Management Essentials

From Survival Mode to Strategy Mode

By Farrell "Toby" Tyson, M.D., F.A.C.S.

Many medical practices operate under a sense of organized chaos. This stems from the thought "If we can just make it through today." This method of operation is what I like to call survival mode. It is where the practice is not worried about or contemplating the future because the present problems are too overwhelming.

Under Pressure

In survival mode, the staff is encouraged out of fear and driven by adrenaline. While this mode can be quite productive in the short term to fix a specific problem, it does not function well over longer periods of time, as physical and mental exhaustion settles in.

The staff is intent on only the job at hand. There is no time for education, training or planning. Worse yet, the practice administrator is constantly busy putting out little fires and waiting to address the emergency of the day. The perception that the sky is falling permeates the practice, affecting morale. This also is frequently used by administration to excuse a lack of performance on core administrative tasks and goal-setting for the practice owners. This cycle has to be broken in order for a practice to move forward and thrive.

Stepping Away From Survival

Establishing a comprehensive employee handbook is the first step in moving away from this mode. This document allows all staff to understand the basic rules of the office. Knowing what is allowed and not allowed calms the environment and limits the number and magnitude of fires that erupt in the office. Once these basic tenets are in place, more time will become available for administration to become more proactive and less reactive.

The next step is a practice analysis. This should be done from the top down. This analysis should be thorough and impartial and will benefit greatly from comparison to national benchmarks.

Once the practice analysis has been completed, goal setting can proceed. Goal setting usually begins with the vision of the physician-owners. This is the dream or the ideal to which the practice aspires. This vision is sharpened with administration's help by defining what actions are necessary to meet the goals and the expected time-frame for their accomplishment. After these goals are laid out, managers can be brought in to the strategic planning and decision-making process to help with staff "buy in."

To achieve these newly stated goals, you need to know the caliber of your staff. This is done through thorough staff evaluations. Staff members are evaluated on knowledge, performance, work ethic and attitude and are ranked on a scale of one to five, with one being a keeper and five being someone who needs to be replaced. After the staff analysis is complete, it is time to implement change.

In our practice, it is not easy to be number one. To be a one, a staff member needs to go beyond what is required and take initiatives that add value to our practice. For instance, we have an experienced staffer who has taken a newer member under her wing and is serving as her mentor. She is taking time out of her day to develop another person's skill set, and is helping to increase our practice's efficiency — thus enabling her to earn the coveted number one rank.

Staff ranked at a level of five needs to be replaced as soon as possible with more competent individuals. Usually after this step, level three and four employees will start to shape up or leave as they are no longer in their comfort zone, having realized that they are now on the bottom of the totem pole.

Once your core staff is in place, it is time for training. Training makes your staff more confident and productive. The ideal amount of training is 1 hour for every 80-hour pay period. This can be accomplished in the form of online training, in-office training, after hours small-group sessions or offsite courses. The key is making sure the training is in the appropriate areas that maximally benefit the practice.

Moving Forward With a Plan

With these steps in place, longterm strategic planning can be addressed. This is where a practice makes its biggest steps. When the day-to-day operations are on autopilot, then planning for future contingencies can be performed, thus continuing to smooth out the operation of the practice. This is the ideal place for your practice to be — striving for the future. The effectiveness of your administrator can be determined by what percentage of the time your practice is running in survival mode versus strategic-planning mode. OM