a cosmetic medical practice or medical spa, when you’re essentially selling time, how do decide where you can set — and then raise — your rates?

Guess what? People actually want to pay a lot.

I learned this as a young painter in New York. My paintings sold between $25,000 and $60,000. Why? It's pretty simple. I wouldn't sell them for less and I could easily get buyers who would pay that amount. I could find lots of buyers that would purchase my work as fast as I could produce it. I had both the skills and business savvy to understand that the quality and uniqueness of my work created the demand and drove up my prices. I didn't just set my prices high. I started by creating a unique niche that I completely dominated; beautiful, realistic women in oil with old world craft. I would never have been able to charge $60,000 for paintings that no one wants and anyone could produce.

Even more, I set myself up as able to demand those prices. Believe me, no one want's to pay $50,000 for a painting. They only pay that amount for a story, and the story is around something that's unique and scarce.

People want to pay a lot for cosmetic treatments.

If you don't know it already, you're in the vanity business. People will pay outrageous prices for vanity. Think of the prices that high end vanity commands; $600 for a felt purse by Kate Spade, $1,150 pumps from Christian Louboutin, the $84,000 Audi A8, the Omega Seamaster watch, any Apple product... The cost is actually integral to the enjoyment.

People want to pay a lot for your cosmetic treatments IF you position yourself correctly AND your treatments are both unique and scarce.

No one wants to pay more for the same coach seat on an airline, but there's obvious satisfaction when someone describes the purchase of an expensive luxury item, even if the price is never mentioned.

If you cater to the lowest common denominator, you'll have to price your services that way too. Specialize in a lucrative niche and your services become not only unique, but scarce as well. Uniqueness and scarcity work hand-in-hand to drive up demand and allow you to raise your rates.

So uniqueness and scarcity are primary ingredients to any offering that want's to charge a premium. We'll deal with both uniqueness and scarcity in other posts. What I want to talk about here is the psychology of pricing and how it relates to your own pricing and your customer loyalty.

Once you have something that's both unique and scarce, you can move on to increasing your prices.

Where's your current pricing?

I’ve met many, many physicians who under price their services.The primary reason that's give is that they have to have low prices to remain competitive in an every more productized marketplace, where every corner has a medical spa trying anything to attract new clients.

This can be true — especially around mass consumer treatments like Botox and laser hair removal — but whatever the reason, charging too little for your services is self-sabotage for two primary reasons:

1. When you don’t charge enough you end up resenting your clinic. You do too much work for too little money. It’s not worth it. (Try to tell me this isn't the primary reason that so many physicians would like to leave clinical medicine.)
2. A low price tells patients that you’re not worth it. It may be all smoke and mirrors in the beginning, but if you want to be perceived as the best, you’d better price your services accordingly. Low prices are THE primary indicator of low quality.

I've seen any number of small clinics where the marketing and pricing plans, if there was one, wasn't well articulated or just rattling around in the physicians head. As a result, these clinics, in an effort to build their own business, underbid services on low quality clients. As a result, they ended up with lots and lots of low fee procedures and special offers. Instead of focusing on high quality premium treatments, these staffs are pushed to get things done as fast as possible to keep the treatments profitable despite the low fees. This poor quality of training, service and oversight leads to mistakes. Clients nitpick and try to get additional discounts or haggle about pricing. Accounts receivable grows. Lawsuits happen. It's no surprise when clients start leaving for the next low bidder to open up shop.

Remember, people value things by price. Just one of the reasons why I’m sitting in Starbucks right now drinking a $4 coffee.  (And no, I don’t think $1 coffee is their best move.)

One of the primary components in positioning yourself is how you price your services.

Price Influences Your Perception Of Quality

As price goes up, so does your perception of quality AND pleasure (satisfaction).

I don't know this for sure but I would bet that 'premium' medical providers are sued less frequently and have higher satisfaction rates than lower priced physicians. It could well be that being the low cost provider puts you at greater risk for lawsuits for a number of reasons. (If you have any relevant information to this, please leave it in the comments.)

A well known study out of the California Institute of Technology and Stanford University details how price influences peoples perception of quality in wines.

Antonio Rangel, an associate professor of economics at Caltech, and his colleagues found that changes in the stated price of a sampled wine influenced not only how good volunteers thought it tasted, but the activity of a brain region that is involved in our experience of pleasure. In other words, "prices, by themselves, affect activity in an area of the brain that is thought to encode the experienced pleasantness of an experience," Rangel says.

