managing people

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|

New EMR/burnout study: Can your practice benefit from its findings?

A new PAMF (Palo Alto Medical Foundation) study on the connection between EMR and physician burnout is getting a lot of attention. The study has limitations (e.g., it focuses on one organization, one EMR and set of workflows, and it aims to infer much from a single question). But despite the need for caveats, the study is valuable because it confirms what intuition suggests about EMRs and physicians' stress. What's more, the authors tested workflow modifications and found they helped alleviate EMR-related burnout at PAMF. You can read about the study here. To summarize it, the study validated that when EMRs encourage message overload, they significantly increase physician stress. The study found that about half of all messages the physicians in the PAMF study received were EMR-generated--i.e., things like health maintenance alerts and medication reminders that the system generates automatically. The researchers found that many of these messages could be handled, or at least triaged, by other members of the care team. For example, medication messages could be routed first to a pharmacist, who would involve the physician only if needed. Nurses and MAs could also handle much of the automated message volume, such as follow-up appointment reminders. Not surprisingly, when PAMF experimented with diverting these lower-complexity messages to others, the burden (and stress) on physicians decreased substantially. Can PAMF's solution work in your practice? PAMF is a large, integrated healthcare organization. Healthcare Dive reported that PAMF launched an initiative called MIST--Multi-Disciplinary Inbox Support Team--to test the idea of sharing the message workload. One year in, MIST seems to have helped reduce physician message loads (and stress) substantially. But what if your practice is not a huge organization with IT and workflow experts or pharmacists on staff? In our consulting work, we often recommend practices involve staff in more meaningful work. To enable physicians to focus as much as possible on tasks that only they can do (working at the top of their licenses), everyone else needs to do as much as they can. Expanding the roles of staff -- within their skills and scope, of course -- can help

By |2022-01-01T22:51:44-08:00July 7th, 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|

Fix the problem, not the blame [practice management tip: operations and workflow]

“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

By |2018-06-11T16:36:02-08:00June 27th, 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|

Consider rolling recruitment for key jobs [practice management tip: human resources]

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.

By |2022-01-01T22:51:47-08:00May 1st, 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|

Need a summer read? We’ve got you covered — and we’ll even provide a beverage.

(c) Michael Jung-fotolia.com Summer's here! If the change of the season has you thinking about reading on a beach, a back porch, a dock, or a hammock, we've got the reads that you need. Judy and Laurie have both published new books. They're both easy reads packed with intriguing case studies of real practices -- the furthest thing from a dry textbook. And you'll find they're full of practical ideas you can readily implement to make your practice run more smoothly and profitably. (We'll understand if you want to wait until fall for that.) In celebration of Judy's latest edition of Secrets of the Best-Run Practices (released just in time for summer), we've got a special offer. Buy both Secrets and Laurie's book, People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business, and we'll send you a $5 Starbucks card you can use for the perfect cold (or hot) beverage of your choice. Here's how it works: Buy Secrets of the Best-Run Practices (3rd Edition) Buy People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business Send us proof of purchase: your emails from Amazon or other retailer, or even a photo of the two books will work (email "info" at capko.com) We send you your $5 Starbucks card! If you bought either book in 2017 and can provide proof of purchase, that works; you don't have to buy them at the same time.  And if you want to buy the books for someone else (like your practice manager), you can tap into the promotion up to three times. This promotion runs through Labor Day 2017 -- you must purchase both books by then. Prefer ebooks? Visit this page for the ebook version of this promotion. Questions? Feel free to contact us.

By |2022-01-01T22:51:48-08:00June 8th, 2017|

Patient rudeness affects physician performance — what should practices do about it?

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

By |2022-01-01T22:51:53-08:00January 15th, 2017|

Specialty associations for administrators and managers: are you in the loop?

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

By |2022-01-01T22:51:55-08:00November 1st, 2016|

The power of managing details

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

By |2022-01-01T22:51:56-08:00May 8th, 2016|

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|

Physicians: useful leadership article about biases from Fast Company

If you've visited here before, you might have seen some of my posts about the challenges physicians face in managing their practices.  In most medical practices, the physician-owners are also very busy health care providers whose business management time is quite constrained.  This makes it that much more difficult to know what's really happening on the business side of the practice and to make good decisions about business operations.  This lack of information may make physicians more susceptible to management biases. This helpful leadership article from Fast Company spotlights eight of the most common management biases that can lead to less informed decisions. In our consulting work, we sometimes see the impact of these biases on business management and especially planning and investing by physicians for their practices. For example, confirmation bias -- the tendency to value more heavily opinions and information that support what we already believe -- can be a greater risk for physicians who don't have the time (and often the inclination) to dig into business data.  Reports that suggest all is well can appear more relevant than "anomalous" financial data that indicates problems. Another common bias, the sunk cost fallacy, may be unfamiliar to those who've never studied economics -- but, once you understand it, it's a powerful way to make better investment decisions (whether you're investing time, money, staff time, or any other resource). The Fast Company piece is a fun, fast read, with a useful nuggets to thing about -- click here to check it out.

