• tjohnson00

leadership log: agreements + clinical utilization w/o feeling like cogs in a machine

***Adapted from a weekly internal email***

Most people thrive when they have clear expectations. This is simple to understand, yet difficult to practice. Just because you have been given a job description doesn’t mean you know what’s expected of you. It’s hard to do a good job when you don’t know how your performance is measured. I like to think of accountability in terms of agreements and as leaders, we can always make the process of making agreements more explicit.

Accountability (one of our five core values at Advaita Health): High standards elevate performance. We rise together.
  • To create a culture of accountability, you’ve got to know what you’re being held accountable for. That’s where impeccable agreements come in.


How to Make Impeccable Agreements:

  1. Make clear agreements (agreement = who will do what by when) and ensure all parties understand.

  2. Record the agreements (we use tools like job descriptions, scorecards, rocks, and software such as Asana, Google Sheets, or Fellow).

  3. Keep 90% or more of your agreements (accountability!).

  4. Renegotiate your agreements with the affected parties as soon as you know that you might not keep the agreement.

  5. If you break an agreement, clean it up and restore any broken trust. (This is a good opportunity to use the CLG clearing model.)

This is adapted from the Conscious Leadership Group and I highly recommend checking out the entire post, not to mention the suite of free resources they provide.


Utilization & Billable Events: We are going to talk A LOT about clinical utilization, our model of care, and what appropriate expectations look like for providers. Ultimately, we are trying to demonstrate that high-quality care can be done within the confines of commercial health insurance. This is very difficult. The reason we measure certain things (like utilization, patient care hours, etc.) is so that we can keep our financial affairs in order without interfering with clinical judgment. Talking about our work in terms of billable events, CPT codes, RVUs (relative value units, for those unfamiliar), etc. feels icky. I don’t even like talking about it. That said, pretending that we are not in the business of healthcare is disingenuous.

  • Providers: We agree to do XX hours of patient care per week and complete the requisite documentation. We agree to do the best we can with our patients and to refer them to other levels of care, providers, etc. as necessary.

  • Leadership: We agree not to interfere with how clinicians practice. (We have ruled out conducting patient visits for less than 30 minutes, not to mention a host of other ‘big picture’ things that should protect clinicians.) We agree to provide clear expectations and support to promote a provider-centric culture that prioritizes patient care.

  • Admin Ops: We agree to schedule patients within the confines of providers’ schedules. We agree to communicate clearly and effectively with providers, patients, and each other.

  • Finance: We agree to provide accurate information on how the company is doing financially and to collect reimbursement in a timely manner. We also agree to be a mission-driven organization, not a financially-driven organization.

  • All: We agree to embrace the Advaita Core Values (Living Centered, Unity, Growth, Accountability, and Transparency). We agree to continue to learn and grow, both personally and professionally. We agree to work together to increase flourishing for our patients, our team, and the community at large.

We all make agreements to the organization and the organization makes agreements to us as individuals. The more explicit the agreements are, the better we can hold each other accountable AND the better we can feel about ourselves. There’s nothing worse than working your ass off only to hear that you didn’t do the right thing. Clear agreements that are transparently tracked reduce subjectivity. Let’s keep working together to increase the clarity of our agreements.

PS: As a supervisor, do your best to make clear agreements with your team. If you’re unsure how you’re being measured and what agreements you’ve ‘made’, talk to your supervisor. This is a two-way street.

Random Thoughts + Quotes

  • If you want to build a bridge, hire a civil engineer, not a quantum physicist. If you want lasting happiness and peace, don’t look to the materialist toolkit. (Here’s a blog I wrote last week regarding happiness and materialism.)

  • From The Power of Less by Leo Babauta: “Doing a huge number of things doesn’t mean you’re getting anything meaningful done…Doing more things means you’re likely to do a lot of unimportant things, and you’ll be overworked and stressed at the same time.

  • Principle 1: By setting limitations, we must choose the essential. So in everything you do, learn to set limitations.

  • Principle 2: By choosing the essential, we create great impact with minimal resources. Always choose the essential to maximize your time and energy.”

  • “Luck and risk are siblings. They are both the reality that every outcome in life is guided by forces other than individual effort.” – Morgan Housel in The Psychology of Money

  • “One’s philosophy is not best expressed in words; it is expressed in the choices one makes. In the long run, we shape our lives and we shape ourselves. The process never ends until we die. And the choices we make are ultimately our own responsibility.” – Eleanor Roosevelt

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