Rangel and his colleagues had 20 volunteers taste five wine samples which, they were told, were identified by their different retail prices: $5, $10, $35, $45, and $90 per bottle. While the subjects tasted and evaluated the wines, their brains were scanned using functional magnetic resonance imaging, or fMRI.

The subjects consistently reported that they liked the taste of the $90 bottle better than the $5 one, and the $45 bottle better than the $35 one. Scans of their brains supported their subjective reports; a region of the brain called the medial orbitofrontal cortex, or mOFC, showed higher activity when the subjects drank the wines they said were more pleasurable.

But the experiment was rigged. While the subjects had been told that they would taste five different wines, they had actually sampled only three. Wines 1 and 2 were used twice, but labeled with two different prices. One wine 2 was presented as a $90 bottle (its actual retail price) and also as a cheaper $10 wine. When the subjects were told the wine cost $90 a bottle, they loved it; at $10, not so much.

In a follow-up experiment, the subjects again tasted all five wines but without any prices; this time, they rated the cheapest wine as their most preferred.

Previous marketing studies have shown that it's possible to change people's perception of how good an experience is by changing their beliefs about the experience. For example,  moviegoers report liking a movie more when they hear how good it is beforehand. Studies show that the neural encoding of the quality of an experience is actually modulated by variables such as price, which people believe is correlated with experienced pleasantness.

The results make sense. Your brain encodes pleasure because it is useful for learning which activities to repeat and which ones to avoid, and good decision making requires good measures of the quality of an experience. But your brain is also a noisy environment, and "thus, as a way of improving its measurements, it makes sense to add up other sources of information about the experience. In particular, if you are very sure cognitively that an experience is good (perhaps because of previous experiences), it makes sense to incorporate that into your current measurements of pleasure." Most people believe, quite correctly, that price and the quality of a wine are correlated, so it is therefore natural for the brain to factor price into an evaluation of a wine's taste.

How 'Cognitive Dissonance' Affects Pricing

Cognitive dissonance is that uncomfortable feeling you get when you're holding conflicting ideas simultaneously. The theory of cognitive dissonance proposes that people have a strong motivational drive to reduce dissonance since it causes internal conflict. They do this by changing their attitudes, beliefs, and actions. Dissonance is also reduced by justifying, blaming, and denying. It is one of the most influential and extensively studied theories in social psychology.

I'm not trying to force a psychology degree on you but  it is useful to have understanding some basic underpinnings of behavior and how they affect pricing, such as why critics don't like your favorite wine, and how wineries get away with charging $500 for a bottle.

Have you ever noticed fans almost never complain about lousy music concerts or albums, yet critics frequently give them poor reviews? What's going on? Are critics just inherently nasty?

Maybe, but the fact is that there's a psychological principal at work that's also in effect every single time you exchange something of value (money) for a product or service.

Here's an example of cognitive dissonance at work.

In a landmark study by Leon Festinger and James Carlsmith, seventy-one male students in the introductory psychology course at Stanford University were asked to spend two hours doing a very boring task, sticking wooden pegs in holes.

Participants were divided into three groups. Some were paid $20 (a lot of money back in 1959). Some were paid $1. And some were told they were volunteers and paid nothing. All were told what their payment (or non-payment) would be before they began.

After two hours of what was surely hellish tedium, participants were asked to rate the 'enjoyment' of the task.

So what do you think? Which of the groups ($20, $1, nothing) thought that sticking pegs in holes for two hours was the most fun?

Here's the answer: The group that was paid $1 found the task most pleasurable. The group paid $20 found it the most boring.

Why? Cognitive dissonance at work.

Here's the way that cognitive dissonance is at work in the real world:

1. If you are induced to do or say something which is contrary to your personal opinion, there is a tendency for you to change your opinion to bring it into correspondence with what you have done or said.
2. The greater the pressure used to elicit the overt behavior (beyond the minimum needed to elicit it) the weaker the tendency to change the opinion.

Let's discuss the first point. In the peg study the task was, objectively, tedious and boring, but people who were paid $20 could easily explain to themselves why they did it: they wanted $20. They rated the task as the most boring. People who were volunteers and got nothing could tell themselves they did it to advance science. They found it less boring than the $20 group, but still somewhat boring.

But here's where cognitive dissonance comes in. The people who were paid only $1 couldn't reconcile with themselves why they spent two hours putting round pegs in round holes. Their brain held two dissonant thoughts: "This task is dull" and "I'm wasting my time for a $1." The second statement was 'fixed' and couldn't be changed, so the brain unconsciously modified its belief about the first to decrease the conflict. People decided they were having fun; otherwise they would be fools for doing it at all.

