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Mon 6 Oct 2008 04:00 AM

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Starting with style

In the final instalment of the series, Medical Times discovers how to apply the finishing touches to a new practice before opening for business.

In the final instalment of the series, Medical Times discovers how to apply the finishing touches to a new practice before opening for business.

For many physicians, launching a medical practice will be the defining moment in their career. Leaving behind a regular salary for the world of entrepreneurial medicine is as big a step a physician can make.

In the past three articles, MT has looked at what it takes to design, build and equip a medical practice. However, the success of these early stages can all be undone by a disastrous opening.

Unlike retail businesses, it is hard to judge how successful the launch of a medical practice has been.

It is one thing to make a mistake when planning; it is another to make a mistake with a patient sitting in your clinic. MT hears how to make it through a practice launch unharmed.

Doctor in the house

One of the most effective, methods of launching a practice is to hold an ‘open house'. If done well, an open house can be the ideal way to introduce your practice to the local community. If done poorly, it can be a day to forget.

Dr Jeffrey Glassheim is a specialist in adult and paediatric asthma and runs a private solo practice. He also consults and lectures on medical practice management topics and argues that an open house should be unique to each practice.

"There are many schools of thought about this and it really comes down to personal preference," he says. "You can have the open house on the week prior to opening, but some people choose to have it after the practice has been open for a while and has ironed out any problems."

Deciding who to invite really depends on the type of practice you are launching, reasons Glassheim. "You can either invite members of the local community, or you can simply focus on the medical community - that's obviously more appropriate if you are a specialist because you want to have the confidence of the primary care physicians in the area."

Even if you are launching a primary care practice, it takes relatively little effort to have a separate event for local professionals - even if just to get an idea of referral sources.

But before inviting anyone to the surgery, it is important to clarify to yourself and your staff how you want the practice to be represented. It might feel a little forced, but it is worth doing some role-play with a close friend or family member playing the new patients.

"It sounds quite staged, but if you can get people to play different roles - friendly patient, aggressive patient - then you can get an idea of how your staff are going to deal with these sort of situations," says Glassheim.

Having guidelines for different patients might feel like overkill, but it is vital that the practice has a uniform approach as employees handles situations differently.

"There is no right or wrong for many of these aspects - so you just have to try and get clear what sort of personality that you want your practice to have," Glassheim explains.

Making an impression

It is difficult to overstate how important a first impression can be to patients. Something as simple as the wrong tone of voice can be very damaging to a practice's reputation.

"In our medical office the staff know never to say ‘no' to a patient but try to help them in any way even if it means giving them directions to our competition," reports Dr Sandeep Grewal, who authors the popular blog, careermedicine.com.

"Despite spending almost US$30,000 on marketing last year in the practice that I work out of, 99% of our patients come through word-of-mouth from other patients."

There is no set formula for generating word-of-mouth referrals, but there is a lot a new practice can do to make the right impression from the outset. A common mistake is to fail to create an atmosphere that patients can relate to.

Novelty can be a great selling point but for medicine, familiarity is normally a wiser course. "How a practice looks when it first opens has to reflect someone's personality and clinical area, but also the demographic that you are treating," advises Glassheim.

Little touches such as the choice of reading materials in the waiting room can create goodwill between a practice and its patients.

"You need to think about these final design choices before you open - do you want something casual? Something more eclectic? Or more sophisticated?" he says.

Try and get a feel for the area that you have chosen for your clinic - is it a more casual, laid-back type of community? Or a suburban area that is serving professionals?

"It is definitely worth spending a bit extra in the reception and waiting area to get the right sort of vibe," states Grewal. "You can be a bit more frugal in clinical areas because it is while they are waiting for their appointment that most people make a first judgement."

Spin doctor

A practice's ambience, however, comes second to getting people through the door. Your marketing campaign should have started earlier than the week before opening, but whatever measures you have taken to promote your practice should reach a climax immediately prior to the launch date.

