In the conversations leading up to our recent burnout panel (Click here to watch!), we noticed a common phrase being used: "I don't manage my staff; they manage me!" There are many factors that contribute to burnout, but perhaps an unexpected culprit is the lack of control many doctors feel in their own practices. Who is really in charge while you are scrambling from exam room to exam room all day? When you don't set the schedule, handle the financials, or manage the employees, it is easy to feel like an employee yourself. As this process plays out day after day or over even over years, the tendency for many doctors is to become (or at least feel) like they are just a cog in the system. The psychological concept of learned helplessness has been used to describe the perceived loss of power between doctors and third-party-payers, but what do you do when it also applies to your staff?
Let's be honest: It is hard to serve your patients well while simultaneously keeping a firm grip around everything that is going on in your practice. It won't happen overnight and it will take some effort, but it is possible to practice medicine and take control of your staff. So, how do you regain control of your practice? Three steps:
Goals If you are a cog in the system that is your practice, it is highly likely that goals do not exist within its four walls. After all, who would hold someone accountable for hitting them? But here's the thing: Once you issue goals to your team, you automatically turn your current practice model on its head! Guess who is in control the moment you give each employee their goals? You are! Historically speaking, the problem with goals is that most business owners either don't set any at all or set really bad ones. George T. Doran developed the SMART acronym to help us here. Here are the five criteria that make up SMART:
Let's say you have one individual (Let's call her Mary.) who is over your billing. How would you implement SMART goals with Mary? Simple You want to start with your biggest need first. Is your accounts receivable (AR) totally out of control? Start there! The average practice AR over 120 days, according to the Medical Group Management Association, is 17.7%. Maybe yours is higher than this or you want it below 10? Sit down with Mary and talk through this goal with her. Tell her why it is important and empower her to solve the problem herself while also making yourself available for questions if she needs help. Measurable How will both you and Mary know that progress (or a lack thereof) is being made? The obvious indicator will be the percentage of AR over 120 days decreases. But what about the method? Will she be sending emails, letters, or making phone calls? How many per day in addition to what she is already doing? How will you monitor her progress here? You can't just measure the results. You always have to measure the method. Assignable This is easy. Mary is going to do it. If she needs help, figure out who is best suited to assist her. This person should also have the capacity in her workload to pitch in. Realistic The results with something like AR are pretty simple: The amount of outstanding AR should rapidly decrease when resources are directed at it. Is one or two percentage points per month fair? Determine what is realistic for the employee and communicate your expectations. Time If your AR is in a bad state, you will need to be gracious with your timelines. You have already set a realistic monthly target for the decrease in your outstanding AR. All you need to do now is match the math. If you knock off two percentage points per month, how long will it take Mary to complete the project? You probably already know this, but anyone can set goals. The challenge comes with accountability. Accountability Doctors are busy. We understand that. But if you want to be in control of your practice you have to, well... control your practice. Here is one place most business owners, managers, etc. fail when it comes to goal-setting and accountability: They don't get the employee to buy in! If you don't get your employee to buy in and sign off on their new goals, excuses will abound when their monthly review comes up. Things like, "Well, I had X, Y, or Z going on, too," or "How am I supposed to reduce the AR when I am answering the phone, billing, and cleaning the lobby!?" You want to prevent excuses and the best way to do this is to:
Questions like these make monthly meetings much quicker and easier. (By the way, monthly meetings reestablish the control of your practice!) If you agree you are going to do something and that it is reasonable and fair, but you don't get it done, you are the only person who can be held responsible! If your employee missed their goals, that sets the stage for a hard conversation! Hard Conversations There is no accountability without honesty. In her best selling book, Fierce Conversations, Susan Scott writes, "During a fierce conversation, my role is not to say what is easy to say or what we all can say, but to say what we have been unable to say. I try to pay attention to things that may pass unobserved by others and bring them out into the open. The most valuable thing any of us can do is find a way to say the things that can't be said." Many business owners live in misery because they haven't found the boldness to say what needs to be said. With staff members, this often starts out as small, everyday miscues, that eventually snowball into total job dysfunction. Things can often be turned around with one conversation while some situations call for the dismissal of an employee. Hard conversations are those that leave you feeling a little sick to your stomach when you know they are on the horizon. That feeling is one of necessity and often means you are on the right track. Conclusion The good news here is that most of these situations can be redeemed if you, the doctor, are prepared to take on the true managerial responsibilities of the practice. This means being able to correct errors made and bad habits formed by your employees for the betterment of your practice (and your sanity). There is no silver bullet here, but laying a foundation (goals), giving both you and your employee an opportunity to meet and talk (accountability), and speaking truth (hard conversations) are the essential makeup of any healthy employer/employee relationship. Most, if not all, doctors want to be in control of their practice. The real question is whether or not we want to take the time to create a healthy work environment for our employees to thrive and hold them to agreed-upon standards that improve both the quality of the practice and the care we provide to our patients.
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AuthorThe staff and doctors at VisionAmerica are committed to providing relevant information for you, your patients and your practice. We hope you find the information in our blog post helpful. Archives
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