July 2018


To the point: Simple practice tune-ups for complex times
Onboarding a new administrator: How to smooth the transition

by John B. Pinto and Corinne Wohl, MHSA, COE

“All stories come to an end to pave way for new ones, but sometimes new stories start from old endings.”
—Hermann Steinherr

No matter their title, your practice’s office manager, administrator, executive director, or CEO is the beating heart of your organization. Changing administrators can feel like the business equivalent of undergoing a heart transplant.
In the last decade it has become vastly more perplexing to hire a practice administrator. The average practice is larger and more complex, obliging deeper management talents and more experience. The environment is more challenging, particularly in regulatory and revenue cycle management dimensions. Labor markets have tightened considerably; competent candidates have multiple positions to consider and are snapped off the market quickly whenever they become available.
Accordingly, wages have risen sharply. For the typical three MD, $5 million practice, the wage, bonus, benefits, and tax costs of adding a new administrator can approach $175,000, depending on the market—nearly twice the figure of a decade ago. And that’s before recruiting and relocation costs, which can top 20% of the first year’s salary.
So it is critical that you be as diligent in the early months of your new administrator’s tenure as you were in recruiting and selecting them. Here are a few key issues and pearls to consider when onboarding your next lay leader.
1. Your board (whether that’s you alone in a solo practice or a 20-doctor group) needs to be clear and unified about the practice’s mission, values, and future goals. Do you want an administrator who will preside over and preserve a successful, steady state practice or a manager who will drive growth and development? We are often called into practices where the new administrator is hitting bunts and base hits, while the board is looking for home runs.

2. Make sure your board is cleaving to an agreed business plan over time. It is not unusual for a board to abruptly shift from a liberal to a conservative stance after a comparatively minor business reversal. Your practice’s committed needs must align with your administrator’s understanding of their expected performance and priorities over longer time frames.

3. One of the common ways of getting this board-administrator alignment is through the use of several written documents:
a. A written business or strategic plan that has been kept up to date, spelling out your service area, growth goals, and succession planning;
b. A written position description for your administrator, which should be in sync with the administrator’s employment contract;
c. Periodic written performance reviews, typically at 3 months, 6 months, and 12 months in the first year;
d. And when necessary, written corrective action plans.

4. Make sure there is a singular, empowered managing partner of the practice. While the administrator may report directly to the board, their most important interface is commonly with the managing partner, who can help them learn “how the company works,” prioritize early orientation efforts, and shield them from undue intimidation from fellow board members.

5. A significant frustration for new administrators is getting enough face-to-face time with the managing partner and board. Be careful to not signal your impatience, time pressure, or disengagement by saying things like, “I can give you 5 minutes, what’s up?” It is appropriate for the managing partner and administrator to have a meaningful weekly meeting; a standing breakfast or lunch meeting is effective and helps to build a deeper relationship. Other owner physicians should make themselves openly available for meetings with the new administrator. Your board should have patience in the early months for somewhat more prolonged monthly meetings, allowing time for issues to be discussed in enough detail to give your administrator a sense of how you make decisions.

6. Pass the mantle of authority crisply from the old administrator to the new one. In ideal settings, an all-hands reception or routine group meeting is held to welcome the new administrator.
7. Even if your former administrator has been terminated under difficult circumstances, make every effort to connect your new and old administrator. Even under-performing administrators who are replaced have legacy knowledge your new administrator will need. It’s best policy to separate from your old administrator in a manner that not only preserves their dignity and their good will, but also sends a signal to your new administrator: “We’re good guys and treat folks well even if things don’t work out.” Take special care to not speak disparagingly of your former administrator; find a kind, professional way to say, “Sally had a lot of real strengths we admired, but marketing was not one of them. We’re looking forward to your ideas in this area.”

8. As difficult as it can be, start your new administrator with 100 points, rather than with zero points and adding slowly over time (which is a common thing for skeptical ophthalmologists to do). Humans have a well-tuned sense for whether or not they are liked and trusted and kept in the loop on sensitive matters. If your new administrator senses your coolness or conditional friendliness, they will not feel secure enough to do their best work for you.

9. Make it an obligation of the job that your new administrator comes to a memorized command of the key performance indicators of the practice within their first 90 days on the job. Just as you learned the norms for cup-to-disc ratio, IOP, and visual acuity early in your training, your administrator should memorize things like profit margin, labor cost-percent, and facility utilization levels.

10. In their first 90 days, your administrator should have:
a. Read all meaningful contracts;
b. Come up to speed on any open legal matters;
c. Observed every lay staff position in the practice;
d. Observed clinic and gone to surgery with most providers;
e. Had meaningful conferencing time with all of the mid-level managers and a significant cross-section of rank-and-file staff;
f. Set up preferred staff and department meeting intervals;
g. Learned how to pull basic reports from your practice management system;
h. Made critical decisions about inappropriate staffing or policies;
i. Provided the board with a written report along the lines of: “Here are my observations and recommendations for the next 12 months.”

About the authors

Mr. Pinto
is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm in San Diego. His latest ASCRS•ASOA books, Simple: The Inner Game of Ophthalmic Practice Success and the Fifth Edition of John Pinto’s Little Green Book of Ophthalmology, are now available at www.asoa.org. He can be contacted at pintoinc@aol.com or 619-223-2233.

Ms. Wohl
is president of C. Wohl & Associates Inc., a practice management consulting firm. She earned her masters of health services administration degree at George Washington University and has more than 30 years of hospital and physician practice management experience. She can be contacted at czwohl@gmail.com or 609-410-2932.

Onboarding a new administrator: How to smooth the transition Onboarding a new administrator: How to smooth the transition
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