"If you are serious about trying to promote your practice then that last week is crucial in terms of timing," states Glassheim. "The last week is the ideal time if you are going to have anything in the print media, or if you are going to take a risk and go with TV or radio."

A last minute promotional push can be conducted across multiple media platforms, but it is essential that you don't forget the simple tasks that help to get your practice on the map.

"You need to make sure you are listed in the phonebook and other relevant directories," says Grewal. "It is also worth sending personalised letters to all of the relevant physicians in the area to let them know a firm date for when they can refer patients to you."

In the initial stages, Glassheim suggests treating your phone number like a lifeline for your clinic. "Really the most important piece of information to be circulating in the run up to opening is the phone information for your clinic," he says. "You want your scheduling up and running as soon as possible and people can't do that unless they know how to contact or to refer patients to you."

Arranging bookings for your first week will inevitably be a patchy affair - very few clinics open to a full schedule and it is unlikely that an opening week will run exactly to plan anyway. Nevertheless, efficient appointment scheduling is one of the key determinants of a practice's profitability.

"You really need to keep an eye on your appointment scheduling over the first few months," warns Glassheim. "You need to have an understanding of what your no-show rate is before it becomes a big problem."

Dianne Walizer is a senior manager at Beacon Partners, a management consultancy firm that advises the healthcare industry. Walizer recommends a policy of overbooking slots so as to avoid dead time for the practice.

"There are really only two things to avoid with appointment scheduling, being under- or being overfilled," she states. "Being under-filled is obviously a bad situation, but being overfilled is fine for the short term. The key is to try and track your no-show percentage and match it to the overbooking rate."

Take a step back

Once through opening week, there will be a point where most physicians will want to stop for a moment of self-reflection. How do you assess how well it has gone?

"Unlike retail businesses, it is hard to judge how successful the launch of a practice has been," says Grewal. "The real spike in the number of patients comes after you've built up a critical mass - and that may take a year before this happens."

While you have to be patient with a start-up, physicians that have taken the decision to leave another practice and become self-employed will understandably want to apply some sort of measure of value to their time.

"An easy way to assess how well you are doing is to look at the numbers for your own personal performance," Glassheim suggest. "This is especially useful if you have a history of performing under different situations and you can track how the practice compares.

"You have to have a baseline in mind and keep checking where you are against it."

Productivity should rise incrementally throughout the year, but Glassheim believes it usually pays to be pessimistic when it comes to predicting revenue.

"You need to know whether or not, after a month, if you are even close to 1/12th of your first year goal - otherwise you might need to revise some of your projections."

Clinical judgement

While it is important to maintain a cool, business-like approach to a new clinic, physicians should also recognise that successfully launching their own practice is a significant achievement. If you aren't happy to be a practice owner then it will be all too apparent to your patients.

Dr Jeffrey Glassheim believes too few modern physicians get to experience the thrill of starting up a clinic. "These days, so many young doctors are brainwashed into thinking that they can only have a career within these large, corporate organisations," he reflects.

"There is a whole generation of physicians who are not giving themselves the chance to develop these entrepreneurial skills."

Setting up a medical practice will always involve risk, but it will also offer doctors the chance to test themselves against the market. Some will discover their entrepreneurial spirit, while others might prefer the buzz of a large organisation - but there's only one way to find out.

The facts: MT’s practice planning essentialsOpen house party:Having an official opening isn't always 100% necessary, but it can be a very effective way of promoting the practice.

The first protocol:The more situations you prepare for, you have less chance of being caught out - make sure your staff are clear what service guidelines you want them to follow.

Something in the atmosphere:It might seem trivial, but it is the smallest touches that can make a patient warm to your clinic.

Media sensation:You need to make people aware that you are there and ready to do business - don't expect a huge return on investment, though.

Keeping tabs:Most practices aren't overnight successes, but the ones that do succeed don't do so by chance - keep a close eye on your costs.

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