But don't forget the second point; The greater the pressure used to elicit the overt behavior (beyond the minimum needed to elicit it) the weaker the tendency to change the opinion.

This is why the 'soft sell' can be so effective. Using less 'pressure' to elicit the behavior actually results in the strongest tendency for a person to modify their opinion.

Let's apply this lesson to how pricing affects the enjoyment of a product or service.

When you pay for anything; food, Botox, liposuction, or wine — your brain knows the price, and you're pretty sure that you're not stupid. So, if you pay $200 to see a live band and they're all singing off-key, your brain can change its evaluation of the performance to "charmingly gritty and spontaneous" or "incredible live performance". Your subconscious is pushing you to find the experience pleasurable.

But the critic sitting in back didn't pay for his tickets. He's just there to do a job, and his brain knows that. If the concert is bad and he says so, that doesn't make him a fool for going, he's just more objective.

Think about it: How often have glossed over a obvious shortcoming in order to avoid tainting your enjoyment of something you've paid a lot for? I know I do it all the time.

Here's what W. Blake Gray says about cognitive dissonance and wine.

I get a lot of free wine, and I pay for wine frequently also. Even though I'm aware of cognitive dissonance, I still think I'm more likely to give the benefit of the doubt to a so-so wine I order by the glass in a restaurant over a wine I taste in a professional setting. I'm paying for it, I'm no fool, it can't be that bad.

There are several implications here:

1. Why do fans of an expensive wine like it more than the critics? Simple: they're paying for it
2. The more money the wine costs, the more powerful the effect of cognitive dissonance. You can freely diss Two Buck Chuck, but that overripe $60 Syrah? It must have some good points. Many Napa Valley vintners understand the implication of this: Charge more, and while the wine might be difficult to sell, people who do buy it will like it more. Hows that for increasing your customer satisfaction?
3. Why does Robert Parker give higher scores to wines than other critics? To his credit, he is well-known for paying for a lot more wines than any other critic. He chooses what to pay for, he doesn't taste blind, and I submit that even for a man whose palate is as consistent as anyone in the business, cognitive dissonance is at work.
4. Why does wine taste better in the tasting room? There are other factors at work as well, but consider this potential dissonance: "I drove out of my way to get here and chose this winery over its neighbors. Plus I paid a $10 tasting fee." Cognitive dissonance is a good motivator for every tasting room to charge a modest fee. (Sorry, consumers.)
5. Why don't professional critics rush to embrace funky, expressive wines, especially those in niche categories? We don't have to; we don't have the cognitive dissonance of "I paid $12.99 for this no-added-sulfite 'organic wine' and it smells like feet." Mmm, feet.
6. How do the Bordeaux first growths get away with those outrageous release prices -- over $500 a bottle for some? In Hong Kong, people are thinking in Cantonese, "I paid $900 for this wine. And I am no fool. This is so worth it." Cognitive dissonance knows no language barrier.

Cognitive Dissonance & Irrational Customer Loyalty

Of course pricing isn't the only factor we're discussing. Let's talk some cognitive dissonance and how it leads to irrational customer loyalty, just what we're looking for.

In a study looking at why cognitive dissonance with dentists and their patients, Duke University behavioral economist Dan Ariely revealed the probability of two dentists separately finding the same cavity in an X-ray as being about 50%. And often, what dentists think is a cavity, turns out to be nothing. All the more odd, then, that as patients, we’re incredibly loyal to our dentists - more faithful, in fact, than to other medical practitioners.

Why? It's cognitive dissonance here as well. In order to rationalize all of the unpleasant poking, scraping and drilling that dentists subject us to, we convince ourselves that our particular dentist knows best:

"Dentistry is basically the unpleasant experience. They poke in your mouth. It's uncomfortable. It's painful. It's unpleasant. You have to keep your mouth open. And I think all of this pain actually causes cognitive dissonance - and cause higher loyalty to your dentist. Because who wants to go through this pain and say, 'I'm not sure if I did it for the right reason? I'm not sure this is the right guy.'"

(Kinda reminds me of Stockholm Syndrome in which people who are kidnapped actually begin to identify with their captors.)

But cognitive dissonance accounts for more than our loyalty to dentists. It also generating increased revenue for dentists and adding to their profits.

And it increases over time.

Imagine that at some point in your dental treatment, you have a choice between two treatments that have exactly the same possible outcome, but one of them is more expensive to you and better financially for the dentist. Which one would you choose, and how would the duration of the relationship with your dentist be affecting that?

