The way we speak about colleagues matters [practice management tip: leadership]

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

By |2022-01-01T22:51:44-08:00August 4th, 2019|

From manager to leader [practice management tip: leadership]

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

By |2022-01-01T22:51:45-08:00November 28th, 2018|

Cost-cutting: pick your battles wisely

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

By |2022-01-01T22:51:45-08:00October 15th, 2018|

Resist the temptation to surveil your employees [practice management tip: human resources]

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

By |2018-04-29T12:24:55-08:00May 23rd, 2018|

The power of you front desk to influence the patient experience – and your reputation

One of our previous clients decided to move on from her group practice to set up her own practice.   After being in town for just a few short years it would be important for her to have a following of loyal patients. For this reason, I decided to research how patients were rating her, and discovered her average rating with several major sites was a 4+ stars.  Sounds pretty good, doesn’t it?  I decided to dig deeper and read some of the reviews.  4 out of 5 had wonderful things to say, but the one critical rating was brutal and contrary to the glowing comments other patients made about this fine doctor.  The strong negative comments by this single reviewer related to his experience with the front office.  I suspect this could have been avoided if the front office team took pride in their work and understood that a major part of their role is to greet each patient properly and make sure their needs are met, as well as preparing them for the visit. Such comments as: “I waited an hour in the reception and was completely ignored; the receptionist was rude and acted inconvenienced; I was a new patient and no one seemed to care” reflect a patient that feels discounted and gets upset before ever being escorted to the exam room to meet the physician.  Unfortunately, it’s not rare to hear patients complaining about the way they are treated at the doctor’s office and how poorly it compares to their experience at Starbucks or their local bank.  It’s time for medical practices to implement some training standards that put patients first. It starts with creating a culture where physicians and managers believe their staff is their number one customer. Staff will only treat patients as well as they are treated by their superiors and the respect and care they are given.  A practice will not thrive unless the work environment is one of respect and appreciation – and it starts at the top! Hire good people and treat them right Be selective in who you hire. The

By |2022-01-01T22:51:48-08:00August 28th, 2017|

It’s everyone’s responsibility, yet no one’s doing the job

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.

By |2022-01-01T22:51:58-08:00November 29th, 2015|

The upside of staff downtime, the downside of multitasking

Employees who are not always busy working are frequently a source of consternation to physicians. Sometimes, practices attempt to remedy the situation by restructuring staff jobs -- not always with good results. Consider the front desk, for example. In almost any practice, front desk workload will ebb and flow.  Depending on variables like patient punctuality, the mix of appointment types, and the number of new patients, the front desk might be swamped or slow on any given day or during any clinic session.  Sometimes, front desk receptionists may have no one needing their help or attention at all.  Physicians and managers may be tempted to rectify the situation by, say, having the phones ring first at the front desk. For a typical, busy practice, that's a foolproof way to increase staff busyness! But does it improve productivity? In my view, usually not. One reason people appear busier when you ask them to switch back and forth between tasks -- or do multiple jobs at once -- is that it's harder to do any of them properly. They're more active, but not necessarily more productive. This makes intuitive sense, no?  But we don't need to rely on intuition, thankfully.  With multitasking so prevalent in modern offices, researchers have good reason to study it -- and the results suggest that multitasking is even more of a productivity drain than your gut would tell you. One study found that people lose as much as 40% of their productive capacity when trying to constantly do multiple tasks at once. When front desk staff are required to answer phones while also helping the patients that are standing in front of them, service suffers. Either the patient on the phone or the patient at the desk feels like they're in second place. And switching back and forth means the employee has to mentally regroup -- adding to the length of time it takes to complete each task. More effort is required to do the same tasks -- yet the patients staff deal with will perceive less effort made on their behalf. Lose-lose for both of the two patients being

By |2015-11-23T16:13:16-08:00November 23rd, 2015|

It’s holiday time again. Will you honor staff with bonuses, a party, or something else?

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.

By |2022-01-01T22:52:03-08:00November 7th, 2014|

Bullying can be a problem at medical practices

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

By |2023-05-23T17:23:30-08:00March 17th, 2014|

Managing includes developing practice staff

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!

By |2022-01-01T22:52:10-08:00January 28th, 2014|

Resolve to give better feedback to staff in 2014

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.)

By |2013-12-24T10:06:33-08:00December 28th, 2013|

Teaching your medical practice employees vs. coaching them

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.

By |2022-01-01T22:52:15-08:00October 8th, 2013|

Think your staff work only for money? Think again

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

By |2022-01-01T22:52:31-08:00June 19th, 2013|

Lessons and reminders from the Yahoo! work-at-home flap

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,

By |2022-01-01T22:52:33-08:00March 9th, 2013|

“Always say yes to networking”

The Harvard Business Review has a great tip today, entitled "Always Say Yes to Networking." I love this tip because it emphasizes how important it is to maintain personal connections with the friends and associates in your network -- and to think of networking as the process of keeping in touch and maintaining relationships, not just meeting up for the purpose of job-hunting or other goals. Most of the physicians and medical office managers and staff we work with do little or no networking at all.  This is such a missed opportunity.  Staying in contact with your network is great for your morale and your perspective -- not just your job prospects. It's harder, perhaps, for medical professionals to break away for coffee or lunch with a friend or colleague.  But, social networking can help -- I'm personally so grateful for the friendships I've rekindled using Facebook.  Find whatever ways work for you to keep in touch with the people you've met along your journey. Read the HBR tip here.

By |2022-01-01T22:52:34-08:00February 12th, 2013|

Do you have staffing troubles ahead?

A poorly-timed departure of a key employee can really put a crimp on your enjoyment and profitability. Recent survey data reported in the online Business Insider cite a lack of trust in corporations and wanting to be their own boss as the top two reasons these workers leave. These data bolster our oft-repeated recommendation that every practice administrator should put a high priority in nurturing the careers of their key employees. After all, how better to foster trust than to take a sincere interest in your employees well being?  What's more, such interest often takes the form of giving more responsibility and autonomy to these employees thereby helping to satisfy their desire "to be their own boss." Read more about here about the 5 Reasons Why Gen X Workers Quit.

By |2022-01-01T22:52:37-08:00November 16th, 2012|
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