Laurie's new book is out! Job Hunting for Physicians is the perfect guide for residents and fellows embarking on their all-important first-job search. It's available at Amazon, Barnes & Noble, and by request at your local bookstore in both print and ebook. Laurie's also looking for a few residents and fellows to review the book. You'll be provided with a free ebook to do so. Reach out to her via our contact page for more information.
I recently learned that this article I wrote for PracticeLink ("Timeline of a Physician Job Search") took silver in a national awards competition! Quite a pleasant surprise (partly because I didn't even know the editor had submitted it). If you or someone you know is a job-seeking physician, check out this link (and if you have comments, I'd love to hear them). -
Do you tend to refer to staff or their roles in your practice with generic terms like “billing person” or “someone on phones”? These descriptors seem like innocuous shorthand. But when physicians and managers speak about people in this generic way, it can send an unintended message that you view your employees as interchangeable cogs. Employees may assume that their career progress will never be recognized, or that employees’ specific contributions are not appreciated. Morale may suffer, and, over time, that can mean higher costs due to turnover. Productivity may be suppressed, too. Whether you’re a physician or a practice administrator, you worked hard to earn the respect that comes with your title. Feeling recognized for your achievements and contributions enriches your work life. The “billing person” who is working to bring money in your door may have invested in education to learn their profession, too. Though the training is nowhere near as competitive or lengthy as medical school or climbing the management ladder, becoming a skilled medical billing professional takes energy and commitment. Perhaps you now have an expert biller on your team, where you once had an eager novice who needed to apply herself to becoming proficient—a point of pride for her, and a financial benefit for you. Even roles like receptionist that have few education or experience requirements can be done with inspiration and excellence when your staff is engaged—benefitting your patients and your practice. On the flip side, if your staff is disengaged and going through the motions, you’re missing a big opportunity for your practice to stand out. Regardless of the roles they play, most of your employees spend more time working in your business than doing anything else. An atmosphere where there are a few valued players at the top and everyone else is considered interchangeable is not one where motivated people will want to work for long. Investing some time in creating (and using) meaningful titles for your employees costs nothing—but may earn a lot in improved morale and stability. A happier workplace with a more positive atmosphere means lower costs -- and
Working in a medical practice, whether on the clinical or the administrative side, amplifies any tendencies one might have to try to do and control everything personally. Given the potential for serious consequences (to both health and finances), it’s not surprising that responsible healthcare professionals focus intensely on getting every detail right. The problem is that trying to do it all yourself has serious consequences of its own. It can even lead to the very problems you’re trying to avoid. When an employee first takes on management responsibility – such as when workload grows, and staff are added to handle it – personally doling out tasks may seem like the best way to utilize a new staff resource. But it’s not scalable. As the team expands, it gets harder and harder for a supervisor to manage the workflow while overseeing tasks so closely. That puts a hard limit on the amount of work the team can accomplish – and it puts the supervisor at high risk for burnout. The staff in these roles will also find them stifling – which can lead to poor morale and turnover that cut productivity. Designing jobs so that employees feel a sense of growth, independence, and accomplishment is a key competency for new managers who want to become leaders. The goal should be to help all employees reach their potential through work. Allowing employees to stretch and learning to trust them with critical jobs can be challenging for managers who’ve been promoted because they have been the best in those same roles. But if managers don’t learn to do this, they hurt the practice. They will also limit their own professional growth. Planning for succession is an essential part of managing well. If your practice or a key department would fall apart if the manager leaves, that’s a management failure. A strong manager always adds value in the job, but also organizes their team so that work gets done without micromanaging. If you’re a practice owner or a practice leader who manages other managers, give some thought to how well-prepared your teams are to
We recently worked with a smart, energetic practice administrator who was very motivated to improve his practice’s bottom line. He’d already found significant savings by switching billing and phone services (even getting better billing results, to boot). Spurred on by those successes, he’d turned his attention to clinic staffing. While the physicians in his practice mostly used conventional medical assistants (MA) for support, a few of the doctors and non-physician providers (NPPs) had opted to use “scribe assistants.” These hybrid staff help clinicians by both scribing during the visit and handling typical MA tasks like test orders and scheduling follow-up care. Because of the extra duties, and because they were hired through an agency, their hourly cost was a bit higher than for the MAs – a 15-20% differential that caught the administrator’s attention. The administrator estimated the hourly cost of hiring a new MA would be about $20, including taxes and benefits. The scribe assistants, meanwhile, cost the practice about $24 per hour. The scribes did some tasks the MAs weren’t trained or expected to do – notably, scribing. But the administrator believed that at least one of the NPPs who was currently using a scribe assistant could do just fine with an MA (she was a recent grad and tech enthusiast). So the administrator decided to suggest gradually switching some of the contracted scribes with employed MAs – and was surprised that his idea met with resistance. (After all, 18% would be a significant cost savings – yet even some of the partners resisted the idea!) As the administrator repeated his idea at a few monthly meetings in a row, the resistance grew into a testier conflict. Was the conflict a sign the administrator was wrong to bring up the idea of saving money on clinical staff? We wouldn’t say “wrong” per se – but we might have not have prioritized this particular cost-saving avenue. It’s natural for clinicians to be wary of any changes to clinic staffing. Clinical support staff is essential to physicians’ productivity. Anything that disrupts clinic flow can make it harder for physicians to
