Practice management principles

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chapter 18 Practice management principles

INTRODUCTION

This chapter provides a checklist of the important factors to consider in establishing and operating an integrative health clinic. It is not a definitive practice management manual. Most of the principles described here are the same as for other medical clinics, but there are some distinctive features.

When considering establishing or changing your practice to an integrative model, you will have a range of options to consider. Your practice might consist of:

• general practitioners (GPs) only, without special CM training, who refer actively to a ‘virtual team’ of CM practitioners outside the clinic
• GPs only, who have an understanding of or special training in one or more CM modalities, which they incorporate into their therapeutics advice to patients
• GPs with or without in-depth knowledge of one or more CM modalities working in a co-located integrated team with CM practitioners, with an in-house inter-referral pattern.

MISSION STATEMENT

An important first step is to know who and what you are, and to be able to articulate this. Writing a mission statement may sound like a simple task, but it can take a significant amount of thought and negotiation to make sure everyone, from the front desk staff to the most senior practitioners, shares the belief described in the mission statement.

Your practice management style will reflect the type of practice, your underpinning philosophy and the mix of practitioners working in your team. Adopting an integrative model of practice should also begin with the practitioners as role models themselves, by incorporating health principles into their own personal beliefs and health habits.

BUSINESS PLAN

Whatever your mission and philosophy, for your practice to survive and thrive, its business fundamentals must be sound. A business strategy needs to be based on the most likely scenario, but it also has to consider the potential ‘worst case’ financial scenarios.

An initial scoping exercise will assess the existing services in your local area and whether there is a demand for the services you are planning to provide. If you provide a largely locally based service then you will need to assess the likely patient demographic and the patients’ special health needs. If your practice is likely to draw from a wider area because it provides more specialised services for which patients are prepared to travel, then that demographic will be different and may only become evident with time as the clinic and its practitioners develop a reputation for expertise in particular areas.

All potential costs need to be factored in, as well as realistic projections of turnover and growth trajectory, including buying or leasing costs of furniture, phone systems, IT, medical equipment, leasing or holding costs of premises, insurances, cleaning, utilities, consumables and staffing.

Material resources need to be planned and discussed with team members and administration staff. Decisions on big-ticket items like computer systems and software need to be made very carefully, with a view to future capacity, not just current need. You also need to decide whether to buy, lease or hire-purchase major equipment.

Staffing levels for administration need to be appropriate to the required skill set and demand due to current and anticipated patient traffic. Staff levels will need to be adjusted as required. The selection of practice manager will be central to your success and your own mental health. This person will need to have the skills to set up and operate the office systems, deal with staff and suppliers, and ensure the smooth running of the business. A mixture of full-time and part-time staff can provide the continuity and flexibility required in a small to medium-sized practice.

Employment contracts that comply with relevant legislation need to be created. It is important to have an occupational health and safety policy and an equal opportunity and anti-discrimination policy in place as an appendix to employment contracts.

Establishing a service-oriented culture from the front desk that pervades your organisation will not only help deliver efficient patient care but also increase the likelihood of profit.

REVOLUTION OR EVOLUTION

Becoming an integrative practice can be a revolution or an evolution. Existing general practices might begin the process by maximising the health promotion opportunities and chronic disease management options offered to patients, as well as encouraging self-care strategies adopted by practitioners and staff.

An existing general practice might also survey its local area for qualified CM practitioners, arrange meetings to discuss practitioners’ areas of expertise and broaden the practice’s referral base beyond the existing list of allied health professionals. For example, an osteopath, an acupuncturist and a chiropractor might be added to the existing referral list where more appropriate than a physiotherapist in some clinical circumstances. The most ‘integrated’ approach is to incorporate CM practices or CM practitioners into an existing GP-only practice, or to establish a planned integrated team de novo.

Your strategic plan ideally will include a statement of goals, objectives, opportunities and potential barriers.

AUDIT THE PRESENT

If you have an existing practice and are planning to move towards an integrative model, you can begin with an audit of the practice’s current performance in this area.

• What does your practice (or practitioners) already offer or provide referrals for in areas such as stress management, dietary advice, exercise advice, risk reduction interventions, community education programs and support groups?
• What are the needs and beliefs of your patients? Rather than taking a wild guess, consider using a carefully constructed patient questionnaire.
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