Breaking Compromises

Each day primary care practices succumb to compromises on many levels. In particular, the expectations of the providers, patients and employees. Compromises are concessions demanded by interested parties by most of the companies in an industry. They are different than trade offs which are value choices such as the difference between a luxury and basic hotel room or a family practice and concierge care*. According to Stalk, Pecaut and Burnett of the Boston Consulting Group (1997) breaking compromises is the pathway to business growth.

Small to mid-sized primary care clinics face constant compromises due to time constraints and budget. Since primary care providers are bankrupt of time and of limited budget for managerial teams a compromise exists in the creation of core business strategies and their execution. We are habitually focused on surviving rather than growing. This is to the detriment of patients who are viewed too frequently as a resource for the practice rather than a paying customer. The lack of strategy focused on growth and continuous improvement hurts not only the patient but the staff, who become disengaged.

Strategy is created through passion for ones work and the thoughtful application of business knowledge. Execution is the application of strategy and the usual stumbling block for primary care because of time and fiscal constraints. To break the compromise, the primary care provider can provide strategy and the employees the execution.

Facilitating the execution of business strategy by employees’ accomplishes three goals. First, it improves the health care experience for the patient. Second, it breaks the compromise which trades off a lack of strategy to gain time or budget. Third, it engages the staff in the desire to improve the primary care experience in the clinic.

While failures can and will occur, it has been my experience that they are more often due to a lack of coherent strategy rather than poor execution. Health care workers are by nature self-starters and highly capable of independent work. Capitalizing on the providers’ passion for care and the staffs’ capacity for organization not only creates a better health care experience for the patient but a better workplace for everyone.


*Many proponents of Health 2.0 are currently challenging an industry compromise that most communications with the primary care provider need be face to face by leveraging powerful home computers and low cost bandwidth. I believe that this challenge is a trade-off rather than a broken compromise to a core philosophy of primary care.