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Join Ram Krishnan, a technology executive. Discover the power of provider feedback in improving health practices and gain valuable insights into fostering a supportive feedback culture, anonymous feedback mechanisms, and leveraging technology for continuous improvement. Learn from Ram’s expertise and real-world examples as we explore the key strategies to enhance efficiency, staff satisfaction, and patient care in health settings.

Ram Krishnan joined Valant in 2020 as an experienced technology executive to lead the organization through its next stage of growth. His passion for listening to customers and building strong teams, coupled with his demonstrated ability to drive scalability, provides a solid foundation for Valant to grow as it discovers new ways to serve the behavioral health care market.

He discusses the KevinMD article, “Gathering clinician feedback at a growing practice.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Ram Krishnan. He is the CEO of Valant, he’s an experienced technology executive, and today’s KevinMD article is “Gathering clinician feedback at a growing practice.” Ram, welcome to the show.

Ram Krishnan: Thanks, it’s great to be here, Kevin. I listen to your podcast a bunch and delighted to be here.

Kevin Pho: Oh, thank you so much for listening and for joining me. And we’ll talk about your article in a little bit, but first off, start by briefly sharing your story and journey.

Ram Krishnan: Yeah. Well, I won’t go all the way back to kindergarten, but I started my professional career as an engineer, so I have an engineering degree, industrial engineering. I think I went through that program never realizing how my whole life was going to be about process improvement. Just sort of stumbled into it, and it turns out to be a personal passion.

I started my career at General Electric. I spent 15 years there, kind of going through management training, a lot of focus on things like process improvement, change management, voice of the customer, a lot of fundamentals that I learned from there. And spent most of the time in health care, so it was a good combination of understanding process improvement and voice of customer for product development and internal process, but also getting a chance to see that all deployed and impacted in the context of health care. Not just in the U.S. but around the world, everything from rural health care to government funded health care to the style and programs we have here.

And at the heart of it, I’ve always been a software and technology person. I left health care for about eight years, got experience outside of health care with the desire to come back, and I did. And so the last three years I’ve been running a company that’s a practice management EHR company focused on the private practice mental health space. We are purpose-built for that market segment, and we spend a lot of time studying how our customers work and trying to build the best product we can that’s purpose built for our market.

Kevin Pho: So process improvement can mean so many things in the health care space. So to you, what are some of the lowest hanging fruit when it comes to process improvement in health care?

Ram Krishnan: Yeah, I’m going to give you some context. Something that kind of hit me early in my career was this article, it was an HBR article, Harvard Business Review article, 2008 something like that. And it really had this, I think it was referred to as the service profit chain. I’m digging back into my past because it had an imprint.

And it was really built around how so many organizations are focused on revenue and profit, or the outcome kind of metric, and how focus on employee satisfaction and then service quality internally within the organization is what ultimately drives employee connection to purpose and mission, and then ultimately drives to client satisfaction, patient satisfaction, however you want to call it. And that’s what drives customer loyalty and revenue and profit.

So a lot of the focus on process improvement is around, how do I make people’s jobs easier? So if you make the job easier and simpler, then you’re making their life better in terms of performing the core value they’re providing, patient care, or whatever it might be in the context of health care, particularly in a growing practice. And that ultimately drives outcomes, right, better client, patient satisfaction.

And then in the context of that continuous improvement, I’ve relied a lot on a manufacturing principle called lean, which I’m sure you’ve heard of and maybe have talked about on this podcast before. And I think the thing that I love, having been through the GE Six Sigma days where we were heavily six, nine, 12 month project focused and trying to reduce defects, lean is so short, simple, and sweet, and it involves everybody who’s doing the work, and it’s just about ripping out waste.

So that’s my long way of saying, process improvement, if you align it to focus on eliminating waste, just tasks and things that don’t really add any value, that’s where you get people a little happier about the work that they do. And if they’re happier, more effective, they’re probably delivering better service.

Kevin Pho: All right, so let’s talk about process improvement in the behavioral health space, which is what your company focuses on. Your KevinMD article is “Gathering clinician feedback at a growing practice.” So tell us about your article for those who didn’t get a chance to read it yet.

Ram Krishnan: Yeah. So the article really leans in on some of these principles from this old service profit chain example. And I think it is, hey, if you want to grow a practice you need to retain the physicians that you have in your group. Retaining your physicians is driven by really listening to what’s driving their experience at the core. And so the article is really about how do you go about getting that feedback, what are some best practices, what are some potential mistakes, what’s the methodology, and how do you set to work doing that.

I think a common mistake we make in gathering physician feedback is just asking open-endedly, what can we do better? And when you do that, I think you sometimes can open yourself up to a whole host of inputs that are not really built around an agenda or a set of goals or purpose or area of focus. And you might be focused on improving the snacks in the breakroom instead of improving client service, as a kind of silly example.

