Barlow/McCarthy Blog

Check back often to hear from our talented team of consultants. Topics covered include: Physician Relations, Physician Recruitment, Practice Marketing, Medical Staff Development, Community Health Needs Assessments, etc.

  • By: Kriss Barlow, RN, MBA |

    I just heard it from a Vice President this morning, “The pressure is on to make sure physician relations is delivering the right results.” Teams are fine-tuning their analytics, field skills, and metrics and really ratcheting up the talent. The result? We’re ready for success- or are we? Maximum field effort gets business to the door. But, have you ever crossed your fingers or said a little prayer that someone answers and tends to their referral needs when your prospect calls? We all have. Granted, physician relations staff can’t over-promise, yet internal obligations can make or break the difference. Here are a few of the tried and true internal alignment needs that support long-term success.

    Leader Commitment. Top-down commitment is not just a program blessing, it is visible support. The leader understands that referral growth requires more than a field team. Culture, implementation and enhanced communication impact repeat business. While physician relations can call attention to external expectations, with multitudes of priorities facing departments, even the well-intended often struggle. We end up with workarounds that result in inconsistencies. Or, one department is great, but others are not. The right tone and message from leadership puts the right level of attention on the physician relations need. When the prospective physician’s eyes are on the organization, efforts to recognize the needs of the referring physician make a difference.

    By the way, if the internal stakeholders step up, the field team has to demonstrate results. It’s a stab in the heart of the program if the field team continues to throw up roadblocks. Swallow a few, if it were perfect inside, they probably would not need field sales!

    What’s your plan to earn the right level of leader commitment? Where do you start and with whom?  Are you really ready to do your part if they do theirs? What if you don’t get the buy-in of leadership?

    Are We Ready? Today our country is filled with different physician relations needs. For some, it’s about leakage. Others’ need referral growth in a very specific market or a specific clinical area. Still, others are working on alignment. The customized physician business strategy necessitates analytics, systems, process, and functions to support the expectations of the organization and the referring physician. If you have not recently done this, evaluate:

    • Goals vs. targets. Have you refined your targeting to ensure you are reaching the right audience for the desired, specific goal?
      • Is there a desire for a selective type of growth? Some organizations are at capacity in a clinical area or for a type of payor. However, they still need selective growth. Make sure you prioritize the relationships with those you value/need most.
      • Is your organization actively moving toward value-based payment? The type of referral relationship and field knowledge will be very different for this audience.
      • Leader expectations are important. Do you know what they expect? We have some clients that will say straight up, “I need volume,” some say that they need better intelligence from the private practices. Make sure that you are set up to deliver what they expect.
    • Put the best foot forward
      • Understand how challenging it is for a referring physician to get a patient to your facility. We don’t get to decide if we are “easy enough,” the customer does.
      • Specialists buy-in and commitment is a critical link in the system. This starts with their field support, communication, ability to “work in a referral” and extends to advocacy for the program and the needs of the referring audience.
      • Once accepted, do our internal systems work? This includes communication back to the referral source, patient experience, scheduling processes, etc.  Stops and starts are really hard on the program and morale.
    • Measurement – what’s valued
      • The quickest way to a CFO’s heart is to show impact in the language they speak. Their support bolsters your value internally. Assuming you know the program is adding real value, then show it.
      • Some organizations are all about contribution margin, others want to see total volume of a specific procedure, while others might like to see shifts in payor mix. What’s the “big number” at your place and how do you show your impact on growing that number?

    Internal trust. Beyond operations and your internal specialists, can other departments like IT and planning be counted on for support? A physician relations program is reminiscent of an old saying, “No man is an island.” The most effective programs are collaborative efforts with many departments lending their expertise to create an environment that recognizes the role of the physician as a valued customer.

    If you don’t have all the elements moving in the right direction, there are choices to be made. Can you educate and gain commitment from senior leadership? What elements of readiness need attention? Can you target areas where you believe you can get some quick wins so you are allowed to develop the program with a long-term focus?

    Get creative. If you need help, get it. If the barriers are too large, continue to work with the internal team and position the value of the relationship program. Start measuring your success and encourage feedback from physicians. Soon, you’ll be positioned for success inside and out.

    Looking for more Physician Relations insight? Check out my recently completed Physician Relations Leader’s Guide. It is a complete workbook that walks you through the process of improving your physician relations skills. Valuable for both liaisons and leadership. Learn more here: Physician Relations Leader’s Guide.

    Blog, Physician Relations
  • By: Allison McCarthy, MBA |

    Does the term “onboarding” best represent the activities involved in bringing new physicians into an organization?  That was a question raised at a recent Onboarding and Retention (OAR) Chapter meeting.

