Long-termism – stop doing stupid t

When people start talking about Long-termism it does sound boring and irrelevant – like choosing your retirement home or saving for your funeral. But Long-termism is kind of cool. It starts with not doing stupid things that make a fast buck but eventually wreck your business (that’s what they call Short-termism). But the fun part is discovering your superpower and then leveraging the living daylights out of it. That’s when the magic happens.

Stop doing stupid things
The problem with Short-termism is that it seems perfectly logical. You need to balance the budget so you think you need to sack good staff to make sure the numbers add up.  You think it doesn’t matter if you have to hire locums or agency to cover the work because they are short term and so aren’t a recurring cost. So you can pretend that somehow next year you won’t need to hire them again and you can ignore them in your projections. But the truth is that you need to put aside wishful thinking you and assess what you really should do to maximise the care you can get for your spend.

Work out what will kill your practice
Actually running out of money and not being able to pay people is a no no. Not looking after patients and having them come to harm is not ok. Breaking the law is bad – especially if you get caught. Not being insured, not paying your taxes, getting struck off – all of these are things to avoid. While you focus on your long-term goals, you may have to make some painful short-term choices to keep your business afloat. You may even need to cut pay or lose some good people because you can’t afford them. But be utterly transparent about what you are doing and why you are doing it. Recognise the necessary evils of these actions and do what you can to mitigate their harms.

Ignore things that won’t hurt you unless they help you (a lot)
Don’t waste time on meetings, audits, emails, letters and requests unless they are actively helpful to you. Even if they are helpful, discard the ones which take more effort than they are worth. Look at your internal systems for things you don’t need to do or could do less – keep your protocols as simple as possible while still achieving their purpose and don’t feel the need to rewrite them unless they are wrong.

Find your Superpower(s)
Every practice has some things it about it that make it special and multiply its effectiveness. Identify these things and use them to make the best use of your effort. It may be that you have a great reception team, or charismatic partners, or have a special patient group or have an unusual source of income. It doesn’t really matter what it is and it doesn’t matter if your first idea doesn’t work. The mindset of looking for advantages to exploit means that if you persist then you will find things that work for you.

Case Study: Continuity as a Superpower
In my practice we had a fairly stable patient population which allowed us to have good continuity with patients. That meant we could get to know them really well and we wondered if that would make consultations quicker and easier because we needed to spend less time finding out about ongoing problems. We also wondered if patients who knew their doctors personally would be more understanding when we were under pressure.

Leverage your Superpower(s) by playing to your strengths
Leveraging is using something to its maximum advantage. Once you have identified a Superpower, look for ways to do more of it and make it more effective. Whenever you are thinking about a change, check it doesn’t act against your Superpower. And then, crucially, make sure your Superpower is having the effect you thought. You need to remember you could be completely wrong and have the humility to ditch what isn’t working.

Leveraging Continuity
We wanted to facilitate continuity by making it easier for patients to see the same doctor about the same problem so we trusted patients to book with the clinician of their choice. We also encouraged doctors to change the “usual doctor” on our clinical system so reception would know who was expecting to look after a patient. When others were adding demand management with triage systems like Doctor First, we felt that they would harm continuity and the patient would have to explain their history all over again to the duty clinician. Instead we chose to stick to named-clinician bookable appointments – even when we were doing mostly remote consultations during the pandemic.

Checking our Superpower wasn’t a dud
We used our clinical system to collate all consultation data on our patients – not just appointments but all clinical contacts including those initiated by the doctor. We found, even in the pandemic and its aftermath, that our patients did their best to look after themselves and our workload was controlled. We didn’t have complaints when we had to go to remote consulting and when we trusted patients to book face to face appointments, they were considerate and didn’t abuse that trust.

Long-term advantages add up
“It takes 20 years to become an overnight success”. While we may not be able to wait 20 years for things to get better, we do need to resist the pressure for instant results and the mantra of “picking the low hanging fruit”. If you persist in doing the right thing, you will find that quite quickly the benefits start to accrue. It is not trendy for leaders to admit that they are simply building on the foundations laid by those who came before, but for successful organisations, this is usually the case.

“We are what we repeatedly do. Excellence then is not an act but a habit”. Don’t be seduced by the “easy win” that robs us of long-term progress. We need to take time to allow the long-term gains to shape our practices so they thrive and survive.