The Iowa Clinic: C. Edward Brown, Chief Executive Officer

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The Iowa Clinic is a $120-million, fully integrated multispecialty clinic with more than 140 physicians and healthcare providers practicing in 32 specialties. The group has about 500,000 patient visits each year, 167,000 of whom are unique patients.

The Iowa Clinic also enjoys national influence thanks to its involvement with the American Medical Group Association (AMGA). Its chief executive officer, C. Edward Brown, has served as a past chair of AMGA and has been a member of the board for 10 years.

The Iowa Clinic continues to be involved in public policy on both state and federal levels. From a clinical standpoint, the organization works hard to establish areas of clinical excellence and remain active in medical education and in research.

“Those are the various venues by which we try to establish ourselves professionally on a regional and maybe even on a national basis,” Brown said.

From paper to technology

Throughout the last six years, The Iowa Clinic has transformed from a paper-based organization to a technology-based organization. The biggest step in this transition was converting every department to a fully integrated electronic medical record (EMR). This was a massive project that took about 18 months to complete. Despite the challenges associated with this transition, the benefits of the EMR were quickly realized.

The Iowa Clinic continues to embrace technology, not only in the clinic setting, but also throughout the organization. For example, when patients check in at The Iowa Clinic, it’s done on an electronic clipboard known as a kiosk. The entire process is now completely paperless. Brown pointed out that only a few organizations in the country are able to say that.

“There’s no paper when you come to The Iowa Clinic,” he said. “You check in electronically, and if you don’t feel comfortable checking in electronically because of your skill sets, we’ll do it for you.”

When a new patient checks in for the first time, the process might take 10 to 15 minutes, but for visits after that, check-in will only take one-and-a-half to two minutes. The clinic also promotes electronic payment.

“Moving to a kiosk has had a positive business influence on the organization because we’ve improved the effectiveness of the data that we’ve received,” Brown said. “It’s standardized. We’ve improved our collections, and it’s improved the efficiency of our operations.”

Letting physicians take the lead

Brown said expanding quality measurements and operational feedback in terms of quality performance has become a physician-driven priority for The Iowa Clinic.

“The entire organization is involved when it comes to quality,” he said. “Each department establishes its measures. We are working with our local payers through a collaborative contract agreement and bonus program focused on performance. The endgame is improved efficiencies and improved quality patient outcomes.”

Another example of physician leadership is demonstrated through a collaboration with the University of South Florida. The Iowa Clinic was the first in Iowa to establish a physician-leadership institute. A cohort of 16 physicians and administrators participate in a one-year program on-site at The Iowa Clinic. The emphasis is on experiential learning in leadership development.

Participants in the program are placed in situations that force them to examine what leadership means to them; who they are as individuals; what their personal skill sets are; and what they need to improve personally in order to be a more effective leader.

The students are divided into three groups and given meaningful corporate projects that have a return on investment to the organization. Upon completion, these projects are delivered as formal reports to the board of directors and then implemented.

The first class focused on the following projects: cardiovascular services, customer service, and defining the healthcare organization of the future.

“Those reports were presented to the board first, and then, they were presented to the entire physician membership of the organization,” Brown said. “That whole program has had a dramatic change on the participants, and at a board level, we believe that it will have a positive cultural change on the organization.”

A more conservative time

With the economic and federal restraints being imposed upon healthcare institutions, Brown said The Iowa Clinic has been focused on paying down any debt it has and on being more conservative in capital acquisition.

He admits to some trepidation about the future, saying that the Clinic will continue to evaluate its strategic position.

“That has become more important now than ever before,” he explained. “With the uncertainty in the banking and lending markets, the amount of collateral one needs to have in order to have access to capital will cause organizations to look at strategic relationships that much more. I will predict that we will have close strategic partnerships with larger organizations that culturally fit with our organization.”

He added, “While we’re in a position of change and uncertainty, we should never lose sight that our primary interest is the patient, and we should never let the political winds or the economic debates allow us to lose sight of that. And we must maintain the position of being the patient’s advocate.”

-by Pete Fernbaugh

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