The Value of Flexibility

Dr Hardy PhotoThis post was contributed by Seth Hardy, MD, member of the ACR Commission on Economics.

Operations management is the study of organizational sustainability. There are four pillars of operations known as competitive priorities: cost, quality, timeliness and flexibility. Effective management of these competitive priorities is how the organizations in which we work and do business become sustainable. Once you are aware of them, they become quite obvious in our everyday lives. Organizations that neglect all of these priorities typically cease to exist.

In the car rental market, we have Budget and Hertz. They clearly compete with each other using cost vs. quality. Enterprise with their “we’ll pick you up” promise utilizes the timeliness and flexibility dimensions to gain a competitive advantage. As for Rent-A-Wreck, there is a reason you will not find them at any airport you want to fly to.

JotNot_06-01-2016

ACR Maine delegation meets with Sen. Susan Collins (R-ME)

Our College purports that, “Quality is our Image.” Among the medical specialty societies with which we compete, the ACR’s stake in quality serves us very well.  Every Hill Day, Senator Susan Collins (R-ME) is very generous with her time. She has made it clear that she listens to our ideas because they represent quality. The fact that they may bend the cost curve is a bonus. The access, respect and exchanging of concerns is based on an appreciation of quality. An organization that understands and exploits their competitive priority(ies), such as ACR does with its focus on quality, is hard to beat.

While the concepts of cost, quality and timeliness are understood to every child who has run a lemonade stand, flexibility as a priority is less obvious. However, if flexibility is well-understood, it is a very powerful space in which to compete. Certainly, if there were a Transformers car rental agency, I would carry their loyalty card in my wallet and toss the rest.

Charles Darwin tells us, “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” As the frequency and amplitude of economic and regulatory change increases, we must be flexible in order to sustain our operations. Listen to Darwin carefully; he is not only claiming that flexibility is the most important competitive priority, he is also linking it to resiliency and survival.

As you work and do business, start to recognize and analyze which competitive priorities are being used, if any at all. If sustainability and resiliency are of value within your practice and life, contemplate which competitive priorities you are going to exploit and remember the value of flexibility.

I invite you to use the comments section below to share examples of where flexibility has helped your practice overcome a challenge.

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7 thoughts on “The Value of Flexibility

  1. “Charles Darwin tells us, ‘It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.’ . . . Listen to Darwin carefully; he is not only claiming that flexibility is the most important competitive priority, he is also linking it to resiliency and survival.”

    In Darwin’s universe – i.e., in the natural world – survival is the ONLY priority. Animals will do whatever they need to do, to survive. Principles and ethics do not generally pertain to the behavior of animals.

    Humans – some of us, anyway – value certain things more highly than mere survival. Some of us feel the need to stand for something other than our incomes. Patrick Henry’s famous exhortation “Give me liberty, or give me death!” is a justly famous example of a person putting principle ahead of self-interest. If the American colonists had decided to be “flexible” in order to facilitate their “survival”, we would not exist as a nation.

    Dr. Hardy’s post seems to suggest that flexibility should be allowed to override principle, as a matter of survival. I can not disagree more strongly. I think we should be flexible with our practices ONLY to the extent that such “adaptiveness” does not lead us to weaken the principles which guide, or ought to guide, the practice of individual medicine – principles such as giving each patient the full benefit of our ability and experience.

    In other words, before I used a Transformers rental car, I myself would REALLY like to know whether I was associating with an Autobot or a Decepticon.

    To make a timely political point: both of the (presumptive) major party Presidential candidates are examples of “flexibility”, and both have successfully used that flexibility to succeed in their lives and triumph in their competitive battles. The result is that a handful of people are voting for one of them because they actually admire that person, while the majority are voting for one because they are more afraid of the other, and a substantial minority have trouble bringing themselves to vote for either.

    If you want our profession to be as universally admired as Mr. Trump and Ms. Clinton, you are on the right track. Personally, I want something better.

    • Not at all, my comments are void of any political, moral, or ethical considerations. Our Founding Fathers knew the power of flexibility as we see in our checks and balances, as well as the ability to add amendments to our Constitution.

      If you wish to apply ethics and morals consider the young partner who has joined a group that practices unethical behavior. It doesn’t matter if it is radiology and it is a group that self-refers to their imaging equipment or commits Medicare fraud, or perhaps a Wall Street firm that is in violation of the SEC regulations. That young partner ultimately has a choice to join in the illegal behavior, or not. The young partner who spends their bonuses on a multimillion dollar house, ski condo, expensive cars, and a boat is not staying flexible and through poor fiscal choices is passively committing themselves to joining the pack. The loose spending of money is exactly what the senior partners are watching for because they know that when the true nature of the group is revealed, the young partner will have no choice but to go along.

      A young partner who spends their money modestly until the true nature of the group is revealed is staying flexible and can make an unencumbered decision to leave when the unethical or illegal behavior is revealed.

      Cost, timeliness, flexibility, and quality are simply tools to achieve competitive advantage. How you use them is up to you.

      • “A young partner who spends their money modestly until the true nature of the group is revealed is staying flexible and can make an unencumbered decision to leave when the unethical or illegal behavior is revealed.”

        And go where?