It turns out that the more time people have been seeing the same dentist, the more likely the decision is going to go in favor of the dentist. People are going to go for the treatment that is more expensive but has the same outcome. More out of pocket for them, more money for the doctor. So in this case, loyalty actually creates more benefit for the dentists with no better potential outcome for the patient.

Now, while it may sound like I'm advocating standing on a patients toes while injecting Botox... not so.

There may be some effect of cognitive dissonance at work when you're performing a Melasma or other treatment where there's some pain and downtime, but what we really want to focus on here is how pricing your treatments higher, can actually increase both your patient satisfaction and revenue at the same time.

Does A Premium Price Drive Actual As Well As Perceived Value?

I would say yes in many instances.

Take a look at these medical spa training manuals and you'll see that they're more than a big hardcover at Barnes & Noble, much more. But we deliver on those prices since the quality of the content is so far above what you can get elsewhere. This isn't generic information, it's specialized, and it's valuable.

The medical spa staff training manuals are priced where they need to be to make the creation and distribution profitable enough that it's worth creating AND creates an incentive for buyers to actually use the information. Some of the most successful medical spas and cosmetic clinics around are using these training manuals. Do you think that someone who's at all serious about their business thinks anything at all about dropping $300 on a product that can optimize their operations and train their staff? Are you kidding?

Sure, I could give all that stuff away. Perhaps there are those that think that I should. This isn't for them. We give away 99% of everything for free already, but real products that give you the most benefit aren't valued if they're free.

It's not about information. It's about motivation. Paying a premium for them actually gives you more value... and pleasure.

Clarity

Look, you know more about your own situation than I do. I'm not trying to convince you to raise your prices if you can't support it, but hopefully you've got something to think about. There's a lot of obvious, anecdotal and researched evidence that shows that higher prices will make you more money and make your patients happier... but pricing is the second step. Creating a service menu and reputation that is unique and scarce is step one.

Pricing is one of the things that all physicians and medical spas struggle with. It is one of the handful of items that actually dictate how much money your clinic will make and where your profits are.

One last point: You've been reading this post for something like 3 minutes now. Isn't this the most interesting blog you've ever read? Please tell your physician friends. They're no fools either.

References

Marketing actions can modulate neural representations of experienced pleasantness published January 14 2008 in the early online edition of the Proceedings of the National Academy of Sciences.

Cognitive Cinsequences Of Forced Compliance Leon Festinger & James M. Carlsmith First published in Journal of Abnormal and Social Psychology

William H. Cummings, M. Venkatesan (1975), Cognative Dissonance and Consumer Behavior: A Review Of The Evidence in Advances in Consumer Research Volume 02, eds. Mary Jane Schlinger: Association for Consumer Research, Pages: 21-32.

The Gray Market Report, Why Expensive Wines Taste Better: Psychology 101 W. Blake Gray

Cognative dissonance on Wikipedia

Assembly Line Medicine & The Patient-Doctor Relationship

By Kenneth A. Fisher, M.D.

The latest data from The Organization of Economic Cooperation and Development is for 2008.

At that time the United Kingdom spent 8.7% of gross domestic product (GDP) on health care while the United States spent 16.0%. The amount spent in U.S. purchasing power parity dollars in the United Kingdom was $3129/person compared to $7538/person in the United States. The disparity in the amount of GDP spent on health care between the U.S. and other industrial countries is similar. A recent Rand Corporation study documents that this imbalance in the per-cent GDP devoted to health care has a negative impact on the U.S. economy and jobs.  Furthermore, this impact will become more evident when per-cent GDP for health care in the U.S. reaches 20% or more.  Unfortunately, the Chief Actuary for the Center for Medicare and Medicaid services predicts that per-cent GDP devoted to health care in the U.S. will exceed 20% when our new health care bill reaches fruition in 2014.  This is an issue of concern for many thoughtful Americans. In the U.S. in 1940 health care accounted for 4.5% of GDP, increasing to 12.2% in 1990 with an estimated 18% for 2010. Why has American medicine become so expensive compared to other countries despite having such a negative impact on the health of the economy?

I submit the major reason is the downgrading of the previous close-knit relationship between the doctor and patient. The causes for this are multiple, but the largest factor is the physician reimbursement schedule for Medicare and Medicaid. Medicare as the largest insurer in the U.S. drives private health insurance reimbursement rates. Initially Medicare adopted a Blue-Cross-Blue Shield (BCBS) payment schedule. BCBS was founded by surgeons and its payment schedule was procedurally oriented.  The Congress of the U.S. probably more than in other countries is heavily influenced by commercial entities and sub-specialty physician groups, both of which emphasize payments for technology and procedures. In 1992 Medicare adopted an even more complex system of reimbursement, Resource Based Relative Value Scale, which again favors technology and procedures.

