September 2020

INSIDE THE PRACTICE

Increasing business discipline with ‘accountability documents’


by John Pinto and Corinne Wohl, MHSA, COE

Physicians, partly by choice, mostly by higher authorities, are almost completely hemmed in by a structure of accountability. Medical records oblige providers to assert an opinion about what’s wrong with a patient and how their problem should be treated and documents that the prescribed course of action has been taken. Surgical notes force a doctor to create a legal record of what they did and how the case turned out. Doctors are accountable to third-party payers through billing records that can be audited and declined—even send you to prison.
So much for nailing down accountability in the professional half of your practice. But what about the other half—the business half? As an owner and the ultimate beneficiary (or victim) of staff performance, do you enjoy the same confidence in your managers as your patients and society at large have in you?
The heart of business—like the heart of medicine—is accountability. And in business, the tools used to assure accountability share much in common with the accountability tools imposed on providers; they are mostly in the forms of written reports and documents.
So-called “accountability documents” help to keep people accountable. Here are 10 common ones. Many of these may already be present in your practice but may also be in need of improvements or updating. Some may be absent. Ask yourself, “Would our practice be better run with this one or that one in place?”

1. Human resources manual: This is the old standby, so common that it’s often drafted, signed off on, and forgotten for years. Owners and managers alike should reread their personnel manual annually, asking themselves “Are we following this? Are any of these standing policies in need of a change?”

2. Job descriptions: We still come across practices on the verge of making a new staff hire but with no written job description to guide the selection. Keeping job descriptions current is typically a collaboration between the administrator/department head and each person who is actually performing the job in question.

3. Employment contracts: While these are usually limited to medical providers and occasionally to senior management staff, employment contracts are the foundation of a worker’s responsibility to the company and your responsibility to that worker. Reread at least annually and ask, “Is this still complete and appropriate?”

4. Performance reviews: While you may have a rising or falling opinion of each worker’s performance, to be a responsible and accountable employer or manager, you need to take the time every 6–12 months to inform each worker (including doctors) formally of how you think they are doing.

5. Checklists: Even the most experienced airline pilots get ready for flight using written checklists. Running an airplane, like running a practice, is maddeningly complex but can get a little boring and routine, so it’s critical to use checklists to ensure nothing is overlooked.

6. Procedure manuals: Even the least demanding tasks in a medical practice have a right and a wrong way to be performed. Too few practices develop a written procedure or operating manual that they then use to train and retrain, audit performance gaps, and drive process improvement. Even the smallest solo practice should have a 100+ page binder or electronic file describing how things are properly done.

7. Financial reporting: Business performance is chiefly measured by units of dollars. Profit and loss statements, balance sheets, annual budgets, and the like help boards and administrators discuss goals and be more accountable for reaching agreed performance targets.

8. Benchmarking statistics: Beyond routine financial reports, there are a lot of stats to stay on top of—more than 50 at last count. Here are a few examples: tech hours per patient visit, patient visits per exam room hour, net profit per MD hour worked, and no-show rate. Each of these have norms, which effective practice leaders memorize, allowing them to be more accountable for company performance.

9. Agenda and minutes: If you are a leader in charge of practice meetings—board meetings, department meetings, and the like—having an agenda and generating brief minutes afterward will help you be more accountable to your leadership responsibilities.

10. Project tracking tools: The average practice department head typically juggles about five projects at once (this might include the purchase of a new piece of equipment and getting up to speed on it or adopting a new practice management system). The typical administrator may have 15 or more ongoing, demanding projects under way. COVID-19 has multiplied these figures considerably, of course. Most people responsible for ongoing projects have their own method of keeping track of them, perhaps on a Word file or an office whiteboard. As a practice leader you can help everyone to be collectively more accountable for these live projects by having a central report showing all open practice projects at a glance. There are numerous project tracking approaches. Before computers we had “scan card” systems, with 3 x 5 cards, one per project. Microsoft Project is one of many robust programs for very large practices. For select clients, we build a simple “action grid” with a line item for each project showing the action to be taken (and outcome desired), its “owner,” the deadline, and dated progress notes (updated every couple of weeks and shared among the entire management team).

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
Wohl: czwohl@gmail.com

Increasing business discipline with ‘accountability documents’ Increasing business discipline with ‘accountability documents’
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