Years ago I wrote an article titled Why Hospital CFOs Don't Hire CDM Consultants. I wrote it because I've seen and read about a lot of bad advice that's been given to facilities and companies that hurt them way more than helped. Being an independent consultant, I couldn't let something like that keep occurring without some input.

I don't necessarily have anything against large consulting companies. However, in all my years of being an independent consultant only once did I have a large consulting company call me to avail themselves of my services, and it wasn't a pleasant experience. I've had plenty of small to medium sized consulting companies work with me and those have worked out nicely. As a matter of fact, I could have used small consulting companies instead of independent consultants but I'll let them write their own blog post on the subject.

Most organizations, when they feel they need to make a statement, go for the big boys, and whether they know it or not, they're not helping themselves any. Why not? Well, that's what this post is all about. Most of my examples will be health care related because that's my main industry, but not all of them. It's just that I can document with more facts better in that industry than I can in the rest of them. But I will guarantee that I'm not wrong on any of them. Here we go.

1. The focus on the job at hand is stronger with an independent consultant than with a large consulting company.

Whenever I work with a client, my focus is on getting the job done as best as I can in the time allotted, solving issues as I go and leaving the place better than when I started. The focus of large consulting companies is to see how much more money they can soak out of their client, not solving issues.

My example of that is this large consulting company that did work for a hospital in Los Angeles some years ago. The hospital had been cited for multiple issues by the state, and the consulting company had come in to help them address those issues. In two years not only did they only fix one problem (yup, all of one issue) but they took financial advantage of a hospital in trouble by what I consider as unethical expenses that, unfortunately, were agreed to in the contract.

2. You know the independent consultant has real world experience in what you're asking them to do.

Whether I'm doing health care, teaching management or diversity, or consulting on social media issues, you can bet that I've actually done all of the work and worked with people on these things. It's a life experience I'm able to bring that helps me relate to the issues my clients face.

On my one assignment with a large consulting company 9 years ago I was working on a project with 8 or 9 other people. I put it that way because one person flew in from another country once every other week for 3 days, and the overall project manager flew in twice and pretty much did nothing while I was there except talk a lot.

Out of all the people who were on the assignment, only two of them other than myself had ever actually worked in a hospital, and one of those people had only worked in a hospital for just over a year... in IT, which means he wasn't qualified to do the work he was being paid for since he didn't do anything with that department in the time I was there. Frankly, with the decisions they were making the hospital really should have asked for people with actual experience doing the job. Charts are only as accurate as the background of the people who are going to assess the information; my opinion.

3. Independent consultants assess information and make real world decisions, while large consulting companies base their decisions on global issues that don't always work.

On one of my consulting assignments I went into a situation where the relatively new billing system hadn't been customized well and billing was in disarray. Not only that but receivables were rising.

During the process of accessing the issue I discovered that there used to be 6 1/2 more personnel in the department than there were when I was there. When I asked about it I was told that the large consulting company that had come in before me believed that the department was overstaffed by that many people and thus they were let go.

This was a stupid recommendation for two reasons. One, whenever you bring in a new computer system, you often need more help than less help because suddenly you're working on two computer systems, trying to clean up existing receivables while working and learning a new computer system. Two, in health care, if you're paying attention, the last place you think about reducing staff is in the business office, the area where people are tasked to bring in your money.

In a worse case scenario, how much sense does it make to let go of a person whose work brings in $750,000 a month while making less than $20,000 a year? Yet, I see this kind of advice all the time coming from large health care consulting companies, and not just for billing positions.

Few of them take the time to learn how departments work; they say they're in the game to help shave expenses. It was decisions like that which led to another hospital I was consulting at slice off their entire physical therapy department when a larger consultants group they'd brought in previously determined they weren't generating enough income off it. I discovered the reason why once I got there, but it was too late to bring it back. Sigh...

4. Independent consultants are beholden to their reputations; large consulting companies are beholden to their stockholders and board of directors.

My reputation is totally based on how good the work is that I do and how sound the recommendations I give are. Even working with individuals on things like executive coaching or seminars, if I don't come fully loaded each and every time my reputation suffers.

For large consulting companies, they may want good work performed but it's all about the billables and the profits their organization generates for them instead of the clients. With so many campaigns going on at the same time, they can afford to have some fail and lay blame on issues with the client that weren't able to be overcome. Somehow they'll end up getting work again because they've built up a name more than a positive reputation. Opinion once again, but I've seen it often enough.

5. Overall prices are at least comparable, though generally much lower.

Let's face this fact; there are some services I offer, like the CDM services I linked to earlier, where sometimes my short term rate is higher than the rate of a large consulting company, but most of the time it's lower. A large company, to get into a hospital so they can look for other services they might be able to provide, might try to undercut my rate, and it's happened to me here and there over the years. There's nothing I can do about that because I can only lower my price so much; I'm much more dependent on my rate than they are in that regard.

At the same time, I remember when I was working in my last hospital system as an employee that, instead of the system allowing someone like me to go to the main facility to help lead during a time of transition, they brought in 3 consultants from a large consulting company at a rate of $300 per hour each, and only one of them turned out to have any hospital experience whatsoever (I asked of course), someone I knew who didn't actually work for the company but had been recruited as an independent to run one of the projects for them.

I think I've made my case here but if there's a dissenting point of view, I'm willing to entertain it. The truth is what it is in my opinion; it's no wonder someone that works for a interim placement company asked on LinkedIn some time ago asked if "consultant" was a bad word to use in referring to themselves as an independent, and why there are lots of articles asking the same thing. It's no wonder I've had people tell me that I'm unusual for a consultant.

No I'm not; I'm just an independent.