By |2014-12-14T09:58:35-08:00January 29th, 2015|

Everyone needs continuing ed — not just clinicians

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

By |2022-01-01T22:52:06-08:00October 3rd, 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|

Six steps physician leaders and practice managers can take to improve the patient experience

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.  

By |2022-01-01T22:52:11-08:00December 14th, 2013|

A taste of MBA training for doctors — without the hassle and cost

If you follow this space, you may already know that I'm dubious about the value to physicians of stopping out for an MBA.  As an MBA-holder myself, I think the coursework can be overkill for independent physicians who just want to run their practices better (this is less the case for those that intend on corporate careers, of course). So much of modern MBA training focuses on things that aren't generally relevant to the small/medium business owner (and, therefore, the typical private practice physician partner).  Even worse, some of the business basics that doctors need most usually aren't well covered by MBA programs -- managing people; the minutia of local, state and federal regulations; the marketing of a small, local business; real estate finance; negotiations, etc. The other issue facing physicians (and sometimes practice managers, too) is the opportunity cost -- and actual cost.  The opportunity cost is the income lost by taking time off from practicing/working to attend an MBA program, and the actual cost is the (often very high) tuition at business schools.  For many, perhaps most, private practice owners and managers, it just may not 'pencil out' to take the time and invest the money*. One solution that can work well as a substitute is taking local classes (e.g., nights and weekends) that focus just on what you really need and want to learn.  This can be a reasonable approach -- and even a trial to see if further investment in MBA education is of interest.  But, there is also the issue of having to attend class at set times -- not always convenient ones. Now, though, there is a better alternative: MOOCs, massively open online courses.  Incredibly, some of the most prestigious business programs in the country, including Stanford, Wharton and Columbia, are making some of their most valuable content available through the free platforms like Coursera and EdX.  And it's not only self-directed -- i.e., you take the classes at your convenience -- it's FREE!  (Yes, unbelievable.) Lest you think this is just throw-away content, Business Insider has kindly assembled a list of some of

By |2022-01-01T22:52:14-08:00October 16th, 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|

A useful quick-tip on interviewing candidates

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.

By |2022-01-01T22:52:32-08:00April 18th, 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|

13 for 2013 Tip #10: Engage staff

Most practices have an underutilized resource - namely, their employees' ability to identify and solve problems. As practices deal with the day-to-day business, it's all too easy to fall into a routine-inspired complacency. To establish some positive momentum, make a point to ask each of your staff to identify problems and possible improvements - and give everyone an opportunity to contribute their ideas during your regularly scheduled staff meetings. We think you'll be surprised at the sources and quality of ideas that emerge. Be generous with your appreciation and praise and you'll see a staff that is happier and more motivated than ever.

By |2022-01-01T22:52:35-08:00February 4th, 2013|

13 for 2013 Tip #8: Manager’s report card

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.

By |2022-01-01T22:52:35-08:00January 29th, 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|

Doing things the MBA way

My partner Joe Capko and I just had a new article published in Practice Link, a magazine for job-hunting physicians.  Our assignment was to explore the idea of a "15 minute MBA for doctors." In other words, are there guideposts that we can draw from business school training that might help physicians know what they need to learn, and how to develop the business skills they'll need to thrive in the future -- whether they run their own practices or work for a larger system? We're delighted with the input we had from the physicians we interviewed -- wonderful advice for newly minted doctors.  We spoke with a wide range of physicians -- including anesthesia, OB/GYN, pediatrics, family practice and academia -- as well as a number of practice management experts to get a diversity of viewpoints. Check it out here - we'd welcome any feedback.

By |2012-01-22T18:50:57-08:00January 22nd, 2012|

Prevent and uncover embezzlement: webinar

Joe and Judy's recent webinar (sponsored by Kareo) was a big hit! If you didn't have a chance to attend 'live,' you can register and view it here: Embezzlment-proof your practice Most medical practices are victims of embezzlement at some point -- yes, you read that right! -- so if you haven't already learned how employees can become thieves and employers become marks, this is a must-watch webinar.

By |2011-11-18T11:27:10-08:00November 18th, 2011|
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