And so I think there’s a potential to use technology to help orchestrate or architect a series of questions, so that when you do collect feedback you’re doing so anonymously, you’re doing so with structure, and you’re doing so in a way that’s quantitative instead of strictly qualitative. And that’s step one, getting that quantitative feedback.

Then I think when you have a qualitative discussion, it can be based around unpacking the real meaning and root behind the quantitative. So if you’re asking for specific areas of improvement across the business, now you have the context to set an agenda, to get a round table going, and start digging into the feedback and unpacking the why.

So that’s a lot of the article. I think the article also breaks into a bit of, OK, what to do with that feedback. How do you take that feedback? A common thing people will do is take the feedback and never share it back with the group. They gave it to you. It’s important to distill the information you collect and share it back. It’s important to decide what you’re going to do and what you’re not going to do.

I think people need to hear that some things are not going to get worked on, just from a priority, budget kind of standpoint. But if you are going to pick one or two things to work on, putting those two things in context, it’s really helpful to gain trust that my feedback was given, it was understood, it was played back to me, it was prioritized, and one thing is going to get worked on, we’re going to get a win out of this feedback, even if the other four or five are put off on a roadmap for the future.

And I think that’s the context that’s often missing. We say, hey, we get clinician feedback, I sent a survey out or I had a round table. But then what? How do we set that whole process in motion, that doesn’t overpromise but ensures receptivity to change in certain key areas?

And I think that the sort of logical next step from the article is, OK, I got the feedback, I prioritized one or two areas, how do I go about changing that? And I think that’s where the lean kind of approach and process and philosophy can really be powerful.

Kevin Pho: So tell us a story, case study or scenario, it could be a hypothetical practice or a real life practice, that really implements your concepts in action, just to really illustrate that point.

Ram Krishnan: Yeah. And if I can, I’d love to give you a product one, out of our own product, which is somewhat driven through process and us listening to physicians, delivering service and understanding challenges.

Early on in the pandemic, we hit the pandemic point, everybody scrambled to figure out how to continue to deliver service. And many of us immediately started getting Zoom accounts and Teams accounts and Google Meet, to sort of continue, have some continuity of care in a telehealth model. And being in mental health, this is a lot easier in some ways, because the therapist and or provider patient interaction was amenable to this kind of model that you and I are having right now.

So in the beginning days that was a great quick fix. But what we started to understand and realize is that, look, there is a workflow that existed before that has changed with this context. And as we got feedback from physicians, we started to realize very quickly, it’s great to send the link out to a patient, the patient clicks a button, they join a meeting, the provider joins a session. But we sort of forgot there used to be a person at the front desk in the administration that collected insurance information, might have ensured forms were up to date, might have ensured assessments were complete, and ensured payment was made.

And all that burden sort of fell right onto the physician. And so we just kept rolling right along, and this is creating a lot of the physician dissatisfaction, because you create distrust between the client and the physician.

And really, when you sit down and start collecting feedback on how the workflow is working, this started popping out everywhere. And it just was an obvious thing for us to say, oh man, you can’t just drop a Zoom link to everybody, we need to replicate that front desk gatekeeper and put that in place ahead of the interaction between the patient and the provider. Output metrics obviously improve, collections improve, the assessments get done more effectively, and then the quality of the patient provider encounter of course improved.

And that forced us to redesign that experience. And so our telehealth product now more effectively puts that, we call it, it’s like a virtual admin that steps in right when you click that link, makes sure you’ve done all your tasks as a patient, and then when you get in it’s a really organic, clean, trusting relationship. That’s a simple example.

Kevin Pho: So in terms of using technology, or leveraging technology, to incorporate and apply that feedback, talk more about that technology piece and how that intersects with that feedback aspect.

Ram Krishnan: Yeah, and I think there are a number of ways to do this. I know a lot of companies will do an annual or quarterly employee feedback survey, and I think you can do this sort of on a macro scale annually and then more surgically on a more frequent basis.

So if you took just general like happiness and employment, do you understand the goals of the business, do you understand the goals of the practice, do you feel like you’re able to optimally engage your time in patient care, those sorts of questions you can ask on an annual basis to gauge the overall net promoter score of your physicians, if you will, in working with your practice.

And you can use survey tools, many of them, everything from SurveyMonkey. They’re pretty cheap, they’re free, they’re online. It’s not terribly complicated to build the survey, get them out, and they’re all pre-built to give you quantitative visualized results, even down to building the presentations for you to go back and share with those from whom you made the information request. And I think that’s important. You want to streamline that process to collect the information, make sure it’s anonymized where possible, organize it in graphs and charts, and be able to present that back to the stakeholders. So to me that’s simple, it’s easily accessible, and I think anyone can do it.