“Fix the problem, not the blame” is a well-known Japanese proverb. It sounds like common sense – isn’t fixing problems what we all ultimately want? But when mistakes happen, the search for culprits instinctively begins – and with it often comes demoralization and tension. Worse, the search for a scapegoat usually won’t keep problems from recurring. Bad systems create more problems than bad employees. When workflow is faulty, the mistakes are built into the process. Figuring out who was working the process when it failed does nothing to prevent failure in the future. As organizations grow and silos (i.e., departments) form, so do opportunities for workflow inefficiencies to masquerade as staff incompetence. We’ve worked with medical practices that have grown so fast, they haven’t noticed their processes aren’t keeping up. But even more than growth, market evolution has put new tasks on everyone’s plate. These tasks may not fit well with jobs as originally configured – and that may mean more errors. Here’s a common example. Insurance has become increasingly complex for patients and staff alike. Higher deductibles have also made front desk collections a priority, but it’s a new priority added on top of everything else. Are front desk employees already trying to answer phones, check patients in, answer questions, collect demographic information, and verify insurance? When patients are seen and it turns out they weren’t covered or aware they owe a deductible, it may seem “obvious” that the front desk staff is to blame – especially to your billers, who must deal with the errors. But more likely, front desk employees are simply juggling too much. As jobs evolve, mistakes may increase. Resentments can fester between departments. But the answer isn’t to find someone to blame – it’s to find out where the process breaks down. In the case of the front desk, a better response would be to reconfigure roles, to let staff focus on the tasks in front of them, without multitasking. As work gets more complex, making people feel embarrassed and afraid won’t help them do their jobs better – retraining staff and refining their
Cutting long-term staff to improve profitability? Not so fast [practice management tip: human resources]
A practice we worked with recently was struggling to improve profitability. The practice’s new manager wanted to make an impact fast, so she decided to try replacing longer-term staff with less expensive newbies; since staffing was such a big practice expense, she reasoned that this was the best way to improve profitability. The physician owners were surprised not just that the strategy hadn’t worked, but that we questioned the decision. “Isn’t that the kind of thing you practice management consultants recommend?" they asked. But cutting experienced staff members who perform well just to save a few dollars isn’t something we’d recommend trying. Those exiting employees will take with them all the knowledge they’ve accumulated – knowledge that is easily taken for granted. While cuts might boost profits temporarily, it likely won't take long for patient service to deteriorate. Service will also be undermined by the panic felt by the rest of the staff. When employees see their most loyal colleagues being shown the door, they’ll wonder if – or when – the axe will swing their way. Once those doubts creep in, your most energetic and ambitious employees will begin job-hunting in earnest. Swapping out older workers for younger ones may draw a charge of age discrimination as well. Worst of all: the potential upside is probably small. Differences in pay for experienced versus new staff are typically large enough to cause a big swing in profitability. For example, a $5 per hour difference translates to $10,000 per year. The costs of recruiting and on-boarding a replacement could easily exceed these small savings. It’s natural to look critically at expenses when profitability is flagging. But insufficient revenue is often the main reason profits disappoint – and cutting your best people will severely impact your ability to fix that problem. Instead of cutting valued but ‘expensive’ employees, look for ways to refocus staff and make the practice more productive.
It’s easy to monitor your employees’ every move with modern technology. So should you? The temptation is understandable. The key question is: Are employees motivated to do a good job? Or does getting the most from them require constant oversight? Intuition might suggest the latter – but experience says otherwise. In the early days of business theory, the idea that management was primarily about surveillance (and “cracking the whip”) was popular. But over time, managers learned that employees aren’t just a cost – they’re an asset. Beginning in the 1980s, lessons from Japanese companies illuminated the value engaged employees bring to an enterprise. Toyota, in particular, found that by encouraging employees to be more involved in decision-making, they could improve product quality and productivity. Toyota’s success at improving manufacturing quality – which endures today – started with trusting employees. A culture of trust and respect tells employees their contributions matter – in turn, encouraging and empowering them go beyond the rote requirements of their job descriptions. With engagement tied to higher productivity, lower absenteeism, and better customer service, it’s easy to see how engaged employees can uplift a medical practice. But it won’t happen without trust – and electronic monitoring is a sure-fire way to communicate that you don’t trust your employees at all. Rather than trying to control your employees with surveillance, consider setting goals and incentives that encourage the behavior you want. Rely on reports and data, not constant monitoring, to evaluate how employees are doing. Start by hiring carefully, so you don’t have doubts about trust right out of the gate. And relax a little: Most people want to contribute and do their jobs well. Give them the structure to do it, and you won’t need to watch them all the time. Another thought to consider: If the huge potential benefits of an engaged staff aren’t enough to make you rethink surveillance, remember that every minute a practice owner or manager spends on monitoring is one that can’t be invested elsewhere. Surveillance is very time-consuming (read: costly). Odds are there are more valuable ways to use that