        You and I are envisioning very different scenarios. You are talking about how a single individual can avoid becoming trapped in a bad situation, can remain free to relocate when the need and the opportunity arises. As an example, you cite groups and institutions engaged in behavior which is clearly illegal, and which you see as aberrant because most people, of course, would never behave that way. (So are they all, all honorable men.)

        My concern is that such behavior can become the norm, and unless ethics is placed at the top of the priority list, there may be nowhere for that individual to run. It is not enough to write laws which purport to circumscribe bad behavior – until you can grease the right palms, of course, or until you are publicly exposed and your erstwhile allies have no choice but to disavow your actions. If people hold success and prosperity as the cardinal virtues, they will always find creative ways to bend or circumvent inconvenient obstacles like laws and policies. The problem is NOT that there aren’t enough laws, but that there isn’t enough commitment to principle. Virtue can not be imposed from the outside; it has to arise from within. If flexibility and quality are made equivalent, it may not arise at all.

        “The young partner who spends their bonuses on a multimillion dollar house, ski condo, expensive cars, and a boat is not staying flexible and through poor fiscal choices is passively committing themselves to joining the pack. The loose spending of money is exactly what the senior partners are watching for because they know that when the true nature of the group is revealed, the young partner will have no choice but to go along.”

        An excellent point, but I wonder if we are seeing the SAME point. Your perspective seems to be that we as a specialty need to remain “lean and mean” – an odd ideal for physicians, in my view – so that we can somehow maintain control over our situation, and forge a better path. Yet the example you provide is of an individual who refuses to buy in to the prevailing ethos, because he holds certain truths to be self-evident, and insists on something better. When it becomes clear that he and the group disagree on the definition of “something better”, you have him simply walking away from that group.

        How will we walk away as a profession, Dr. Hardy? Where are those greener pastures? When you ask us all to accept and adapt to the changes being imposed on medicine, are you not asking us to do precisely what your “young partner” does NOT?

        “[M]y comments are void of any political, moral, or ethical considerations. . . Cost, timeliness, flexibility, and quality are simply tools to achieve competitive advantage. How you use them is up to you.”

        Yes, that’s exactly my concern. Quality is NOT simply a “tool to achieve competitive advantage”; it is, or should be, the primary goal and end-point of the work we do as professionals. You still seem to be suggesting that we should balance out quality and ethics with things like cost, timeliness, and whatever actions you are including under the rubric of “flexibility”; but that is a recipe for survival of the “fittest” – not survival of the best, or even of the good.

        To simply accept Darwin’s world view as inevitable is also to accept the result: the creatures that survive are not necessarily the smartest or the most talented, and certainly not the ones which best embody the ideals of civilization; they are just the ones who were willing to do anything to win. Those instincts served us well for hundreds of millions of years, and would continue to guide our behavior effectively if we were still hunter-gatherers. Building a stable civilization, on the other hand, requires new values – and a new definition of “winning”.

        An inaccurate report delivered in a cost-effective and timely fashion is simply fast crap.

      • Barry,

        You and I are essentially in agreement. The competitive priorities of cost, quality, timeliness, and flexibility apply to organizations as well as individuals. Unethical behavior, a deviation from quality, is certainly enough to destroy any positive gains from cost, timeliness, or flexibility. The VW diesel scandal is a perfect example of poor unethical quality and is going to hurt that company badly. Any gains VW made on other fronts are wasted. A group that commits fraud is one you don’t want to be part of no matter how good they are on the other 3 priorities. Nobody wants fast crap either.

        The potential positive effects of flexibility are something that perhaps we don’t often consider in our lives and it is worthy of a good discussion.

      • “You and I are essentially in agreement.”

        My sense is that we agree on behavior, which is certainly worthwhile, but perhaps not on principle. You still seem to be arguing that unethical behavior is wrong because it can be costly, if discovered. I am arguing that unethical behavior is wrong because it is unethical.

        At the same time, I am mindful that my perspective is not universally shared, and in a purely practical sense, your own outlook may function nearly as well. As Prince Feisal said to an English diplomat in “Lawrence of Arabia”:

        “With Major Lawrence, mercy is a passion. With me, it is merely good manners. You may judge which motive is the more reliable.”

        ********************************************************

        “The potential positive effects of flexibility are something that perhaps we don’t often consider in our lives and it is worthy of a good discussion.”

        On this, at least, we can agree fully.

  2. I would like to share my experience on a challenge topic for multi specialty radiology practice: review of outside images. Re-interpreting a study done outside without your supervision and care for the patient is not appropriate and yet is performed by many practices. I recommend to re-think this practice by applying the same concept that clinicians have done when consulted by another specialty professional. This is a difficult issue with lots of variability across the country for radiologist. It also creates ethical issues with a study with two interpretations.
    I propose the use of the Interprofessional Consultation non-face-to-face 2014 CPT codes and the development of a workflow and standard language for consults on outside images ranging from non-diagnostic study to wrong imaging modality for the specific request. This approach is becoming very successful in my practice and adding quality and VALUE to the healthcare. Please contact me if you want to know more about this new model of dealing with outside images. I hope the economics committee listens so some new ideas on dealing with challenging practices.
    Thank you.

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