The good news: You successfully purchased a strategic alignment of several physician practices. The bad news: You successfully purchased a strategic alignment of several physician practices. The sticking point may be that you purchased everybody in the group practice. It's a little like going to a once-a-decade family reunion and encountering never-before-seen relatives who, how shall we say, do not exactly share your values.

Even the most nitpicky, fastidious, analytics-laden business analysis may not uncover culture problems. Hey, anyone can seem normal for a period of time when they're being watched. (Just think of Aunt Alice.)

Chances are pretty good that any given group practice experiences many of the same issues that you encounter at the hospital level. Now, in addition to one big institutional problem, you have myriad smaller but equally annoying problems. Take, for example, patient satisfaction.

Waiting times are one of health care's big bugaboos. The average waiting time to see a doctor on appointment is 24 minutes, give or take a few ticktocks.

Now you reason — and so does the physician— that doctors are doing important and very complex work and shouldn't be held to the same standards as someone manning a fast-food drive-through. Makes perfect sense, doesn't it? Patients should just sit there, read the old magazines, and suck it up.

OK. Now close your eyes and imagine you are at the airport. You are on an airplane, sitting on the tarmac. And you sit, and sit, and sit in the dark and no one tells you what's going on or how long you may be stuck waiting there. Do you calmly contemplate how difficult it is to run an airport or an airline company? Do you think about what important, complex, skilled work the pilot does day in and day out, or what unforeseen extraneous circumstances may be affecting your particular flight? No. You don't. You're steaming, hopping mad and you want answers right now, by golly! "Don't these people realize how important my time is?" Well, so much for the quiet cerebral response.

I'm not even going to elaborate on the nurse or front-office worker who measures the value of his/her life by the number of patients she stonewalls who dare approach the "reception" desk looking for information. Let's not consider the unreturned or tardy phone calls or the late or absent test result reports. Who could be sitting at home worrying about a little thing like that?

Then there is the factor of patient engagement to consider. The very nature of the word "engagement" leads one to strongly suspect that good communication might be involved. One might expect such simple things as an exchange of information and questions asked and answered by both parties. But what happens when a somewhat imperious doctor frequently cuts the patient's narrative or answers short? Does this sound engaging to you? One study found that of patients 50 or older, 76 percent left the physician's office confused about what to do next. I don't foresee these patients actively managing their own health. Physicians are quick to complain that patients are noncompliant. Well, of course they are. They don't know what the heck they're supposed to do.

But once these primed patients are admitted to the hospital, you can set them on the right patient experience track in no time. After all, we're all in the family now.

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