Enhancing Practice Performance

Guide mid-level managers to success

Here is what they need to know to accomplish practice goals.

By Corinne Wohl, MHSA, COE and John B. Pinto

Who, exactly, is in charge of what? This question lies at the heart of your organization’s function. The classic, pyramid-shaped organizational chart provides some clarity about who’s in charge. But even the most clearly delineated “org” chart can make it hard to determine the role of the indispensable middle manager.

Mid-level department managers consist of supervisory staff whose roles are sandwiched between the practice’s senior leaders (the administrator and managing partner) and the rest of the front-line employees. They are responsible for the granular, day-to-day operations within each of their domains, and include titles like “head tech,” “billing supervisor” and “marketing director.” Not only are these managers responsible for their own to-do lists, they also have to execute tasks delegated by administrators.

Years ago, an East Coast administrator in a large practice wanted to challenge her five mid-level managers (billing, clinic, optical, operations and patient services) to make more of their own in-the-trenches departmental decisions. The goal was for each manager to grow in his or her own role and for the practice to be less dependent on the administrator and managing partner.

In the absence of moment-by-moment administrator oversight, the patient services manager made a poor decision and cut back on appointment-reminder calls. This decision lead to an expensive increase in no-show patients. The administrator quickly discovered this failure because she closely checked no-show rates. Such brisk, easily reversed department-level failures provide a relatively painless lesson to mid-level managers and administrators alike, making both stronger leaders.

Here are five success factors for all mid-level managers and their supervisors based on observations in numerous settings.

1. AUTHORITY, PERMISSIONS AND LIMITS

Practice leadership must clarify the boundaries and expectations for mid-level managers. They need decision-making authority to direct the day-to-day operational issues. Without it, they are figureheads with little power to improve patient flow or keep staff motivated.

On the other hand, mid-level managers need to recognize what they know and don’t know … and seek appropriate clearance. This is where the administrator must take an active evaluative role to provide feedback and guidance — just like the interplay between physician and technician.

2. TOUGH AND FAIR MANAGEMENT STYLE

Our clients consistently report through staff surveys and interviews that they prefer working for a tough-but-fair supervisor and that this is most effective. Managers must avoid the reality and perception of favoritism. Employees promoted through the ranks, changing from peer to supervisor, are at particular risk for this. (Some wise administrators work to show that they are harder on their favored staff than they are on rank and file.)

Making the transition from peer to supervisor is difficult. We’ve found that this tough-but-fair ethos can be challenging to administrators and owners, so imagine how much support and guidance are needed for your management team.

Be a role model, and set the expectation that there will be zero tolerance for anything except balanced treatment for all staff.

3. PRACTICE LEADER SUPPORT

Practice leaders must offer unconditional support to mid-level managers in public. Otherwise, the manager is undermined, and it doesn’t take long for employees to figure out who actually has the power and authority.

Also, always provide support, even when a manager makes a mistake. The practices we’ve seen that shower praise and provide redirection instead of showing reactionary anger or evoking shame are those that retain devoted, developed staff for years and benefit from their loyalty and growing confidence.

Administrators and mid-levels must be able to speak openly behind closed doors. Establish this mutual understanding in advance. Let your managers know that anything can be said safely (respectfully of course) in private.

4. BASIC LABOR LAW KNOWLEDGE

Managers must be trained in basic human resource law. This includes interviewing protocols, performance evaluation, disciplinary action and proper methods of communication.

They must recognize red flags that indicate potential trouble and when to notify the administrator immediately, especially when they are unsure about a new situation. It’s important to instill a “risk management instinct” to protect the practice and individual employees. Send your managers to local HR seminars or contact your labor attorney for local training assistance ideas. Also, weave legal updates and case histories into internal management training sessions.

5. COMMUNICATION SKILLS

Listening, speaking and writing well are critical skill sets for all managers. Most aspects of our workday in the ophthalmic clinic require all these skills. But we are not all born with a high innate ability to communicate.

In a medium-sized clinic in Atlanta, we saw a relatively new mid-level manager with staff sprinting to please her: She was super motivating. What made her special was her ability not only to speak clearly about practice goals but also to write protocols for exactly what her people needed to do. It was a fine example of how raw communication skills are key, even more than job tenure and experience.

CONCLUSION

How can you know for sure that your mid-level managers have these skills and apply them to your practice? Spend time observing them. Take a few minutes throughout the month to shadow each of your direct reports. Watch how their departments function under the pressure of a busy day. Also, spot-check your staff’s knowledge of important goals and policies. Help your mid-level managers see any gaps, and guide them to improve. OM

	Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. Corinne earned her Masters of Health Services Administration degree at The George Washington University and has 30 years of hospital and physician practice management experience. She can be reached at czwohl@gmail.com or 609-410-2932.
	John Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the leading author in America on the business of ophthalmology. His latest book, “Simple: The Inner Game of Ophthalmic Practice Success,” is now available at www.asoa.org. He can be contacted at pintoinc@aol.com or 619-223-2233.