    OAR members were concerned that the title “onboarding” was diminishing the function that integrates new physicians into an organization – especially with senior leaders who may perceive “onboarding” to be another word for “orientation.”

    Those responsible for new physician onboarding know it’s so much more than orientation.  It includes all the tactical activities needed to launch and grow a new physician in practice alongside the relationship building efforts needed for long-term engagement.

    Organizations with well-established onboarding programs, including the right tracking metrics, go beyond orientation by focusing on the social, relational and fulfillment needs that achieve new physician satisfaction, productivity and long-term retention. More specifically, that means working on:

    • Transfer of knowledge – helping the new physician become quickly familiar with the organizational “rules of the road.”
    • Building connections – ensuring the new physician builds a solid network of personal and professional relationships.
    • Immersion in the Organizational Strategy – by understanding how their role fits into the organization’s goals and objectives, they will feel important to the organization and a part of its success.

    While admittedly some of this is orientation, onboarding primarily centers on practice development and physician engagement.

    The OAR group considered other words to describe the startup and integration of a new physician into his/her practice.  Because “onboarding” is the term widely used by other industries to describe the same for other professional employees, the OAR members decided to hang on to that descriptor.  The challenge is not the title, but having health system leaders appreciate the full scope of onboarding.

    For more on this and other topics, consider purchasing a copy of the Leader’s Guide for Physician Recruitment. The Leader’s Guide is a comprehensive workbook designed to help you in your role as a physician recruiter. We have more details and purchasing information here: Leader’s Guide for Physician Recruitment.

    Blog, Physician Recruitment
  • By: Kriss Barlow RN, MBA |

    As summer wraps up we have fresh memories of getting in and out of very hot cars, people you need being away on vacation and the daily distractions of summer. We all have positive and not so positive things about our jobs. But these are not necessarily the same as feeling unhappy in the job. Forbes reports that three of four employees report that their boss is the worst and most stressful part of their job. Doing sales calls in a hot car has nothing on this stat!

    This is a tender topic to even write about. No leader sets out to demotivate their staff. Managers want to be successful and they recognize that effective staff are central to the process. But, many managers have not actively done the field role. So, while they have a great sense of the organization, the data and doctors and goals for the field effort, they often have a gap in what works in the field.

    While it has been “more than a couple” of years since I’ve been a field rep, my ears are open and my conversations with field staff are frequent. Here’s what they say.

    1. Be responsive. Field staff are motivated when they get consistent response at two levels.
    • First is timely communication within the team. Effective managers are consistent in letting team members know when and how they will respond. They offer tools for self-management where situations require it. And, they communicate how to bypass the usual systems if there is an immediate need.
    • The second need is at the organizational level.  A key gripe of a liaison is when they need to respond to a doctor and an internal reply is late or not forthcoming. They cajole, remind, ask and ask until they feel like nags and at a point it feels like others have no interest in earning the relationship and referral.
    1. Take care of the referral. Today it takes between 4-6 visits to earn an acute care referral. Field staff get really frustrated when the internal team drops the ball. Back in the day we could ask the doctor to try us again. Today, it’s one and done.
    2. Value my expertise. Field sales is a job filled with rejection. We work in a normal state of rejection that nobody else experiences, except maybe your bill collector. Feedback is essential, but field staff are a tough on the outside, tender on the inside group. They are more motivated when the conversation starts with their perceptions and things they are working on. In fact, that may be solid advice for managers in general.
    3. Manage “out of the field” requests. Everyone wants everything right now and it’s often kicked down the chain of command until it lands in the lap of the field staff. Managing impromptu requests several times a month is different for those in a field role than an office. It can drive field staff out of the field and to their desks or require after hours work. We all get that it happens occasionally. The key question is, when does occasional become repetitive and, dare we say, annoying.
    4. Consistent, involved goals. The boss sets clear goals in all good physician relations programs. It’s right and good, but can be problematic when it is done in a vacuum. Goals need to be thoughtfully created, achievable and consistent. Good field staff want to exceed expectations, so a moving target often results in motivation problems.
    5. My work, my glory. Back to the ego side of great field staff. Making others look good is foundational to a field role. Every day is spent talking up their doctors and organization. It is motivating when the team member’s story is consistently told with their name or when they are called out and given credit for a new success.
    6. Investment. People want to know that you are willing to invest in their success. For some it is skill-building, for others it’s getting them connected to the right clinical knowledge. For many leaders, it is a business or financial decision. However, for many field staff, it feels personal. While it may be a big investment to send someone to a national conference, small call outs that recognize them for great work can pay large dividends.