In the product world, we engage in maybe slightly the next level of technology, in that we are periodically asking about specific functional areas, or checking in on their happiness with their overall experience in the product. We present that on a periodic basis, it’s pre-timed per user inside of the product. Sometimes we’ll do it in a specific functional area, and we see someone try something many, many times and it doesn’t seem like it’s sticking, we’ll ask them if they’re having trouble and what would make this better.

So we’ll weave that into the product experience. It’s actually almost like a feature set. There’s technologies available to integrate into your product to do that. We use a product called Pendo, for example, that’s woven into our product to collect that feedback.

So I think there’s the easiest to the most complex. And I think in some ways we have the potential to offer that back to our clients, our own practices, to let them collect feedback in product, in workflow, on their practice. That’s probably the natural extension.

Kevin Pho: So we’ve talked about collecting the feedback, whether it’s from patients and clients about their doctors and clinicians, or employees about the institution itself. So now that we have this feedback, what are some tips to best apply it to make positive change in an organization?

Ram Krishnan: Yeah, great question. And I think that’s at the crux of the gap often, is that we collect the feedback, step one, we don’t present it back. Step two is to prioritize it.

I think it’s really critical to work with the physicians and at least get some input on which ones are the most important. Be clear, we may or may not be able to do all five of these, but let’s say, hey, there’s five key areas that we can make a difference on, let’s prioritize them, let’s weight them, and let’s pick one. And I think it’s important to demonstrate success.

So I think the common first mistake is to say we’re going to change everything, and you’re unlikely to. Pick one, make a difference, and start a project around that one particular area. It might be simple, it might be complex. Sometimes it’s really simple, it’s one simple policy change, it’s one simple process change. It might be as simple as how we’re routing prospective patients on intake, who gets it. There’s lots of different ways that it could have simple impact.

And then the more complicated ones, we’re wasting too much time doing all of the paperwork that you’re asking us to, or the process is onerous, too many steps, too many clicks, I’m not getting the patients I want to see, I’m not getting to spend the time with them I would like to. Sometimes you’ll get it in that big of a size.

I really love the concepts of lean for unpacking those sorts of things, because there are tools implicit in the lean process improvement methodology to track what’s called a value stream map, and it maps out the work process from start to finish. These sound like big corporate tool sets. They’re not, they’re not too hard to learn, they’re not too hard to employ, and they’re the most empowering change management process tools you have.

Ultimately it helps you visualize what the work is that’s happening. It helps you see where you’re doing things that add value, add value is actually taking care of patients, and which steps don’t add value. And it allows you to sit in the room with the people doing the work to design the solution. Lets you sit in the room with them and say, OK, that step doesn’t seem like it adds any value, how do we cut that one step down from 10 minutes to five?

And the promise isn’t to solve the entire equation, if you will, but to just keep chipping away at it. Take that one step from 10 to five, maybe one day to zero, and then once you’re done with that work, go to the next part of that map and find a place where there’s another source of wasted time and effort, and you focus on that.

And what happens is, the answers are with the physicians or the administrative staff or the nursing staff. They know, they’re working on the ground, they know the stupid things we’re asking them to do every single day, and they are very quick to find better ways to do them when we give them a framework in which to do that. Finding the time to do that is essential. If you really care about this, you’ve got to carve the time out to do it.

Kevin Pho: We’re talking to Ram Krishnan. He’s a technology executive, he’s the CEO of Valant. Today’s KevinMD article is “Gathering clinician feedback at a growing practice.” Ram, let’s end off with some of your take-home messages to the KevinMD audience.

Ram Krishnan: Hey, thanks. Look, I think we’re all out there working in a practice to serve patients, right? At the end of the day, our purpose in our business, even though we’re a software company, is to make the world a mentally healthier place. We do that through our customers who are serving patients.

We have to remember that the folks doing the work have a voice. They have things that drive frustrations, they have ways in their minds that could deliver better outcomes, better service, better quality, better overall engagement with patients. The answers lie within them.

Collecting feedback from them is essential to making sure their voice is heard. Then prioritizing that feedback in terms of actions you can take, communicating that with the folks you got the feedback from, and then having in mind the methodology or tool set to go drive that change, is just an essential part of a commitment to continuously improving how you deliver.

And I think at the end that makes your physicians feel heard, that makes the administration, or the management clinician relationship, trusting. And that commitment to continuous improvement is what drives results. So I think just make sure, if you go collect feedback, know that you’re in some ways beginning to make a promise, so be ready to fulfill it.

Kevin Pho: Ram, thank you so much for sharing your perspective and insight, and thanks again for coming on the show.

Ram Krishnan: Awesome, thanks. Thanks for having me, and it’s great to be here.