Dear Doctors, What are Lead Measures and Lag Measures [in your practice]?

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At the 2019 Concierge Medicine FORUM hosted by The DPC Journal’s sister publication, Concierge Medicine Today (CMT) in Atlanta, GA USA (Oct. 24-26, 2019)

Lead measures are a Doctors best friend. So for most Physicians in Membership Medicine (or some form thereabouts), you want to serve a Patient by providing a subscription-based healthcare service that will help a certain amount of people (lag measure). However, it’s impossible for you to measure that immediately. So instead, you may want to measure the amount of hours that are being worked towards achieving that goal (lead measure). So forecast your lag measures in your business planning (about every year or sometimes quarterly) and then find out what your lead measures are and then get to work helping patients!

By The DPC Journal Editor-in-Chief, Michael Tetreault

This won’t surprise you … but it should rattle you.

Still today, the number one reason why Patients leave a Doctor they’ve known or seen for years or even a few months is due to staff.

Staffing is such a critical and important part of a Doctor’s office for so many reasons. Mainly, they help YOU, the Doctor, do what you do best by fulfilling duties each day or week that you might not want or have the capability to do.

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Whether we like it or not, even membership medicine offices and yes, even direct primary care (DPC) clinics are held to a higher standard of service and performance by patients and people who are now expecting something entirely different from you, your facility and yes, even your staff.

Performance Standards for your employees inside your subscription-based medical office are the heartbeat of the job description for your current staff and new hires. They describe the what’s, how-to’s, and how-well’s of the job your employees are doing now and in the future. They are important to you because you can fallback on them for measurement and accountability. They forecast the level of service and responsibilities you expect when you check-in with your team.

Each of your performance standards should state three things about the employees job:

  • What the employee/staff member is to do;
  • How it is to be done; and
  • To what extent it is to be done (how much, how well, how soon).
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As a Doctor and now business owner, a lot of pressure now falls flat your your shoulders. You carry the burden as the CEO/Physician now in this space when a staff member incorrectly bills a patient too much or a team member has an unfortunately brash conversation with a Patient. It all falls on you at the end of the day.

We see that many Doctors omit the job description when bringing on new medical and practice team members. Doctors often times put too much emphasis on a potential staff members history and where you’ve worked and where you got your education vs putting time into writing a good job description BEFORE you interview the potential staff person. Not only are job descriptions a valuable tool in the recruiting and hiring process, but they also provide you with a list of the weekly, quarterly or even daily duties and responsibilities of what each employee is to do for patients. But, a job description using performance standards is much more useful than a simple explanation of duties or qualifications.

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Anatomy of a Membership Medicine (includes Concierge Medicine models and Direct Primary Care models) Staff Performance Standard

  • Job classification: Front Office Manager
  • Type of work: Scheduling, records updates, phone calls, and public relations with patients
  • Performance Standard: The Front Office Manager will help patients when they arrive and answer questions with 100% accuracy using our internal standard of business procedures.
  • How this looks on a day-to-day basis: The Front Office Manager may encounter the following and will …

Mary Massad, Director of HR Product Development for Administaff says “When it comes to job descriptions, flexibility is the key. It may be wise to create more generic job descriptions that emphasize expectations and accountabilities, rather than specific tasks, thereby encouraging employees to focus on results rather than job duties.”

Once employees and your medical staff know what to do and how to do it, they can concentrate on improving their skills. Improved skills helps improve communication with you and with Patients.

Performance Standards Set Healthy Boundaries and Improve Morale in the membership medicine practice.

At the 2019 Concierge Medicine FORUM hosted by The DPC Journal’s sister publication, Concierge Medicine Today (CMT) in Atlanta, GA USA (Oct. 24-26, 2019)

A performance standard can reduce conflict and misunderstanding in your practice as well. Which as we know, not every employee will get along with you, their team or Patients 100% of the time. Everybody knows who is responsible for what. Every Patient understand that the leadership of the medical practice rises and falls squarely on YOU, the Doctor. You’re responsible for the actions of your team. You’re responsible for their morale, their communication tools and if it’s not right, Patients want YOU to fix it.

Employees and your team know exactly what parts of the job are most important to you. They’ll learn what you want over time. They know the level of performance you expect in each position of the practice ONLY if you set healthy boundaries early on in the process using clear, thorough job descriptions with good performance standards built-in.

What are lead measures and Lag Measures?

Well I’ll let the extract from Deep Work by Cal Newport speak for itself:

Lag measures describe the thing you’re ultimately trying to improve. For example, if your goal is to increase customer satisfaction in your bakery, then the relevant lag measure is your customer satisfaction scores. As the 4DX authors explain, the problem with lag measures is that they come too late to change your behavior: “When you receive them, the performance that drove them is already in the past.”

Lead measures, on the other hand, “measure the new behaviors that will drive success on the lag measures.” In the bakery example, a good lead measure might be the number of customers who receive free samples. This is a number you can directly increase by giving out more samples. As you increase this number, your lag measures will likely eventually improve as well. In other words, lead measures turn your attention to improving the behaviors you directly control in the near future that will then have a positive impact on your long-term goals.

Finally, remember that there’s no such thing as a perfect staff member or employee. Grace and understanding is just as important as a leader as it is to be consistent using  performance standards to reduce or eliminate low productivity and high turnover. When your membership medicine practice employees are told clearly early on what to do and you’ve set expectations and methods of measurement you expect them to report to you early, they are learning and taught how to do their job, on-paper, on purpose. Doing this they now know how well they need to do and are doing because there is a standard of measurement which you evaluate as their employer to monitor their effectiveness in that position.

At the 2019 Concierge Medicine FORUM hosted by The DPC Journal’s sister publication, Concierge Medicine Today (CMT) in Atlanta, GA USA (Oct. 24-26, 2019)

As a Membership Medicine Physician, you can also help and support them with additional conferences, seminars, training or service coaching when standards are not being met as you’d like in the practice. All this makes for much better relationships between you and your co-workers.

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