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A friend of mine is Dave Hubbard, the motivational speaker, an All-American collegiate athlete who played professional football in the 1970’s for Hank Stram of the New Orleans Saints and then the Denver Broncos. Dave is extremely familiar with healthcare both professionally (serial entrepreneur) and personally (broke his back jumping out of a perfectly good airplane!).
We’ve had a series of interesting conversations about, of all things, football plays and EHR workflow. We co-wrote the following post to see if we might enlist you in telling us if you think we’re on to something, or not.
–Chuck & Dave
Medical offices are like football teams: an offensive line moves a patient encounter forward while a defensive line seeks to create chaos and stop encounter progress. This analogy is more productive than you might think!
Medical office staff members interact in ways that are similar to a football team. For example, they have an offensive line whose responsibility it is to efficiently, effectively, and flexibly move an encounter from waiting room to checkout. There’s a quarterback who calls plays. Sometimes it’s the physician who directs staff to administer a vaccination or auditory test; sometimes the plays are called automatically based on the reason for the patient’s visit, such as “well child” versus “ear ache.”
Tasks are “passed” among team members, such as a nurse gathering vitals and checking medications and allergies before passing the assessment and treatment tasks to the physician. “Dropping the ball” results in inefficiency that slows the encounter and ineffectiveness that affects patient care and physician revenue.
The defensive line may be less obvious, but it consists of threats to the accomplishment of efficient, effective, flexible workflow. It is the offensive line’s responsibility to protect this workflow. For example, the phone nurse blocks defensive line interruptions that would otherwise distract the physician from maximizing use of the most important and constrained resource in the practice, his or her time. Anyone (or anything) who contributes to the hassle factor of practicing medicine is part of the defensive line.
Similarities between a medical team and a football team are more than an amusing analogy. All teams are cognitive systems, and their study is called team cognition (with contributions from distributed cognition). Shared mental models, workspace awareness, radar views, and teams of experts versus expert teams are topics of team cognition that apply to all teams, including those in medicine and football.
Using this football metaphor (and some ideas from cognitive science), we encourage you to think (and comment!) about office processes from the perspective that to win, the ways in which the plays are being run must be examined. Doing so will allow people to express what they are most proud of, but also to critically evaluate performance problems in a constructive way, one in which everyone is committed to success.
Questions to consider:
How is your medical practice similar to a football team?
What position does each employee play? Who is offense? Who is defense? Are there any special teams?
Who is the quarterback? The coach? Does everyone know their position?
What about the referee? The coach? The patient? The fans?
Who owns the team? Is there an owners’ association? A players’ association?
If your medical practice were a football team, what would be your version of the following: Holding? Tripping? Unsportsmanlike conduct? Unnecessary roughness? Running versus passing? Huddling? Incomplete pass? Field goal versus touchdown? Memorizing key plays? Time-out? Substitutions?
Suppose you could review game films with your staff. What are examples of plays you’ve run to achieve major yardage or touchdowns?
What are examples of plays where you’ve thrown for a loss, fumbled the ball, or suffered interceptions? Why did they occur and what can you do to keep them from happening again? How do you define victory?
Do different styles of medical practice lend themselves to different sports analogies? Soccer? Golf? Which do you suggest and why?