Do you find yourself reluctant to discipline difficult employees because they’ll be hard to replace if they quit? Is that same fear causing you to retain employees who’ve failed to improve, despite being counseled again and again?When the consequences of poor performance never materialize, underperforming employees will soon perceive they’ re exempt from the standards you’ve set for everyone else. Even worse, your better employees will have to pick up the slack and tolerate negative energy from complainers – increasing the risk you’ll lose the people you value most. Many practices feel squeezed for talent in their local markets. It’s understandable to be concerned about a key job staying unfilled for too long – but, still, keeping underperforming employees can harm your practice much more. Instead of going soft on performance problems, consider amending your hiring practices. For example, a little redundancy in your medical assistant ranks (e.g., maintaining one or two “extra” floaters) ensures coverage when someone’s out sick – or ends up leaving the practice. Those additional hands can also tackle valuable ad hoc tasks that might otherwise get skipped, such as recalls that serve patients better and generate additional revenues. A rolling system of recruiting can also ensure you don’t miss a chance to hire talented new grads. Establish recruitment relationships with local training colleges and med schools, and maintain key job postings for year round. (Be sure to use screening questions on recruitment sites and filters in your email software to help manage the applicant flow.) Even if you don’t need help immediately, being aware of available talent will allow you to hire opportunistically if someone exceptional becomes available. It will also provide a clearer picture of the current talent pool, so you don’t feel compelled to hold on to employees who aren’t measuring up.
Background checks in hiring are sometimes confused with reference checks. While both are important, the differences between the two are critical to understand. Reference checks involve conversing directly with a candidate’s former bosses and coworkers. It’s a subjective process that provides insight into a prospective employee’s strengths and weaknesses. Checking references helps you learn how well a candidate’s self-perception matches that of former bosses and colleagues. It can validate (or refute) key narratives shared by candidates, such as how and why they left their former job and what their work style is like. Background checks, on the other hand, deal with purely factual aspects of a candidate’s record. For example, did they earn the degree they claimed? Is the stated employment history accurate? And what about legal scrapes – is the candidate’s background free of convictions or sanctions that disqualify them from working in healthcare? There’s no escaping the time required to contact references directly, but technology has significantly streamlined background checking. With automated online fact-checking services, checks that once required numerous phone calls and faxes can now be done more quickly, completely, and reliably, at much lower cost. Background checks offer peace of mind in any hiring situation, but they’re even more essential in healthcare. For physicians and non-physician providers, verifying credentials and licenses is, of course, mandatory for patient safety and to avoid liability. HIPAA also requires care be taken to protect patient information; with medical identity theft on the rise, too, careful hiring is critical for every role in healthcare. Detailed background checks may even help protect against embezzlement – an all-too-common crime in medical practices. Technology can help you perform these crucial checks more quickly, thoroughly, and easily – usually for less than a few hundred dollars.
So what does this old saw from Silicon Valley really mean – and how can it help your medical practice? Just like in Silicon Valley startups, medical practice teams are usually small enough that every person has an important role to play. When a key position in your practice is vacant, near-desperation can set in if the right candidate doesn’t materialize quickly. That can lead to hiring impulsively and compromising too much on important traits, skills, or knowledge. Because even the best candidates will have a learning curve, you probably won’t realize you’ve made a bad hire for months. Those extra weeks that you “saved” by not extending your search to find a stronger candidate will, in retrospect, seem trivial in comparison to the lost benefits of having the right person in a key position. When a key role is held by an underperformer, your entire practice is dragged down. But – just like in the tech startup world – the small size of practice organizations can feel family-like. In fact, that’s one of the most appealing aspects of working in an independent practice. However, that close-knit culture can make it hard to confront under-performers, who wind up staying in their jobs longer than they should. Physician owners and practice administrators often move slowly in dealing with performance problems out of compassion for the underperformer – not recognizing that their other employees are picking up the slack and, in effect, being penalized for doing a better job. Hire slow, fire fast is an important lesson mainly because most people’s natural tendency is to do the opposite – hiring too fast out of urgency, and firing too slow out of misplaced kindness. Both of these can lead to having the wrong employees in place for far too long, dragging down performance and morale in your practice.