The result of this 50 year odyssey is insufficient reimbursement for doctor-patient interactive time.   This decreased time has led to assembly-line medicine. Many if not most physicians in the U.S. spend about ten minutes face to face with a patient during a visit. This is grossly inadequate; core skills atrophy.  History taking and physical exam skills of many perhaps most physicians in the U.S. are inferior to those in Great Britain. Recently some prominent American physicians have commented and written about this problem (i.e. Dr. Abraham Verghese), but no formal rectifying action has taken place.  As confidence in and time for history taking and physical exam skills diminish, reliance on technology increases.  As patients consult with multiple physicians there is little coordination and care suffers.  As hospitals and pharmaceutical companies advertise, patients become less influenced by the decisions of their primary physician. As the trust relationship dwindles, patients are more confused as to the appropriateness of care, especially in end-of-life situations.

Congressional attempts to control spending, with the ever present lobbyists have only exacerbated this problem. One group, trial attorneys, seem to have an undue influence, increasing defensive medicine.  We seem to be in a deteriorating cycle, more assembly line medicine, less reliance on human skills, greater costs leading to more assembly line medicine and so forth. One could ask, “Where are the medical societies, why don’t they speak out about this issue?” I believe the answer is that our societies are looking at short term gains, see themselves as just another lobbying group and are afraid to impact the income of some segments of our profession.

In my opinion the U.S. must provide universal coverage at about 15% of GDP. This means that the documented approximately 30% of care that is non-beneficial, costing about $700 billion/year must be addressed and significantly decreased. This can only happen if physicians combine their efforts to dramatically improve the patient-doctor relationship by insisting on an increase in funding for patient visits, while working together to control non-beneficial activity. Being a physician is a person-to-person relationship involving humanity, judgment, knowledge and skills.

Signature: Doctor Fisher is a board certified Internist and Nephrologist. He has published many scientific articles and is the author of, In Defiance of Death: Exposing the Real costs of End of Life Care (Praeger 2008). Recently he published an electronic book, The Ten Questions Walter Cronkite Would Have Asked About Health Care Reform. He blogs at www.drkennethfisher.com 

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Physician Career Transition is a Process, Not An Event

Remember that old saying from Ralph Waldo Emerson about how life is a journey, not a destination?

Well, the same can be said for successful physician career transition.  The process can be as important, if not more important than the end result.  True!  End results will change and evolve ... but without careful consideration of the steps required to make a sustainable career change, the direction you take may not be the right one.  I've seen this lead docs into repeated unsatisfying attempts to move into non-clinical environments ... and has the propensity to end up convincing them to stay right where they are, resigned to being unhappy in the work they've chosen.

But this doesn't have to be the case.

The tricky thing is, by the time that most physicians have made the mental and emotional decision that they want to leave clinical practice, they become impatient to act.  Sometimes their drivers are purely negative ones:  they're burned out, frustrated, they want to escape what medicine has become and their place in it.  But more often than not, I see the drivers that really get them going are the positive ones:  they are excited by the potential opportunities they see, directions that they can take their medical knowledge in, possibilities for doing something bigger.

The problem is for some docs (at least some of the ones who call me), is that they see the possibilities and they want to do it now.  I'll never forget a mid-career physician who contacted me in July and decided that he wanted to be in a new, non-clinical, non-healthcare related role by January ... could I help him make that happen?  After speaking with him at length, I could respect and admire his enthusiasm and his desire to get it done ... but I had to give him the major reality-check that this just would not, could not happen in the timeframe he desired.  There were some critical things that he would need to do first.

Unfortunately, too many physicians considering non-clinical jobs (like my caller) only keep their eye on the finish-line.  With a vague idea that a particular job might be interesting of "something they could do", they forge ahead.  They skip going through the process of stepping back... that is, making sure that the desired job / industry / career is a good fit for them, making sure it will provide them with their "must haves" for fulfillment, and assessing whether they could be successful doing it.

And this process of stepping back takes time.  But it is worth it.

Successful career transition - particularly when you're moving from a highly specialized field into an industry or role that requires a significantly different skill set (most non-clinical jobs!) - takes focus, effort, money, and yes, time.  It is a process that requires moving through a series of critical phases to ensure that you are setting yourself up right.  The last thing you want to do is dive into a new career, taking your family along with you, only to discover a year or two later that you're as unhappy as you were in clinical medicine.

