I've recently been relishing the team I've got in my office.  

Jamie joined the practice before I opened, showing great faith in me and my ability to pay her wages in this unknown adventure we were taking.  She was the nurse assigned to me and my patients while I was at my previous practice.  It's a good sign that despite this fact she agreed to join me.

Jenn joined us last year, also having worked in the old practice.  I worked with her predominantly in our after-hours clinic.  It adds a significant dynamic to an any situation when you add a third person to the mix.  I talked to Jamie at length regarding hiring Jenn, and we both agreed that we could deal with her known weaknesses (mainly the fact that she was occasionally a little too "perky" in the mornings) because we both knew we could work well with her and trusted her work ethic.  We were right.  It has perhaps taken some patients aback to be greeted with her perkiness at times (Jamie and I could never be accused of being accused of being perky), but pretty much all of our patients have come to love and trust Jenn.

One of the most important things in building any business is hiring the right people.  I feel like I've been very fortunate to hire people who I knew well enough to know they'd fit in with the mission of what I do.  Yes, I used the word "mission," which is often hijacked by CEO's and imposed on employees in the form of mission statements that purportedly reflect the "soul" of the business.  The reality is that a "mission" is something that grows out of the culture of the business, hopefully from the person who runs the business, but often from the ones who actually encounter the customers.

Yet in our business, like many non-profit organizations, the reality of our "mission" is what seems to drive all of us who work here.  I've not had to come up with a mission statement to have it adopted, which is perhaps the best way to do it, yet I think we could all articulate what our mission here is.  Let me try:

  1. We work for our patients.  They pay our salary and give us their trust.  
  2. We serve our patients by making healthcare which is high quality, personal, convenient, and doesn't waste their (or anyone else's) money.
  3. We want to give such a good experience in our office that they will forever be dissatisfied going anywhere else.
  4. We are not giving care to our patients, but are instead enabling them to take care of themselves by being available to help them.
  5. We respect everyone.  We may not agree with all of their decisions or choices, but many/most of these come from reasons we don't understand.  Our goal is to understand people well enough that we understand their motivations, and can help them make better choices.
  6. We know that we are no better than our patients.

There may be more, but this is a start.

So as I thought about this issue, I realized that there is another issue me and my staff believe: we are doing something very important.  This is not just another business or medical practice; we really think we have something that is very much needed: a better way to do healthcare.  It really is better - better for us, better for the patients, better for those who pay for care (because we save money).  There is a certain subversiveness to this - a "sticking it to the man" - that also gives us much motivation and energy.

It's this point that I think is also shared with our patients.  Many of my patients are simply seeking a better and cheaper way to get care.  But I think most of them also feel that they are part of something bigger.  They sense the fact that our success could make a difference in the bigger picture of healthcare.  If we can make a better model of care - one that is better for patients, better for doctors, gives better care, saves money, and is something that can be adopted by other doctors without harming people seeking care - it can totally change the system.  Doctors and patients will flock to such a practice model, and payors will accept it readily because it saves money.  

I think that.  My nurses certainly think that.  I am sure that many of my patients now believe that.  We've had very few patients leave because we couldn't give them the care they desired.  Many who left us because of cost have come back after being "spoiled" by our practice model.  This is the better way to give primary care. 

When I look at this bigger picture I see several important things we need to accomplish:

  1. I need to make the business sustainable and of clearly higher quality than "normal" primary care practices.  This should be easy.
  2. I need to keep the environment one in which patients feel well cared-for.
  3. I need to be able to have a model that is reproducible by other doctors, not just by ones who have the craziness I had to do this kind of thing.
  4. I need to have enough salary to make this an attractive alternative to the old model.
  5. I need to have enough patients that widespread adoption of this won't destroy the bigger system.

It's a big job, but it's sure a lot easier when I have my nurses and my patients rooting for me and helping me achieve this goal.  Really.  I cannot express just how much better life is in this practice than it was in my old one.  From what I've heard, things are just getting worse in that world.

It's my mission to help pave a road to a better way.  I am grateful to have not only nurses on my side, but patients joining in this mission.

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