A new study from the University of Florida found that patients' rudeness towards their physicians can have a "devastating" impact on medical care. Patient rudeness may play a critical role in medical errors, which by some analyses are now the third leading cause of death in the US. The Florida researchers determined that patient rudeness causes more than 40% variability in hospital physician performance. (By contrast, poor judgment due to lack of sleep led to a 10-20% variance.) The reason for the huge variance is that despite intentions to 'shake it off,' experiencing rudeness disrupts cognition, even when physicians are determined to remain objective. The researchers found that key cognitive activities such as diagnosing, care planning, and communication are all affected -- and the effects last the entire day. The study suggests that patients need to understand the potential for rude behavior to undermine their care, even when clinicians try their best to be patient and understanding, and even when the rudeness is driven by understandable frustration. But I think the results are also a reminder to practices to try to limit patient frustrations in the first place. Doctors often bear the brunt of patient rudeness when aggravation and anxiety boil over, even though most of what bothers patients happens before they even see their physician. Because administrative issues are frequently the source of dissatisfaction, it's possible for practice staff to prevent or ameliorate many blow-ups. Doing so may help patients have more productive visits with their clinicians, while also helping to protect the practice's reputation and maintain a pleasant work environment for the entire team. If you're concerned about emotional patients disrupting your practice, here are a few ideas to consider: Evaluate, minimize your wait times. A long, unexpected wait in reception is a sure-fire source of patient frustration. When it happens in your practice, is it a rarity or SOP? If running significantly behind is an everyday occurrence your practice, consider a review of your scheduling processes, to come up with a schedule that is attainable. And make sure your front and back office staff are working together
Does your specialty have an association just for practice administrators and managers? Specialty practice management associations like the AOA (for ENT administrators), ADAM (for dermatology managers), and others are some of the most lively and valuable networking and education groups around. If you haven't looked into whether your specialty has a practice management association, it's definitely worth your while to investigate. Not only do these groups offer the chance to network with other managers in your specialty (who understands your world better than someone else in the same role?), they often have other benefits to help you succeed in your career, such as: Benchmarking and compensation surveys Discounts on products and services Specialty focused coding help Annual conferences and regional meetings Online education, webinars, and certification programs for skill-building Job boards To save you the time of investigating, here are some of the specialty focused administrator and manager groups that we're aware of. (If you're a member or representative of a specialty practice management group we've omitted here, please contact us so we can add your group to our list.) Specialty Association Website Dermatology ADAM (Association of Dermatology Administrators & Managers ada-m.org Emergency Department EDPMA (Emergency Dept Practice Managers Association) edpma.org ENT AOA (Association of Otolaryngology Administrators) aoanow.org Neurosurgery NERVES (Neurosurgery Executives Resource Value & Education Society nervesadmin.org Oncology AOPM (Association for Oncology Practice Management) oncpracticemanagement.com Ophthalmology ASOA (American Society for Ophthalmic Management) asoa.org Orthopedic AAOE (American Association of Orthopedic Executives) aaoe.net Pain Medicine SPPM (Society for Pain Practice Management) sppm.org Podiatry AAPPM (American Association of Podiatric Practice Managers) aappm.org Radiology RBMA (Radiation Business Management Association) rbma.org Reproductive Medicine ARM (Association of Reproductive Managers) asrm.org/arm Rheumatology NORM (National Organization of Rheumatology Managers) normgroup.org Urology AUAPMN (AUA Practice Managers' Network) auanet.org
I'm working on an ebook right now about medical practice staffing. More specifically, it's about how the instinct to cut staff, to be as leanly staffed as possible, can backfire*. There are dozens of little details that any practice can explore to improve profitability. These small changes can be made with much less risk than eliminating a job or cutting staff hours. And because they improve the profitability of your processes, they are a gift that keeps on giving, making your bottom line a little bit bigger every day. Here are just a few of the possibilities I explore in the ebook. Are you taking full advantage of these opportunities to improve your bottom line? Reduce no-shows: Take a quantitative look at your no-show rate. Are you tracking both true no-shows and last minute cancelled slots that can't be refilled? Audit your reminder process and results. Is your timing right? Experiment with reminding further ahead or closer to the appointment. Remind people using the technology they prefer. Capture email and cell info: Being able to reach people electronically opens the door to multiple efficiency improvements, including more effective reminders and better collections. And your patients that want to be emailed or texted, not called, will appreciate the option. Win-win! Train patients on portals: Too many practices make portal adoption a low priority, or abandon the effort altogether, because they find it hard to get patients engaged. It is hard! But it's still very worthwhile. As more patients use your portals, you have more ways to reach them for marketing. Portals make other key tasks more profitable, too. Notice I said "portals," plural? If you don't have the ability to collect payments through your EHR portal, investigate the option to set up a payment portal with your PMS vendor. Patients want to help themselves -- and they want to pay without having to write a check or find a stamp. They'll reward you by paying faster and more reliably. If you cut staff before checking out all the possibilities to improve your operations, you may not have the people you need
Are some jobs at your medical practice just too urgent or important to assign to specific people? That's the argument some practice managers and physicians make, e.g: "Phones need to be answered by the first available person, whatever their job" "Everyone should keep an eye on the fax machine, and deliver faxes they see piling up" "Let's all keep an eye on the reception area, to make sure no one's waiting too long" "It's the entire team's job to make sure the patient bathrooms are clean and stocked" When the entire team is engaged on these important, urgent tasks, the theory usually goes, there will always be someone available to do them, right when the need arises. Everyone will have an equal stake in making sure they'll get done -- right? Alas, no. Have you ever heard the amusing little story about four people named Everybody, Somebody, Anybody and Nobody? It goes like this: There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody's job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn't do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.* There is a lot of organizational insight packed into that little verse. When something is everybody's job, it's effectively nobody's job. Nobody is actually accountable to do the work, and everybody can rationalize that they thought someone else would do it. When everyone has other work to do that they believe is important, they'll be more likely to assume someone else will take care of the group responsibility. We have worked with several practices that have applied this "everyone's job" idea and been very unhappy with the results. Laurie, they say, why aren't the staff answering the phones? We tell them over and over that everyone has to answer the phones! Instead, our messages are piling up, patients and other doctors are complaining, and nobody's getting the help they need when they call.