To ensure sustainability, success, and overall happiness with your choice of "next chapter", you  need to ensure that the change you are making fits you, that you are comfortable with your skills/expertise and the value you bring, and that the market has a need and recognizes your value.

So how do you do this?  You start by paying attention to the process.  You start from the beginning.

Get Introspective.  You may think that you know what you want, who you are, and where you need to go to be happy and professionally fulfilled.  But do you really?  Until you have truly taken the time to dissect some of these things, it is easy to miss some very critical truths about yourself that may impact the direction you decide to take.  Inventory your values -  not your professionals ones, not stewardship and teamwork and all that, but your personal ones.  Really clue into what motivates you, and what makes you tick.  This may take some deep, personal work.  Prioritize your values, and figure out how well-aligned your current professional life is to them.  You may find that there is a significant disconnect that is fueling some of your discontent.  Start to explore and research work that aligns better to what matters to you as a human being.  

Go further to figure out exactly what you bring to the table by sifting back through all of your past experiences and identifying the skills (healthcare and non-healthcare related) that make up your unique value proposition.  Find your specific leverage points - those particular skils/experiences that can launch you towards your next career.  Research where you could best fit the needs that are out there.  Figure out what your "optimal job" characateristics are and prioritize them.  Compare any potential opportunities to that list of must-haves and be honest with yourself.  Make sure you understand and honor what you truly need to be happy and fulfilled in your next career.

Too many physicians want to skip this introspective work and start developing their resume.  It is true that resumes are a critical part of the career change process, but they are not where you start.  Until you really understand your unique value proposition and your unique direction, building your resume at this point is premature.

Introspection is a critical component to professional fulfillment.  You can't start in the right direction without truly knowing what the right direction is.  Once you've figured this out, you can begin to see what your finish line might be - the right one for you.  All subsequent steps in the career transition process - exploration, preparation, acquisition, and finally transition (thanks to Dr. Michael McLaughlin and his book "Do You Feel Like You Wasted All That Training") - will go much more smoothly if you know that you are moving toward a goal (job) that will be what you need when you get there.

Lastly, recognize that moving from one career to another will not be a linear process.  It will have its stops and starts, and sometimes it will circle back.  But as long as you know that you are going in the right direction, you will be making progress toward your goal and venturing toward the best finish line for you.  And that is what matters in the long run.

So to get started, get to know yourself really well. You might be surprised what you learn.

On Being A 'Real Doctor'

Have we created a system that is more 'careless health' rather than 'health care'?

A medical colleague of mine recently shared the below video with me that strangely struck a chord. Trust me...it's worth 4 minutes out of your life to view.

Sadly, in my opinion, there is some truth to the narrative.

Have 'real doctor's' become so out of touch with reality? Are we nothing more than mere paper pushers? Is direct patient care nothing but a faded memory?

I would argue that without a unified and experienced voice -- OUR voice -- we risk such an outcome.  The real doctors become 'Watson' like figures while everyone else shuffles electronic paperwork to keep the system afloat. While I realize this is a polarized stance, my purpose in sharing this entry is to stir and excite this health community to take action.  As I am sure it comes as no surprise to anyone on this thread, our ailing health system is plagued with inefficiencies - which only means it is equally ripe with opportunity. But who is going to answer this call-to-action? Are we to assume that our non-health professional counterparts are looking out for our best interest?  My experience tells me - not likley!

Having sat on both sides of the table, we as diversified health professionals, need to be an integral part of the conversation.  Although I am relatively new as a contributor to the group (but longtime follower) I tip my hat to the authors, members, and voices on the FreelanceMD network.  Many of you, including myself, have taken the leap out of direct clinical care to try and help fix this mess.  This is clearly a group of doers, not just talkers.  I observe that together we make up a diverse set of skills and health backgrounds that can clearly make an impact. Lets take advantage of that.

At its most vulnerable time in medical history, I argue that our health system NEEDS people like us. We are not a luxury, but a necessary voice to help spur & drive innovation in health care so that, one day, we can all be proud once again to say we are 'real doctors'.

Want to continue the conversation? Join me in my pursuits for leading health innovation!

Cheers,
Gautam

Physician Leadership in Driving Culture Change

Getting your organization aligned with your vision and plan

Whether you are a physician leader in industry or clinical practice, you know you need to get your organization to a new place.  The way everyone in your organization works, thinks, and behaves may (or may not) be okay—but to achieve your aspirations for the future, you are going to need a better approach.  Your challenge is to move your organization from where it is today—to where it needs to be in the future.   And you need to do it before the future runs over you like an avalanche. 