    If you are a staff person, likely there are a few that pop to the top of the list. Recognition is often the first step in effective change. For field staff, we can work on taking things a little less personal if most other attributes of the job are pretty good.  For managers, I suspect we all see areas where there’s more to the story. And perhaps a few topics that will resonate and need attention.

    Blog, Physician Relations
  • By: Allison McCarthy, MBA |

    The airlines have recently demonstrated some danger signs for physician recruitment. With their focus on filling airplanes versus the quality of the experience, a few carriers have damaged their reputations with the flying public. As one who flies regularly, I feel as though I’m just a widget moving through the air travel process rather than a customer to be satisfied. The airlines seem to be more concerned with volume than value. And customers are pushing back.

    Physician recruitment may be on the same trajectory. With searches per recruiter reaching 30, 40, 50 per year, that increasing volume just means less time and attention available to bring value to individual candidates.

    Recruiting a new physician is a big deal for any health care enterprise. Physician-generated revenue can range from a half-million to a few million annually. If we anchored our thinking in the potential to generate “millions” for the organization – if we successfully recruit and retain the physicians – I believe we would see the need to be more “high-touch” oriented.

    How we interact with candidates during recruitment sets the stage for a potential long-term value proposition for the organization. Here are a few areas to consider.

    • Pre-search prep – how much time is spent in discovery to get the key differentiation details needed to pitch the opportunity? What benefits are you really offering physician candidates? Is that practice ready to represent the organization’s brand in the recruitment market?
    • Time invested with candidates – to really understand their needs and interests. While we may spend considerable time ensuring community fit with the physician and family, are we doing the same on the professional side? Likely there is room to dig deeper and learn more about their career goals and aspirations. What would it take to have them choose to practice with you versus a competitor? What are the key attributes most likely to hold them long-term?
    • Extending offers – rather than talking physicians through the offer, we email a document and ask them to sign and return. Then it can take weeks to prepare a contract – sent by an attorney more interested in protecting the organization than being a relationship-building partner.
    • Onboarding – that critical juncture when the organization’s return on investment needs to be managed. But unless responsibility for new physician onboarding is assigned, practice ramp-up and new physician satisfaction is at risk.

    I’m challenging us to look at physician recruitment from a retention perspective – for its ability to attract the right talent that can bring long-term gain to the organization. We run the risk of going the way of the airlines – with high volume expectations and a low value approach. Physician recruitment needs a “high touch” orientation so sufficient time is spent working leads, having in-depth conversations with candidates and really considering potential long-term fit.

    Consider the mix of physicians being pursued today. What are they worth long-term to the organization? If your physician recruitment approach has more of a “fill rate” orientation, then it may be heading down the same path as the airlines – volume over value.

    Blog, Physician Recruitment
  • By: Kriss Barlow, RN, MBA |

    No doubt about it. Today’s gatekeepers are more impenetrable than ever. We can blame it on pressures in the practice, or more “office visitors” than they can manage. But, let’s face it, their issues become our issue. Most field staff need to get past a gatekeeper to get to the right audience, so it is part of the job. Take a minute to consider your track record in the last six months.

    What’s a Rep to Do?

    Step one is to recognize that getting through is your obligation. Your organization has hired you for meaningful conversations with doctors. If you are working on leakage, referral growth or market softening, the physician is the pivotal decision maker, so meaningful connection with them is key. Easier said than done.

    Make sure you have something of value when you do meet with the doctor. Value for them is rarely a pitch about your products and services. The pre-call plan should define your approach for involving them, understanding their needs and making sure they feel the time spent with you is worth it.

    Earning Entry

    There is no magic script or approach that works every time but, here’s a short list of ideas to try if you’re getting stalled out by gatekeepers more than you’d like.

    1. Professional warmth. Be kind and interested in them, but make sure they understand you are a professional representing the hospital and that you have a job to do. First impressions count so prepare for your meeting with them and work to find that right position of interest and involvement with the entire office, but with clear lines of expectation.
    2. Positioning is crucial. Use your organization and its stakeholders to position your role and differentiate your position. For example, “Dr. Smith our chief of cardiology suggested I should meet with your new family medicine doctor, Dr. Doe.” This, of course, requires that you have permission to name drop. But, when you can, it paints a very different picture.
    3. Never bait and switch. You know this, but if you go into a practice to learn insights from a doctor then that’s what you do. Don’t say that your visit is to follow up on a patient or learn their needs and then use the time to pitch your products.
    4. Ask for what you need, not what you think might be suggested. The goal is to meet with the doctor, so request a few minutes with the doctor, not with the office manager. Yes, I know that 90 percent of the time the suggestion will be to meet with the office manager and that works, but if we ultimately want a conversation with the doctor why not ask for that.
    5. Respect. If you ask for five minutes, stay for five minutes. If you see the lobby is full you might offer to come at a better time. Office rapport is a forever need and they remember those are sensitive to their realities beyond the doctor’s agenda. Show it every chance you get.
    6. Less is more. The longer we talk, the more likely we are to say too much. Keep your message short, easy to understand and focused on them.
    7. Remember your ultimate goal. If at first you don’t succeed try, try again. Find another resource in the practice, use one doctor to get you to another one, use outside meetings to stage the visit, just stay at this and you will almost always have luck.