It’s not too soon to think about the holidays and how you are going to honor staff for everything they’ve done to get you through the year. Will it be the typical holiday party and a gift exchange or do you plan on giving Christmas bonuses – which can be troublesome? I say this because most practice leaders just aren’t sure how to handle bonuses. I mean, really, maybe staff has just come to expect a bonus and don’t even realize it is intended as a reward or gift of gratitude. Maybe Andrea doesn’t understand why Heather, who has been with you less than a year got the same amount she did. Sometimes staff are actually disappointed – expecting more and feeling the bonus is paltry. It is not that unusual for staff to assume the practice can afford much more. This is unfortunate for the practice that struggles to maintain a reasonable profit during these difficult times. Is it time to change how you manage holiday giving how you recognize staff? Do you need to deal with the mindset of staff and get aligned? Is it time to educate the staff that it isn’t business as usual and profits have been sliding or are being threatened by healthcare reform? And do you even know if you are paying staff appropriately in the first place? This all seems burdensome to deal with, but it is that time of year again. I suggest practice leaders get a jump start on addressing holiday bonus and recognition programs and analyze how they financially honor staff once and for all. Begin by getting a grasp on your current pay scale to make sure you are paying market rate for each position based on the qualifications and responsibilities that each job requires. This will ensure you attract and keep the best employees. If you want staff stability and longevity you must create and maintain a desirable workplace environment where staff is respected and treated fairly. Next, think about the value of the paid holidays you already provide for staff. Not all practices are equal here.
When I was in business school, the idea of continuing ed for MBAs was occasionally bandied about. It just seemed odd that other professions like law and medicine made ongoing education and improvement a priority while ours didn't. Of course, the most obvious response to this is that the competitive nature of the business world makes mandating continuing ed unnecessary for MBAs and other business professionals. If you're not constantly learning and adapting, your skills can quickly become outdated -- and it's almost impossible to hide that in a typical business setting. That's why companies invest in corporate training and conferences, and why ambitious managers read (or at least skim) all those hot business books and why they network so much more regularly than physicians. In business, everyone takes charge of their own continuing ed -- and if they don't do so, someone else who is more in step with new ideas will come along and, as the saying goes, eat their lunch. In medical practices, though, we sometimes find physicians don't appreciate the need for ongoing business education for their managers. I've personally even encountered physicians who describe their managers as "fully trained." Perhaps it's because continuing education for managers isn't a regulatory requirement that physicians don't understand how important it is. Whatever the reason, if you're a physician who is not encouraging (and funding) ongoing education for your manager(s), you're making a mistake. No field has as much constant change as medicine. Medical practice managers, billing managers, and other practice business leaders need to not only stay on top of normal business evolution (e.g., technology change, marketing and communications change), they have to keep up with medicine-specific changes (e.g., regulation, research, clinical standards, insurance). Investing in continuing education for your managers is frankly cheap in comparison to the risk and costs associated with falling behind. So when your manager asks for budget for a conference, book or online education program, think twice before saying no. And if your manager never asks for these things, think about whether you've unintentionally discouraged a behavior that is essential to your practice's
Yahoo! reports that a recent study by the Workplace Bullying Institute showed that bullying -- defined as "abusive conduct that is threatening, intimidating, humiliating, work sabotage, or verbal abuse" -- is a problem at nearly half of all US workplaces. They also found that 27% of all adult Americans have directly experienced it, 21% have witnessed it and 56% of perpetrators are bosses. More discouraging, the study found that employers are doing little to combat bullying. Among employers who had received complaints about bullying, only 12% established policies to combat bullying, and only 6% reported a zero-tolerance approach to eliminating it. And, the researchers also found that all this bullying has a high cost in employee turnover: 61% of employees who were victims of bullying either quit, were fired or were forced to quit. Medical practices exist to help patients, and usually most of the employees in a practice were attracted to the field for that reason -- so you wouldn't think that bullying could be a problem in the practice workplace. But bullying is something we often uncover in working with practices, especially when we're brought in because of high turnover or operating problems that the physician owners are having trouble solving. Despite being rooted in a caring profession, medical practices often have characteristics that make it possible -- even easy -- for bullying to take hold. These include: Physician owners are most often with patients and have little time to observe ordinary interactions between staff Physicians often dislike the management side of their practices and become too trusting of and over-reliant on one or a few key managers -- who then have too much power Managers spot the opportunity to seek excess power from uninvolved physicians -- becoming expert at managing upward and hiding the true nature of their relationships with staff* Physicians may have experienced very demanding, bullying (or quasi-bullying) environments throughout their medical training -- and may adopt the same management style almost automatically, without appreciating the costs When our analysis of a practice suggests that a manager, supervisor or physician colleague may be creating a threatening
