By Arun Sharma
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June 9, 2019
On June 7, 2019, I presented the concept of the liquid organization to more than 30 attendees at the CEO Club at WorldCity . An interesting subject that was raised in the discussion was how to make firms built on individual expertise (e.g., physicians, lawyers, tax accountants) more liquid. These firms are characterized by deep expertise or specialization, and a focus on one-to-one relationships—factors that reduce liquidity. I think that specialist firms can become more liquid and I demonstrated this using physician practices as an example. Traditionally, physicians with specialization (e.g., pediatricians, interventional cardiologists) practiced alone. However, like-minded physicians started group practices where doctors saw any patient (not just their own), and patients had access to multiple doctors with similar expertise. Patients at a group practice could see a doctor quickly, as they did not have to wait for an appointment with a specific doctor. Similarly, doctors in a group practice could have a more flexible schedule and reduce some of the time they spent on paperwork and calls (being available in case of need). The results were very encouraging. Once patients had used a group practice, they preferred it to visiting an individual physician. Also, insurance firms and hospitals preferred to work with group practices rather than individual physicians. It is estimated that the majority of physicians in the U.S. currently belong to a group practice, and less than 17% of physicians have a solo practice. Our research finds three characteristics of successful physician group practices. The first characteristic is that although each physician in a group can have super specialization, they need to be able to see 90% of the patients that come to the practice; in other words, they need to be generalists first and specialists second. The second characteristic is heightened attention to patient data: physicians need to provide detailed notes on patients, allowing other physicians to quickly understand patient history. The third characteristic is culture: successful group physicians like working with their colleagues, and have a transparent culture and robust process improvement focus. As an example, successful group practices examine each adverse incident transparently, do a root-cause analysis, and take corrective actions. Specialist firms (e.g., legal and accounting firms) can become liquid by following the same principles. First, firms need to hire and promote specialists that can address 90% of their clients’ needs. The second change, which is more difficult, is to create a process of capturing client details so that other specialists can work with the client. Most firms will need to develop a customer data capture process, which will be disruptive to current processes and requires patience and an implementation focus. The third and most important change is to develop a culture of cooperation, transparency, and continuous focus on process improvement. The cultural focus needs to come from top management, and recruitment and promotion decisions need to incorporate culture.