    My list should get this conversation started. What’s on your list of successful techniques to effectively get face time with doctors? Everyone is in the same boat with this issue so if you have a technique that works for you, please let us know.

    P.S. B/Mc is sponsoring a Destination Sales Training in Amelia Island, Florida on September 14th. In addition to gatekeepers, the content will include the full relationship selling cycle and the opportunity to exchange ideas with your colleagues. CLICK for details and to join us get your registration in by August 10, 2017.

    Blog, Physician Relations
  • By: Kriss Barlow, RN, MBA |

    The word “sales” has a negative connotation for many.  That disappoints many of us who work so hard to do it right. Having said that, I suspect we can all share a time when we were on the receiving end of an individual who totally owned the phase “slimy sales.” Think, “What would it take to get you to drive this car off the lot today?

    Nobody intends to be a turn-off, yet not every field approach creates a positive feeling or trust. As I share a few of the sales styles that go too far, take a minute to examine your approach. Are there times when borderline approaches creep into your conversations?

    1. Manipulation. Persuasion is an important aspect in relationship sales, but let’s be clear about the difference between that and manipulating a conversation, a person or an expectation to seal the deal. While I am all for putting the best foot forward, failing to be candid, or manipulating the facts for personal gain, is going over the line.

    For example: Here are some borderline actions to avoid

    • Creating a perceived crisis to get internal stakeholders to respond to your needs.
    • Getting a new specialist to do rounds on short notice to get your numbers to the right place.
    • Using relationships with key stakeholders to get your own way.

    In these examples, I suspect you recognize that it’s not that the activity is wrong, it’s why it was done. Manipulation is self-serving; nobody wants to feel that someone played them.

    1. Pushy. Great field staff find that sweet spot of gentle persistence, but they recognize that pushing too hard is a turn-off.  Pushy sales people can often be found hammering on the same points over and over and hoping to get a different reply. Contrast that to a good field plan that gently unfolds solutions based on the customer’s buy-in. This takes reading the customer and aligning with their priorities and, frankly, bringing your brain to the call. Pushy people are often those who think that if they just “ask for the business” enough times, eventually the customer will just give in.  In the world of earning referrals, if you push too hard or you are a “One Note Nancy,” you are soon sitting alone in the waiting area and wondering why you can’t get time with the decisionmakers.

    Footnote on this one: I often hear leaders, who likely have not sold, suggesting that field staff do not do a good job of “asking for the business.” It is absolutely the role of the rep to ask for the business, but the ask needs to occur when the client is qualified and has verbally agreed to your benefits. In other words, asking for the business will be pushy if you have not earned the right to close.

    1. Selfish. Every successful field rep needs to have enough ego to strongly represent themselves and their organization. The distinction here is between a self- confident field rep and one that is so selfish they fail to recognize the customer’s needs. Selfish reps fail to be good listeners and are solely focused on telling the physician what they think he/she should hear. Being a non-selfish rep goes beyond understanding the client’s needs, it also includes doing the total office visit and understanding the role of each person in supporting the process.  It means that if you can’t provide something and another field rep in your organization can, you work to learn enough to do a seamless hand-off. This is especially true for service line reps or organizations that have different teams who sell ancillary vs. acute care.  Another example is failing to listen to the doctor’s needs because you want to push your agenda on that day.
    2. Misrepresent: This one often starts innocently enough with a little stretching of the truth. Over time, the facts you offer move further away from the reality. The result is that the sales person ends up misrepresenting the product, the service, the experience or the approach. It doesn’t really matter why or how it happened. If the prospective physician or other client was provided with information that was not accurate, that is not okay. With this one I always think of those high profile individuals who padded their resumes. Over time, it just gets to be part of their story until they are found out and we all know what happens then. Field staff work so very hard to build trust and credibility and it can be lost with one small distortion.  Getting it back will take a long time, maybe a lifetime.

    Did you have other turn-offs that I did not call out? I suspect that is the case.  While it’s great to learn from optimal experiences, my best learnings are often about what I do not want to do.

    Blog, Physician Relations
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