Our work with medical practices often involves analyzing a practice's data against benchmarks from sources like MGMA, NSCHBC, specialty society surveys, etc. But, it's not enough just to compare against the averages and percentiles; you have to know whether meeting or beating a benchmark is a good thing. Believe it or not, this is not always obvious. Among the benchmarks most subject to misinterpretation are staff per provider and staffing expense per provider. Most physicians and practice managers we work with are very focused on keeping headcount and staffing expense low -- and so they're pleased to learn they're in the lower tiers for headcount and staff expense ratios. The pleasure shifts to confusion, though, when we explain that squeezing staffing down to the lowest possible expense is not usually a path to higher profitability -- and can often be associated with lowering profitability! There are several reasons for this. The most important is that well-trained, well-paid, motivated staff -- and enough of them -- free up providers to focus all their attention on the tasks only they can do. Coincidentally, the tasks that only providers can do are almost always also the only tasks that generate revenue for the practice. Increase provider time spent on revenue generating activities (and not on unpaid tasks that don't require their training), and you're on the way to more profitability. Consider that an additional medical assistant might cost a practice about $100-$150 per day. If that additional assistant allows a practice to see as few as 1-2 more patients per day, that's a profitable addition. Often, one additional assistant can help more than one provider -- and help the practice quickly generate more revenue than is needed to make the addition a profitable one. When a practice is focused primarily on expense control and minimizing headcount, sometimes that results in providers doing too many tasks that could be handled less expensively by staff -- an opportunity cost for the practice and a direct hit to revenue potential. What's more, when a practice is too reluctant to add headcount, existing staff can quickly become
Sometimes, the business of medical practice management is a fuzzy science. Managers have to keep the patients, and their bills, moving through the practice. Most often, physicians are satisfied if their managers accomplish that much. But managing optimally includes softer skills, like bringing out the best in staff. Recently, we've worked with several practices with managers who do a great job of managing upward -- reinforcing the confidence their physicians feel for them -- but who don't have much insight into really managing their own teams effectively. Keeping an eye on the team, and making sure everyone's doing what they're supposed to do, is a huge chunk of a manager's role. But it's not the entire role of a truly effective manager. A truly effective manager helps each member of the team develop his/her skills, understanding each person's strengths and weaknesses, and figuring out how each direct report can contribute more and be challenged and grow. This is not just key to helping the practice improve its short-term results, it is critical to retaining the best staff and successfully completing growth initiatives. Turnover alone can be so costly to practices. Hiring and replacing employees is a time-and-money sink. And while critical jobs stay unfilled, mistakes can happen -- and patient service can suffer. This recent Harvard Business Review article delves into this issue -- and makes the important point that a poor relationship with their direct manager is a primary reason (if not THE primary reason) employees quit. We see it every day! Medical practices often pay a great deal of attention to provider education -- partly by necessity. And managers can often attend conferences and find other paths to learning and development. But staff are often left out of the equation. And if managers aren't finding out what staff career goals are -- and how they can help them learn, grow and achieve them -- then the practice will suffer as a result. Make sure you're evaluating your managers on this important skill!
Turnover and hiring are costly. Staff are so important to your practice's patient service, financial performance and overall functioning. Given these things, one of the best investments you can make in your own leadership abilities as a physician owner or practice manager is to develop the skill of delivering effective feedback to employees. The importance of giving effective feedback to staff really can't be overstated. Your ability to nurture better performance and address inadequate performance impacts everything from employee skill development, to team morale, to legal risk. Every aspect practice performance depends on getting the best from your staff, and that depends on giving the right feedback at the right time(s) and in the right way. Giving employee feedback is not easy, and getting really good at it requires effort and focus. But your efforts will be rewarded many times over. One of the best recent summaries I've seen lately on delivering effective feedback comes from the Stanford Graduate School of Business -- a summary of a lecture by Carole Robin. It's a short list of seven pithy tips, and you can act on it now! Highly recommended reading. (A couple of previews: "Do it now" and "Stay on your side of the net." Read the piece for quick explanations of these ideas -- and five more.)
Leadership sets the tone for the entire practice. Staff will model your commitment and follow your expectations. Much of the manager’s role focused on managing practice finances, maintaining practice viability, and keeping a highly motivated and efficient staff that is respectful and trustworthy. Add to the list a new yardstick that changes how physicians get paid based on a patient experience that improves compliance to result in better outcomes. Develop a plan and set up programs to help staff understand how the patient experience relates to both outcomes and practice finances. Show your commitment through continued communication and actions that reveal a consistent effort to improve the patient experience. Give staff the education and tools to succeed in delivery consistency in your customer service organization-wide. Coach staff to improve performance. Provide them with the support and encouragement with implementing essential changes on the road to being more patient-centered. Manage progress well. This means conducting a baseline patient satisfaction study based on key performance areas and periodic follow-up to be sure targeted areas of improvement results in satisfactory results. Set your goals for becoming a best practice. Be explicit in what you expect and intend to achieve. Honor each person’s contribution and celebrate successes that achieved along the way. Leaders have the ability to set the stage for success, instill a sense of pride and hope within the organization, and meet the challenges of strengthening the relationship between the clinical practice and the patients they serve. In the end, we seek to improve the health of our patients, enjoy the relationship we have with patients and be among the best.
