Practice Management
July 2023
by Corinne Wohl, MHSA, COE, and John Pinto
We are often asked by practice owners to evaluate and upskill their administrators. This is a reasonable request. And in many cases, it’s appreciated by the most ambitious administrators, who are always on the lookout for career coaching tips. But the reality is that a doctor’s concerns about administrative competency are as much rooted in a physician’s leadership and supervisory skills as they are in issues of administrative competency.
This area of practice ownership can be a major communication hurdle for managers and physicians to work out. Here are seven rhetorical questions physicians can ask themselves to understand their role—as well as their managers’—in running a better practice together.
1. Am I a good listener? When the administrator is presenting facts or answering questions, am I focused on the information, or have I already formed an opinion and tend to ignore the answers to questions I have asked?
A good listener is present and in the moment. They pay attention to the person speaking and ask questions when appropriate. They perhaps begin the conversation with an opinion but not with a closed mind to alternate views and approaches.
We sometimes see managing partners and administrators talking past each other rather than talking to each other. A managing partner who is not open to hearing about options to address uncomfortable issues tends to create a practice culture of staff frustration, high staff turnover, and a level of mediocre customer service.
Learning to be a better listener is possible. Be present. Stay focused on the conversation. Don’t interrupt or think about what you will say while the other person in the conversation is still talking. Be open minded and not defensive when you hear something you don’t like. Sometimes it helps to take a pause and absorb the conversation to consider the possibilities.
2. How do I know if the answers I receive from the practice administrator or mid-level managers are accurate and reliable?
Follow the numbers. The strongest practice leaders, both physicians and managers, make data-driven decisions. Set the expectation that the use of metrics and benchmarking will be part of the decision-making progress. If your administrator says, “I think we need more staff because the techs are complaining about too much work,” that is a start but not enough.
If your administrator says, “Our tech staffing ratio is 0.8 tech hours per patient visit, and the standard benchmark is 1.0–1.1 tech hours per patient visit, so it is understandable that the department feels understaffed,” you know they have studied the problem and provided a reasonable recommendation.
3. Is my administrator happy in their role? They seem stagnant in the position. Does this mean I need to replace them?
First ask yourself, do I prioritize time with my administrator? Do we have a weekly scheduled meeting together, or do I meet with them intermittently when it is convenient for me? Do I show respect for their time and role? Do I fully consider their recommendations and approve their good ideas?
Then ask your administrator if there are ways that your working relationship and communication could be improved or if they are happy with the way things are.
The answer we hear most often from unhappy administrators is that meetings throughout the practice are not prioritized. This communication deficit is a key reason for poor staff performance, staff frustration, low patient satisfaction, and increased management challenges.
4. As a physician, I depend on my administrator. How do I know when an unreasonable dependency has been created?
There is nothing wrong with a healthy interdependency with the administrator. The administrator role is designed to decrease the administrative time of physician leaders so they can focus on patient care time. However, it is important to fully understand the specifics of their role and be prepared and able to step in to either perform some tasks yourself or know how to direct others to fill in the gaps.
When an administrator is dismissed or leaves unexpectedly, their absence can create operational chaos if a backup plan is not in place. In small and mid-size practices, a physician commonly acts as the interim administrator. When you lose a manager, scores of wheels can fall off the bus—timely billing and cash flow, human resource management, passcode management, accounts payable, and financial/bank account management. For larger practices, a strong core of mid-level managers can ease the disruption, but there are still many details that administrators do not generally share with department managers.
You also want to be able to hold your administrator accountable (and vice versa) to the practice goals and role of the position. This is only possible if you fully understand their role and responsibilities beyond reading the position description.
Another important aspect is to have strong financial controls in place to deter embezzlement opportunities. No one wants to think that the administrator they have worked with for years would ever divert funds, but it happens more than you can imagine. With close oversight and controls in place, opportunities for theft are decreased.
5. What is the appropriate way to interact with mid-level managers without undermining the administrator?
Some administrators can get protective or defensive when you communicate directly with the mid-level department heads that they oversee. This needs to be handled sensitively for trust to be maintained between the physician and administrator.
The best approach is to include the administrator in the process. We see that managing partners have the most success when they participate in formal “management committee” meetings, held about every 2 weeks with their administrator and mid-levels all in attendance.
6. What kind of meetings should be held regularly for good communication?
Beyond these “management committee” sessions, physicians should make sure that the following group meetings are being held:
- Managing partner/administrator meetings – weekly
- Department meetings (chaired by the department manager) – monthly
- Board meetings (administrator and physician owners) – monthly
- Provider meetings – monthly, bimonthly, or quarterly, depending on practice size and the issues the practice is working through
- All-staff meetings – monthly, quarterly, or semi-annually, depending on the size and geographic footprint of the practice
7. How do I eliminate or reduce the avoidance of conflict in a practice?
Avoidance and withholding of information work against open, free-flowing, trusting communication. If top leadership behaves this way, the practice culture follows.
Ways to keep communication flowing and always improving include:
- Set the expectation that great communication is a priority.
- Accept that feeling uncomfortable and approaching issues openly (especially when sensitive topics arise) is necessary to provide high-quality patient care and service.
- Set the example for being open to hearing constructive criticism and improvement suggestions. Issues don’t go away when they are not talked about openly. They linger and fester beneath the surface, becoming larger and more difficult to solve over time.
- Encourage all practice employees and providers to speak up. Let them know that they will be heard.
About the authors
John Pinto
President
J. Pinto & Associates
San Diego, California
Corinne Wohl, MHSA, COE
President
C. Wohl & Associates
San Diego, California
Contact
Pinto: pintoinc@aol.com, 619-223-2233
Wohl: czwohl@gmail.com, 609-410-2932
