01/01/2026
Business Grand Rounds™ — Case #001
In medicine, we’re trained to form a differential based on the clinical picture, then review vitals, labs, and trends. Assessment, plan- road to recovery.
When I work with a medical practice, I take the same approach: understanding the presentation, analyzing the operational vitals, and improving the patient-to-payment pipeline, revenue cycle, and overall workflow cadence.
The longer you’ve been at it, the more cases you’ve seen—and the faster you recognize the patterns that predict trouble and how to solve them.
Last week, I walked into a practice and immediately recognized the stress pattern—the cadence was off. Poor financial performance. No clear way to see what was actually happening.
No North Star.
Patient: The practice
Presentation: Payroll rising, cash flow tight, staff increased—but patient volume unchanged. Days felt heavier, and the physician was covering gaps to keep things moving.
Vitals & Trends: (signals the system lacked visibility)
• Payroll ↑ month over month → no consolidated view of labor costs
• Visit volume steady → staffing increases not translating to output, no single source to track productivity
• Revenue lagging expenses → no clear line of sight to where money was leaking
• Physician hours quietly expanding → no system to monitor workflow dependency
Assessment:
The practice did not have a system.
No unified reference for key metrics.
No KPIs.
No North Star.
It was running on sheer grit- admirable but not sustainable.
Like a patient in the unit—we need an EKG, serial labs, and a clear disposition.
Insights:
• The practice was reactive rather than proactive
• No leading or lagging indicators to anticipate issues
• Key operational signals scattered or invisible
Plan:
• Define the North Star
• Create a single reference for operational indicators
• Establish cadence and ownership for workflow
Disposition: Operational, Sustainable, Scalable.
I design systems that work.
Design the system. The results will follow.
With intervention his practice could thrive—but only if the plan is followed.
Curious how your practice measures up under a stress test?
That’s exactly what we explore in Business Grand Rounds™—analyzing operational vitals.
Happy New Year! 🎉
As we start 2026, think of your practice like a patient: now is the perfect time for an annual operational physical—stress-test your systems, review your vitals, and make sure your workflow, revenue cycle, and patient-to-payment pipeline are healthy for the year ahead.