Just back from speaking at the wonderful Association of Otolaryngology Administrators (AOA) annual conference -- what a valuable event. It's such a great experience as a speaker to participate in such a well-attended, well-run event. In both of my sessions, attendees were so attentive, taking notes, asking great questions, and making great comments and sharing anecdotes about their own practices. The attendees were helping each other as well as benefiting from content from all of us speakers. I have no doubt all attendees will go home with dozens of ideas to improve their practices' profitability. I was just one of dozens of qualified presenters -- what a download of information for the attendees. And they were clearly so motivated to soak up as much information as possible. (For example, I tried to sneak into the talk before mine -- which started at 7:30 AM! -- on the Affordable Care Act. Standing room only, despite the early hour.) Physicians may sometimes doubt the value of sending a manager off to a conference like this. The cost may be in the neighborhood of $2,000 when travel and downtime are figured in, so it's not a trivial expense. But just one coding tip that brings more revenue or marketing tip that brings more patients -- or compliance tip that avoids an audit -- would pay for that expense many times over. And the network that attendees can form is absolutely priceless. This is especially true when your specialty has a dedicated practice administrators association like the AOA -- but, even at the larger/general practice management events like MGMA, medical office managers will meet like-minded professionals they can bounce ideas off of and gain advice from in the future. In tight times, cutting out conference attendance may seem like an easy choice. However, you may be unknowingly hurting your practice's chances to grow new revenues, stay ahead of regulatory issues, or nip costly problems in the bud. It's useful to be picky about attending events -- make sure they'll have a variety of relevant subject matter that is important to your practice. But don't
Let's take a few moments to consider what risks you may be carrying around with your phone. One common vulnerability is stored passwords on your phone, e.g. within a “notes” program. Imagine the harm that could come of a thief having access to your banking accounts or practice management software. Your firm could suffer an immediate financial hit, malicious mischief or a potentially devastating breach of patient data. The start of such grief can be your unattended phone meeting with a disgruntled employee or dissatisfied patient. These risks mean that phone security justifies your consideration. Phone security starts with maintaining disciplined control over the physical device. Naturally, your phone should not be left untended in your office, on a shared counter-top or anywhere else where it might be easily stolen. While it seems obvious, it’s very common to see busy administrators leaving their phones behind as they scurry about the office. Luckily, most phones have security features that can significantly mitigate your risk – although many of these features are not enabled by default. In many phones, a four-number passcode can be readily “cracked” by a thief. Better is a quality passcode (avoid common English words) that uses letters and numbers – with iPhones this can be changed under settings/general/passcode lock. Keep you phone’s software updated, as security vulnerabilities are fixed as they are discovered. If you use an iPhone, make sure you have the application Find My iPhone installed (and updated) and enabled. iOS 7, the latest iPhone operating system, security has been greatly improved – potentially making your phone valueless to a thief, but you must first have an Apple ID (and remember it!). Phones using Android 2.2 or greater have a built-in application that can help locate or your phone and/or completely delete the contents of your phone and any installed memory (SD) cards. You’ll need to make sure these features are enabled on your phone (settings/security/device administrators). Regardless of what device you use, be careful when accessing sensitive information when you’re out and about as your phone may connect to an insecure Wi-Fi connection, allowing others
Today's Harvard Business Review features a wonderful tip for medical office managers: Know when to coach versus when to teach. Teaching -- i.e., demonstrating or instructing an employee on exactly what to do -- is key for bringing new employees up to speed (aka, training). It can also be useful when corrective action is needed -- e.g., "Emily, please be mindful of HIPAA when speaking with patients about private information -- ask them to step out of the reception area, like so." Teaching can backfire, though, with competent and motivated employees who just need a little help with problem-solving. Coaching -- supporting and gently helping staff find the right solution -- is the right approach in that case. For example, let's say one of your receptionists is having trouble collecting co-pays -- but, she's a quick learner who's eager to try new things. Giving her ideas and asking questions about what she's already tried could help her develop an effective style she's comfortable with -- and that she'll be able to use routinely. By coaching employees with ideas and, most important, asking questions, you help your employees feel competent and trusted. What's more, even though it might take a little longer to solve today's problem, your coaching might lead to your employee finding a better solution that will pay off over the long run. For example, if your instinct would have been to pick up the phone to get urgent payer feedback, but your encouragement leads a biller to find an important source of information via the payer's portal, that could save a lot of time for you and your biller down the road.
