Last week, we left Ridgeway O&P considering a hospital contracting opportunity. Our fictional practice had earned the hospital’s attention through its reputation and documented patient-reported outcomes, and the owner was intrigued enough to evaluate the opportunity. The question was not simply whether Ridgeway could take on more work, but whether the way it had always worked was still the right approach for what might come next.
That question comes into focus as the owner considers what the contract might require: “If we take this on, we will need to increase our prosthetic capacity.” Before deciding how to do that, the owner needs to understand what additional capacity would be required and where the current approach would fall short. Hiring another prosthetist is one possible response, but choosing it now would mean selecting a solution before defining the problem. The starting point is the gap, if any, between what Ridgeway can provide today and what it would be committing to provide.
When familiar becomes automatic
I can understand why Ridgeway’s owner would be comfortable with the way the practice operates. The team’s relationships and results give the owner good reasons to respect its current approach. If the owner says, “We have always done it this way, and it works,” I would want to understand what makes it work before suggesting anything different. At the same time, I would not want that success to close the discussion about whether another approach might better support what comes next.
That is where “Why fix what isn’t broken?” deserves a closer look. Ridgeway does not have to find fault with its current operation to consider organizing the work differently. The hospital opportunity gives the owner a reason to examine what limits the practice’s capacity and whether those limits are tied to the way the work is arranged. If the discussion stops at “we have never needed to do that,” the practice has not evaluated an alternative; it has simply described its history.
Of course, looking at a different approach does not mean adopting it. The time, resources, and disruption involved may outweigh the benefits for Ridgeway, but that conclusion should come from understanding the options. There is a meaningful difference between deciding that the current approach remains the best fit and retaining it because it is the only approach anyone has seriously considered.
Clarifying the hospital’s expectations gives this discussion a practical purpose. Once Ridgeway understands the proposed commitment, the team can examine where its current approach would serve it well and where something might need to change. That grounds the conversation in the work, rather than in a general argument for or against change.
Define the commitment, then examine the approach
The proposed contract includes inpatient coverage and post-discharge O&P services. For a patient facing a planned amputation, Ridgeway would ideally become involved in preoperative consultation when circumstances allow. The owner needs to establish whether the hospital envisions the same relationship and what availability and responsiveness would be expected. That conversation should reconcile what Ridgeway considers good service, what the hospital needs, and what the practice would agree to provide.
Information about workload and service mix would help test whether additional prosthetic capacity is needed. Ridgeway should also distinguish the coverage it would promise from the post-discharge business it hopes to receive. A brief summary of expectations and unanswered questions would give both organizations something concrete to discuss, but the hospital is not the only party the owner needs to hear from.
The people who would make the arrangement work also need a chance to discuss what it would mean for their working days and their lives outside the practice. A clinician who currently works in one location might now be expected to leave the clinic, travel to the hospital, and return to appointments or unfinished documentation. Colleagues remaining in the clinic might need to handle interruptions, rearrange schedules, or cover additional responsibilities. Before accepting those changes on the team’s behalf, the owner should understand what they would involve.
This is where the thinking behind our “People First” discussion becomes practical. The owner needs to ask employees how the proposal would affect them and what would make it workable. One person might welcome hospital involvement as an opportunity to develop professionally, while another might place greater value on a predictable schedule or being able to leave on time. I would not assume that additional compensation would make either person comfortable with the arrangement or ask them to disclose private circumstances to justify a concern.
Those conversations should happen while there is still room to shape the proposal. A concern about travel, schedule uncertainty, or added responsibilities is not necessarily an example of the inertia we are trying to avoid; it may identify a real cost that the owner has not yet considered. Leadership still involves making decisions and explaining tradeoffs, but the plan should not depend on employees quietly absorbing hardships nobody discussed with them.
The capacity question now includes the full commitment: What arrangement would meet the hospital’s expectations, preserve existing patient care, and be workable for the people providing it? The goal is not merely to find enough hours to cover the work, but to establish how those hours would fit into a working life the team can reasonably sustain.
Give the unfamiliar option a fair hearing
Against those expectations, Ridgeway can compare ways to provide any additional capacity it needs. Another prosthetist may be one option, but the owner has also heard that assistants can help a prosthetist serve more patients. Ridgeway has never used that arrangement, which makes it something to learn about rather than dismiss. The useful question is whether it could address the needs the practice has identified.
I would want the current prosthetist and office lead involved in evaluating the idea. Which responsibilities could appropriately be assigned to an assistant, and would doing so free the capacity Ridgeway needs? What supervision and training would be involved, and how would those responsibilities fit alongside the prosthetist’s existing work? This is a chance to understand both what the arrangement would ask of the team and what it might make possible.
Conversations with practices using assistants could help, particularly if Ridgeway asks how their work is organized, what preparation was necessary, and what limitations remain. Their experience could give the team better questions to ask, but it would not establish what the same arrangement could accomplish here. Ridgeway would still need to verify appropriate responsibilities, qualifications, and supervision under relevant professional and state requirements, separately from any applicable hospital or payer conditions.
The same examination should apply to another prosthetist or a different distribution of existing work. Each option needs to be considered against the commitment, the capacity it would provide, and its effect on the people involved. “We have never done that” can begin an inquiry without deciding its outcome.
Staying the same should be a decision
Ridgeway may come away from this evaluation with a different staffing approach, a proposal to negotiate expectations with the hospital, or good reasons to preserve the way it currently operates. The owner does not need to make a change to justify the time spent looking. What matters is being able to explain the choice in terms of patients’ needs, the people providing care, and the direction of the practice.
Perhaps the current arrangement provides the reliability patients need and a working life the team can sustain, while the alternatives offer too little benefit to justify the disruption. Or perhaps the discussion reveals an approach worth developing even without the hospital contract. In either case, Ridgeway would have a more useful explanation than “we have always done it this way.” The choice would reflect what the team had learned rather than what had become familiar.
At your next management meeting, consider one familiar way of working and ask the team what makes it worth keeping. You might hear good reasons that deserve recognition, along with frustrations or possibilities that have not received much attention. The purpose is not to find something wrong or launch another improvement project, but to understand whether the approach still serves the practice well or simply has not been reconsidered.
On November 20, we will turn to the next decision: what would make a promising opportunity worth committing to? Being willing to reconsider the familiar approach does not mean accepting every possibility that emerges. Ridgeway still needs to establish what it can afford, what it must protect, and the conditions under which expansion would make sense.