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Simple Changes Boost Productivity

Richard L. Reece, MD

October 2007
Business Management

Simple changes in physician practices may pay off big in practice productivity, quality, and satisfaction. Many physician leaders regard large integrated multispecialty clinics as the most rational solution for solving small-practice woes; in other words, work together in large systems or die. Fitzhugh Mullan, MD, author of Big Doctoring in America: Profiles of Primary Care and a family doctor on the board of editors of Health Affairs, describes these physician leaders as “system doctors,” because they are medical directors of large health systems.

In his book The Innovator’s Dilemma, Clayton M. Christensen, a professor at the Harvard Business School, says that “disruptive solutions” can undermine even the best managed organizations, even large medical groups. A disruptive solution is a new technological invention, product, or service that eventually overturns the existing dominant technology or product in the market.

Disruptive Innovations
Simple, convenient, and powerful innovations aimed at the low end of the market disrupt large organizations. In health care, the market’s low end is primary care physician practices, and the high end is large multispecialty organizations. Like all large organizations, they may be mismanaged, develop bloated overheads, become overly bureaucratic, and may not appeal to physicians who seek more autonomy. In short, large organizations are complicated bureaucracies, and many, if not most, physicians do not feel comfortable in complicated working environments.

A good example of a disruptive innovation (also called disruptive technology) is EClinical Works, LLC, a software company in Westborough, Mass., that develops electronic health record (EHR) programs. In head-to-head competition with three larger EHR companies—GE Health, AllScripts, and NextGen—for small group practices in three Massachusetts communities, 170 of 180 physician practices picked EClinical Works as their vendor of choice.

The reason was quite clear. The three larger ....

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