No matter where you wish to take your organization, you will need the support and commitment of your colleagues—if you are to succeed.  However, getting your people unstuck—getting them not only to embrace your vision, but to change the way they work and think to achieve it—is often more challenging than defining the goal or objective. 

The key to achieving meaningful change in your organization is to align every thought, action, and behavior (the expression of an organization’s culture) with a clearly defined and well-communicated vision.  While this can seem to be a daunting task, you can achieve alignment if you break the process down into manageable steps.      

Know where you want to go

The first thing you need to do is be clear.  Create your leadership team and mutually define where your organization is going and why.  Work with this team to clearly and unambiguously justify the decision for change.

Avoid the “anywhere but here” cop-out

Clearly identifying and communicating the need for change is not the same as knowing where you want your organization to be in the future.  Some leaders initially convey their objectives in terms of what is not working in their organizations today.  The focus should instead be on where you are trying to take your organization.

Once you start the “makeover,” people need to know where they are going if they are to focus their energy and sustain the momentum.  Otherwise, they will continue to drift or, even worse, return to the old ways you are trying to escape.

Your team: don’t leave home without it

There is probably no group in your organization more emotionally invested in the old ways than your leadership team.  The process of getting this team fully committed to a shared vision can be messy and slow.   If the team is not on board regarding the vision, the rest of the organization will be left in the dark regarding the direction and benefits of future change efforts.

If your leadership team is not aligned with your vision, you either have the wrong vision, the wrong team, or you have not effectively communicated your perspective.  In the early stages, some will line up along one side or the other.  Focus on those in the center; this is where the leverage for change lies.  If you can move the majority of these team members to your point of view, the few on the other side will either move to the middle or move on.

Use the vision as a filter for decision-making

Ideally, your vision—along with other descriptors, such as the mission (or purpose) and values of the organization—would serve as a template or “filter” for making decisions.  Some refer to this as the “social architecture” of the organization.  What’s important, however, is not what you call it—but how you use it. 

The description of your organization’s future goals and plans is critical; it is the highest level template for the many decisions made in your organization every day.  The most effective models are clear and concise statements that can be fleshed out with open dialogue to ensure that everyone shares the same understanding of their meaning.

Create, communicate, and translate

The process of establishing a clear vision and direction for your organization is as much about internal communication as it is about planning. The challenge is not in formulating a vision; it is in making it meaningful to everyone in your organization every time they must make a choice.

Communicating your vision is as important as the vision itself—and believe it or not, you cannot over-communicate your vision.  A well-communicated but poorly translated vision is just noise.  On the other hand, a well-communicated and well-translated vision has a good chance of influencing behavior.  Many of the vision statements on plaques on waiting room walls probably don’t lend themselves to easy communication and translation.  Because your vision is the heart of your change communication strategy, it must be crisp and concise.  There can be a lot of supporting language, but the statements themselves—and what they stand for—should be accessible to everyone in the organization for every decision that needs to be made.  

If you aren’t going to measure, then don’t bother

You’ve heard it before: “what gets measured gets done.”  It’s still true.  An effective measurement system that scans both the lagging and leading indicators should become the framework for managing change.  It can also allow for course corrections.   Since you can’t make every decision yourself, your measurement system will become one of you most critical tools for communicating what is important—and should be considered in every decision. 

The best measurement systems are those that are simple and have the most impact.  After clarifying the desired destination, the leadership team creates a “dashboard” of the few, critical performance indicators.  This provides a framework for monitoring the progress of change and making course corrections as necessary.

Some management teams tend to focus on a litany of financial measures.  While financials are important, they are also retrospective—like looking in your rear-view mirror.  They can only tell you where you have been, not necessarily where you are going.  It’s also important to ensure that these measures are cascaded and aligned throughout the organization.  So, if what gets measured gets done, then what’s getting done must be aligned with what you are trying to achieve. 

Stop talking about change

Getting everyone to align their behavior with your vision for the future usually means they will need to change, at least in part, the way they work and think.  And most people seem to resist change.  But then, what they  really resist is the loss of control over their work lives—and the resulting uncertainty about the future.

If this is the case, then it is not a stretch to figure out how you, as a leader, can help your people begin to retool and regain control.  Of course, the starting point is an effective two-way dialogue.  Present the case for change in such a way that helps everyone envision the future while developing a picture of their role in it.   

As physician leaders, we need to stop talking about managing change—and focus on helping our organizations reestablish control over their lives.  If we could do this, the challenge of aligning our organizations becomes much less formidable.

