Riverside Pediatric Associates Five years ago, doctors Alvero Sanchez and Josh Hudson opened a small pediatrics office in Riverside, California. These longtime friends, who had graduated from medical school together, had finally achieved the dream of starting a pediatrics practice with the vision of providing excellent care to children in their local community. The five doctors, six nurses, and accountant who staffed the office quickly developed a reputation for being caring and conscientious. The staff also partnered with local organizations to serve the underprivileged in the community, providing free flu shots and health clinics at the local YMCA. Sanchez and Hudson were energized and ecstatic that they were living out their dream, managing their small practice in the midst of a community that respected them. Their dream started to unravel, however, as the practice began growing at an unwieldy pace. The population of nearby Hispanic communities was burgeoning, and so was the number of patients coming to Riverside. Although Sanchez and Hudson had always dreamed of a large, profitable practice, they realized they were not prepared for such unprecedented growth. The number of new patients was skyrocketing, and the staff at Riverside was unprepared to handle the influx. Waiting rooms were packed, the staff was becoming short tempered, and communication among staff was breaking down. Internal systems—like the electronic medical records systems—were overloaded, and patient health records were getting lost. Patient scheduling was chaotic, causing long waits for many people. The systems and procedures that once provided a firm underpinning for the small practice could no longer sustain the rapid patient growth. Frustration mounted as the founding doctors spent more of their time managing the growing business and less time on patient care. They realized their original vision of providing excellent pediatric care in a comforting environment was fading fast. Most importantly, they were growing dissatisfied with their work. Instead of diagnosing illnesses and building relationships with patients, they were spending more time overseeing expansion and growth of their practice: interviewing and hiring additional doctors and nurses; supervising construction of the office expansion; and training new staff on office procedures. Their primary reason for opening a practice seemed like a long-forgotten memory. Under the growing pressure, staff morale began to buckle. Heated arguments and short tempers among the staff were becoming commonplace. One stellar nurse had resigned, feeling powerless and disenfranchised by the conditions in the office. Another had been fired after arguing with a frazzled parent. Even Sanchez and Hudson were growing frustrated and unhappy in their work. Secluded for a quick lunch in the break room, Hudson confided in Sanchez. “There was a time,” he said, “when we found meaning in our work. I felt most alive and fulfilled when we were just starting out. Now, we’re just scrambling to keep pace with the change, but we’re falling behind and drifting away from what’s important—excellent care for our patients.” Their lunch was interrupted by a knock at the door and some unexpected news from their accountant. The quarterly financial reports painted a grim picture, she told them. The recent pattern of decreasing revenue and escalating costs was continuing in this quarter. A financial crisis was beginning to brew, impacting both cash flow and profitability. The accountant explained that quick action would need to be taken to improve the practice’s financial health. “We have three problems,” she explained, “and those are declining reimbursement from insurance companies, delinquent payments from patients, and rising costs of medical supplies and lab work.” She paused and then added, “It doesn’t help that our billing software is archaic. It simply can’t manage the size of this practice.” Sanchez tore a page from his prescription pad, flipped it over, and scratched out the following: To survive, Riverside Pediatric Associates must (1) improve service to patients and family; (2) improve respect and collaborative communication among the staff; (3) save money; (4) collect fees from patients in a timely manner; and (5) encourage innovation and creativity from our staff to solve routine problems. He slid this list across the table to Hudson, asking, “How do we make this happen?”
1. Assume you are Sanchez or Hudson and plan to implement immediate organizational change within the practice. Where would you start? What steps would you take?
2. The accountant recommended that Sanchez and Hudson consider using AI to facilitate positive change within the practice. How would you implement the four steps of AI? Be specific. What kinds of things would you expect to arise during the Discover and Dream steps of AI?
3. Sanchez and Hudson are caught between being physicians and being leaders of their practice. How do you suggest they resolve this dilemma? What leadership qualities will Sanchez and Hudson need to display in order to lead positive change in their practice?