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“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us…”

The opening lines of Charles Dickens’, A Tale of Two Cities, portray, with profound simplicity, the deep contrasts of the society in which he lived and, certainly, the society wherein we find ourselves today.

In the realm of healthcare the contrasts are equally as stark and daunting.

We are amidst the best of times for many and the worst of times for too many. It is also a time of rapid change – changes in technologies, treatments, medications, health systems, the laws and rules affecting healthcare delivery, payment systems and health information. The many moving parts are like a Rubik’s cube in motion – with an added dimension that periodically (and seemingly randomly) some of the colors of the face of the cube change – making it nearly impossible to surely navigate to the destination.

In its simplest form, nearly all that relates to healthcare can be summarized by two hats – “A Clinical Hat” and “A Business Hat.” The Clinical Hat is all about quality and access to care. The Business Hat is all about efficiencies, cost, and best practices. In today’s healthcare environment both hats must be worn effectively.

Regardless of history, we are now seeing these two priorities emerge as never before. So here is the question – on the micro level, where I live – will these hats converge and crash, diverge and derail, or run parallel and harness the power to enable my practice or organization to thrive?

It has been my experience that medical practices, hospitals, and healthcare organizations can align both their clinical and business objectives in such a way that they line up like parallel rails on a train track – empowering the engine of healthcare delivery to be deployed in a manner that maximizes quality and access and ensures economic results, operational efficiencies, and a better patient experience.

This is never accomplished by default, but by design – by action and not reaction.

So where do I begin?

Reality: Accept the present circumstances rather than pretending they will go away. Accept the fact that drifting into success is impossible.

Vision: Decide what you intend to be. Be realistic. Define it in 1 to 3 sentences.

Plan: Make a plan to get there. Be very practical. Have specific, attainable, and measureable goals that validate the effectiveness of the plan.

Incremental: Systematically accomplish the goals necessary to reach your objective.

Determine: To stay the course. Nearly all winners simply try harder.

Flexible: Be flexible – more change is coming, more rapidly, adjustments will be required. The rules and opportunities of today are already becoming history. Learn how to effectively anticipate the changes on the horizon.

Time: Use time as friend that presses toward progress a few steps at a time. Measure results through parameters of time (quarterly, annually).

Journey: Most of the foundations of the past have proven to be slippery and unstable – recognize that you are on a journey rather than a destination.

Aligning clinical and business incentives inside a medical practice or healthcare organization are achievable. I have had the privilege of being part of several remarkable teams who have proven this on the front-line of healthcare – the tangible and intangible results were most meaningful.

Now is the time to effectuate this change. Those who do so will be rewarded. Those who watch and wait and wonder will remain on the launch pad waiting for someone else to “light the candle.”

Steven M. Coplon, MHA, CMPE, ACHE resides in Memphis, TN. He is currently the Chief Administrative Officer of the Metropolitan Anesthesia Alliance, PLLC, a practice with 75 Anesthesia Providers & Physician Reimbursement Consultants, LLC, a medical practice billing and consulting company. He has a faculty appointment with the University of Memphis Graduate Program in Health Administration. In 2005, he was named National Medical Practice Executive of the Year by the MGMA. In 2009, The Memphis Business Journal named him Business Executive of the Year.

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