Dumbing it Down is Downright Disrespectful

It's not uncommon that someone will make a comment to me about how we (physicians) need to "dumb it down" when it comes to publishing information for consumers. 

In fact, this is exactly the wrong approach when you are trying to reach people with important health information.  Instead, what we need to strive for is a smart translation of medical science. 

While it's true that people who are not in healthcare likely won't understand a highly technical medical research study (just as doctors probably wouldn't understand a complicated document in another industry), what isn't true is that our patients, readers and consumers need to have information "dumbed down."

A smart translation means that you are approaching your reader with respect for his or her intelligence and knowledge.  Dumbing anything down is just plain disrespectful.  Attitude comes across the written page and seeps into the "take home messge."  A respectful attitude means that readers are more likely to consider the information presented.  Perhaps to heed the advice and even to share it with others. 

Bottom line: everything that physicians write and publish should be done with the goal of offering a terrific translation for a given audience.  I think about this a lot.  When I don't get it right, it isn't because I dumbed my communication down.  I just didn't quite nail the translation.  Great translations aren't easy, but they are incredibly effective.  Offering important health information along with respect is what we should all aim for all of the time. 

I Know What Kind Of Experiences I Will Want My Patients To Have.

By Isaac van Sligtenhorst

I know what kind of experiences I will want my patients to encounter.

We wait.....and wait......and wait in the Clinical Trial department.  Finally, someone whom we presume is the research coordinator, as she fails to introduce herself, enters the room.  My brother did not get into the PI3K inhibitor clinical trial as the company had temporarily halted enrollment.  She starts going into a potential alternative clinical trial for my brother.  She starts spouting off words like 'Bendamustine' and 'Avastin' and then asks if he has questions.  Really?  Short of someone with training in oncology, what person is going to know what these words mean, much less if these are good drug options for him?  I ask for some basic enrollment questions and she's not even up to speed on the specifics.  Great.  She leaves (thankfully) and we wait for the doc....and wait.....and wait.  Nearly three hours after our appointment time, the doc walks in, sits down, and the first thing out of her mouth is, "do you have any questions for me?"  I can hear my brother's frustration as he tries to wrap his brain around what in the world is going on.  We showed up early that morning so he could get bled to determine if he'd be eligible for a PI3K clinical trial.  Now we have a Plan B thrown out there with absolutely no background given and the doc is asking for any questions.  Fine.  I've got one.  "I thought avastin was contraindicated in squamous cell tumors.  Can you please comment on the risk of hemoptysis in combining avastin with a cytotoxic agent in the context of a squamous cell morphology?"  No?  Then please go do your homework first before entering into the room.  I understand this doc was covering for another but have the professional courtesy to at least glance at the chart before entering the room.  Walking in with no prior knowledge of the patient's diagnosis and status just isn't helpful at all.  At least review the bloodwork, but no, we didn't even get that.

Experience #2

Again, we wait.....and wait.....and wait.  This time it’s for Supportive Care to review my brother’s pain management.  The wait is not quite as bothersome because A) we didn't have an appointment and it was only through their kindness that they agreed to squeeze my brother in and B) there's a comfy bed for my brother to snooze in.  But still we wait.  The nurse comes in and he gathers the basics.  Back to waiting and the nurse quickly peaks his head in.  My mom asks, "any idea how much longer it's going to be?"  Just a few more minutes.  The doctor is reviewing my brother's chart.  What a novel concept.

He comes in and begins the usual, "tell me what's going on."  My brother has to be sick of repeating his story hundreds of times over and I suppress the urge to give a quick medical review of him to save time but I know the doctor needs to hear it from the patient's mouth.  From his accent, I can tell the doctor is Canadian, eh, but I don't hold it against him, eh.  He is soft spoken, calm, patient, and attentive.  My brother asks him some questions.  I ask some.  And my mother asks some.  He thoughtfully engages each one in turn, draws diagrams to help explain his logic, and gives firm answers when necessary.  He is clearly in charge of the situation and carries a certain degree of quiet confidence (reviewing the chart helps, too).  But most importantly, he has the presence of mind to look at my brother's pain management thus far, looks at the severity of pain being experienced and says, "this obviously isn't working.  Are you game to try something different?"

I know what kind of experiences I will want my patients to encounter.

About: Having spent nearly 15 years at the bench in drug discovery, Isaac van Sligtenhorst now helps his dad and brother walk through their fights against cancer, while during his spare time he is currently attending med school at UT Health Science Center in Houston, Texas. He blogs at
http://heartofalonelyhunter.blogspot.com

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