If you haven’t read Dan Ariely’s entertaining, highly-readable and best-selling book Predictably Irrational, consider adding it to your summer reading list. Ariely, a cognitive psychologist at Duke, designed and conducted many experiments that illuminate some surprising reasons that guide behavior. Many of these experiments have relevance for the way that medical practice administrators manage their staff for greater productivity. Many of Ariely’s study participants are college students that are paid modestly for their efforts to complete routine tasks – i.e., their incomes are low enough that small increases should matter. In one such experiment, the subjects were paid to identify and circle instances where the same letter appeared side-by-side on a page of text. Test subjects were paid for each page on a descending scale - the most for the first page and less for each subsequent page - until they declined to continue. Students were randomly assigned to groups that would have one of three variations on this basic theme: 1) Subject wrote name on page, the examiner visually scanned the page and gave a verbal cue to acknowledge the work before placing the work on the pile of worksheets. 2) Subject did not write name on page. Examiner simply placed the finished page on a pile without visually scanning or acknowledging. 3) Subject did not write name on page. Examiner immediately placed finished worksheet into shredder. If participants cared solely for the compensation they received, the study results would indicate that all three groups ceased to work at approximately the same pay rate (remember the descending pay rate). The study results showed that the group that had its work shredded immediately upon completion stopped working at almost twice the pay rate than the group that had its work cursorily acknowledged. The group that had its unnamed worked immediately placed on a pile? It stopped working at very nearly the same pay rate as the group that had its work shredded! These findings are consistent with what we find in our tour of medical practices across the country. When we talk with practice staff members, we find that the
Practice managers and physicians often feel like they're fumbling in the dark when negotiating salaries with prospective employees, and feel unsure about whether their compensation structure is adequate to retain their best people. But, this is at least partly because they're not utilizing all of the tools available to stay on top of market compensation rates -- some of which have only really taken hold in the last five-ten years. For example, sites like Salary.com provide market data on job content and salaries -- all matched to your local market. (This type of data used to be available only in pricey salary surveys! On Salary.com, the base data is good -- but, more detail can be had for a fee.) Even scanning online ads, such as on Craigslist, can give you a quick read on what others are offering. We often work with physicians and practice managers who are very concerned about over-paying staff. If you're among them, take heart: as this story from Freakonomics observes, sometimes getting the 'best deal' on labor is no deal at all. I'm usually much more alarmed when practices are under-paying than over-paying by a bit. Freakonomics (via Marketplace): A Cheap Employee Is ... A Cheap Employee
Today's Harvard Business Review tip on interviewing prospective employees is really useful. How do you know if the candidate really has the skills he/she claims to have? Drill down with 'how' and 'why' questions. For example, if a practice management candidate claims to have implemented internal controls, drilling down for examples can give you a better idea of how well she really understands them. Or, if a biller states that he chose a new PMS for his current practice, ask about the details of making that selection. Read the HBR tip here.
Practice managers and physician owners might look at the media attention focused on Yahoo! CEO Marissa Mayer's decision to end work-from-home at her company and think, well, that doesn't apply to me. And it's true, with only a few exceptions (say, billing), medical practice staff members are unlikely to be able to do their work from home -- not just because they need to be where the patients are, but also because of the privacy risks of bringing documents out of the office. That doesn't mean, though, that the controversy and discussion that Mayer's decision engendered (and now Best Buy CEO Hubert Joly's as well) are completely irrelevant to physician practices. Because even though working at home is an option that won't often make sense for medical office staff, the media frenzy about one company's HR decision does illustrate how challenging it can be to make management changes without unintended consequences, even when the need for the change seems obvious. Change sparks fear One of the theories that immediately emerged about the Yahoo! telecommuting ban was that Mayer was simply implementing "backdoor layoffs" -- i.e., that she'd determined that forcing everyone into the office would be an easy way to encourage telecommuters to quit to achieve needed cost reductions. Naturally, this theory provokes fear in all staff -- what if there aren't enough quitters to bring costs down, and my job ends up on the chopping block? There are mixed reports of how the end of telecommuting is actually playing with Yahoo! employees -- despite the ongoing outrage of bloggers, there are also reports that many current Yahoos understand the need for and actually support the change. But, certainly the situation is a good reminder about how important it is to communicate effectively with employees, to help prevent unnecessary fears from taking hold -- otherwise, you risk losing your most valued employees, who will begin job hunting in earnest when they sense trouble. (I have seen changes as small as eliminating free coffee to save a few bucks lead to swirling rumors that bankruptcy is imminent! When communication is missing,
Good practice managers understand the importance of regular performance reviews for motivating staff and making them feel appreciated as well as addressing and documenting needed improvements. But sometimes the manager's own review by the managing physician of the practice slips through the cracks -- and, physicians don't always understand the importance of giving structured feedback to their practice managers. If you're a physician who hasn't established a regular schedule for meeting with your manager to provide performance feedback and set goals for the coming year, now's the time to get started. The role of practice manager continues to evolve as the business of medicine does -- is your manager developing the skills he or she needs to keep your practice running smoothly and profitably? Are you supporting your manager to take on important challenges for your practice -- whether in staffing and staff development, reaching out to patients via new channels, or upgrading technology? Is your manager aware of the long-term plans you and your physician partners have for your practice -- so he or she can properly support your goals? An annual meeting to review progress against past goals, and set plans for the coming year's efforts can be an effective way to empower your manager to move your practice's business in the right direction. And, it's essential for retaining and grooming a talented manager as well.