Kaizenovate Blog 


  1.  Vision
  2.  People
  3.  Data
  4.  Process
  5.   Issues
  6.   Traction

Running a successful business means getting really good at identifying and tackling issues.  As Good to Great author Jim Collins has said, great companies are able to “face the brutal facts.” Your practice’s success is directly proportional to your ability to solve your problems. This is not new information. In the well-known book by author Napoleon Hill, Think & Grow Rich, he cited a study that analyzed 25,000 people who had experienced failure. Procrastination, not making a decision, was one of their major causes of failure. In contrast, analysis of several hundred millionaires revealed that every one of them had the habit of reaching decisions quickly and altering them slowly. The fact of the matter is most teams discuss the heck out of problems, but rarely do they have efficient and effective ways to solve them. So how do you reverse that trend?

  1. Set the tone: First you have to have an environment where EVERY and/or ANY person on your team can speak freely without fear of reprisal. This is not always an easy environment to create, especially when you and your team are not used having frank conversations. Sitting down with your team and explaining why it’s so important to be able to speak freely to solve the ongoing issues of the clinic, and helping them understand that you won’t, and they should not and cannot, take any of these issues personally, is a good first step. Further, before having that first meeting, I highly recommend having your staff read Patrick Lencioni’s book, Five Dysfunctions of a Team. This is a must read and explains the five elements each team must have to be high performing and have fun working together.
  2. Identify Your Biggest Issues and Create an Issues List: Once you’ve had preliminary discussions with your team and they’ve read Five Dysfunctions, now it’s time to have a second discussion. Ask them what they thought of the book, what they liked and what they didn’t like. Also ask them to rate, on a scale from 1 (worst) – 5 (best), how your clinic performs for each dysfunction. It’s a great starting point for the issues list! If you have areas where you’re not performing well as a team, then you need to put that item on the issues list. The issues list is used to identify any and all areas that are holding back your practice from its mission.  When you start creating an issues list for the first time (I like to use a whiteboard or poster paper), it can be very lengthy. That’s ok. The first step in this process is to recognize that all businesses have issues, and to have the courage to face them head on is the right step in the right direction. Once you have exhausted all of your issues on this list, now group together issues that are the same or similar. Once that is completed, identify your top three issues that you must solve and move to the next step.
  3. Discuss: Most companies don’t do a very good job in this area. They discuss and discuss and their discussions never lead to solutions. When people say the same things over and over again in an issues discussion, we call that “politicking”. It’s trying to lobby for your position and it’s a huge time waster. When you or any member of your team does that, then “throw the politicking flag” and tell the individual, you heard them, it’s on the record, and unless there is anything new to say, we need to move on to the next person. Further, another “communication penalty” is “the tangent.” The tangent goes something like this…

Dr. Smith: “So now that we’ve identified one of our three biggest issues, insurance claim rejections, let’s discuss some of the underlying causes.”

Sally, the insurance CA: “The biggest problems I see on these rejections are data entry. So if Jane was able to double check her work before sending the file to me, I could see a drastic reduction in denials and a great increase in our payments.”

Jane, the front desk CA: “Well that’s all fine and good but the real problem is that the am sun shines in on the computer screen. When I try to enter the information, it takes too much time because of the sun and then to go back and check it is just not feasible. If we could just upgrade our computer to the brand new iMac, then it would really help. I saw one on the online apples store when I was looking for a gift for my sister’s baby shower. I think we could afford a new one…”


TANGENT ALERT! The am sun really has nothing to do with her double checking her work because you have blinds in your office! Certainly, if she stopped shopping online during work hours, I’m sure she could find the time to ensure her work was perfect! Tangents kill productive conversations because they throw the emphasis off the real problem. When it happens, throw the “tangent alert flag” and get back on track!

The purpose of the discuss step is to really dig down to the underlying cause of the problem. For instance, if claims are being rejected by the carriers and that is your issue, what’s the core reason behind it? Is it data entry, a problem with the billing software? A problem with the clearinghouse? The insurance company making errors? Once you know the root cause (see Six Sigma last month) you can move on to the next step.

4. Solve! Now that you’ve identified the root cause of the issue, it’s time to solve it, and move your practice forward. Gino Wickman, founder of EOS and author of the book Traction, states in his book,

“George Perles, the head football coach of the Michigan State Spartans from 1983 to 1994, once gave a dinner talk at a function I attended. He shared a mantra from his days as an assistant coach for the Pittsburgh Steelers during their heyday in the 1970s. He said, ‘We made every decision like we were going to the Super Bowl,’ and they ended up winning the Super Bowl four times. That is what every leadership team needs to do. You should make all of your decisions as though you are going to your own Super Bowl—as though you were achieving your vision.”

That’s sound advice – think and solve problems like a winner! Please remember, if you haven’t completed your vision, mission and values (VMV) component of your infrastructure, you’re going to have a much harder time solving problems. I’ve written these leadership articles in order for a reason, so if you haven’t done this, make sure you iron this out before working on solving your issues. Each decision you make MUST be in line with your VMV…

Three types of solutions will emerge from an issues-solving session. The first is when the issue is solved and requires action. For instance, “Jane is going to double check her data entry before sending to Sally.” In this example, Jane takes the action item and completes it, and it is solved. The second type of solution is when the issue is merely awareness, and the conclusion is that all members of the team concur with that awareness. For instance, “Okay, so we all agree that all patients will be greeted with a smile within 5 seconds of walking through the door.” The third is when the issue needs more research or facts. In this illustration a team member is assigned an action item to do research and bring it to a specific meeting. For example, “Sally will gather the claim denial reasons for the last three months, and we will make the issue a top priority in next week’s meeting.”

It’s important to ensure that all of this information – the issues and the solutions are recorded so that you can revisit the progress on solving them at each weekly staff meeting. Identifying, Discussing and Solving issues will get you and your practice on its way of achieving its vision! Stay tuned for next month’s article: The 10 Commandments of Solving Issues!

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