What You Don’t Know Can Hurt You - Is There a Lack of Leadership in Your Practice?

• AUSTIN

Do you feel sometimes your staff do not have the same commitment to the goals you have for the office?

Do you feel frustrated by staff that are not doing their share of the work?

Do you think it’s a staff issue or could it be one of the providers causing the problem? 

Any one of these could be hindering the practice and keeping it from reaching established goals.  So, how can you assess the problem if you feel one of these questions applies to you? 

I recently worked with a practice that was investigating these same questions.  They had been without a manager for over a year and it was becoming clear that lack of leadership was stifling the practice, causing decreased morale, and contributing to other operational problems.

In addition, it was rumored that some of the providers were causing problems.  Stories had emerged that some doctors were difficult to work with, at times even yelling at the staff.  Because of this, staff were leaving the practice.  It was clear there were major issues that needed to be addressed.

One of the first things I did was complete a front and back office operational review.  I reviewed the operational problems that were keeping the practice from succeeding.  Just as important, was to determine why the staff were so frustrated and turnover so high.  Individual interviews were completed with key front and back office staff to get their opinions as well as recommendations for resolving them.

A number of interesting things were discovered that I believe are more common than we think:

Staff felt underappreciated.  Doctors showed little if any consistent appreciation for the work they did.  Doctors were quick to criticize rather than thank them for what they had done well.

Staff felt underpaid.  Staff felt they were not being paid appropriately and wanted to be paid more consistently to the market. 

Staff felt there was a lack of leadership.  Since the manager had left, the practice was being managed by one supervisor.  This caused little, if any, accountability and substandard staff continued to do substandard work. 

Operational work flow issues were evident.  The flow in the practice was not efficient.  New doctors and staff were added, but no plans were made for the growth.

The following recommendations were made:

A change of attitude was needed.  Doctors needed to acknowledge good work and let staff know they are appreciated.  Doctors discussed this in a meeting.  Specific quotes from staff were reviewed in order to impact the importance of this change.

Salaries were adjusted.  An analysis of the staff salaries was completed with recommendations made for changes.  When compared to peers, it was determined some individuals were under paid.

The practice needed a strong leader to deal with daily human resource issues and creating strategies for improving the practice.  The doctors wanted someone who could develop a budget, complete financial analysis of ancillary services as well as marketing.  A strong leader will be needed to accomplish these objectives.

We discovered the current phone system was inadequate and was causing back logs and dropped calls.  A new system was needed.  Also, the back office needed improved efficiency with phone calls.  A triage person was hired to handle the daily phone calls and referrals that were reducing the floor nurses time.

Polices and procedures needed to be developed.  Many practices, including this one, need policies and procedures for daily activities.  This can be used for new staff training and for consistency in how the practice should handle certain office situations.

More refined employee manual.  This manual, and others I have reviewed, is not detailed enough to address specific things that could come up.  This caused confusion and frustration on how things should be interpreted.

As you look at issues within your own practice try to get to the root cause.  If you find the cause you can begin to make the changes necessary to help your practice thrive.  Don’t be afraid to ask your staff what the problems are as well as how you can best fix them.  You just might get some great ideas on how to improve the practice.• DT 

Bradley Reiner, formally with Texas Medical Association, is now owner of Reiner Consulting and Associates.  He can be reached at 512-858-1570 or email at breiner@austin.rr.com.