Practice leadership styles have a significant influence on your practice’s financial successes or failures. For example, financial success results more often when a practice administrator focuses on building core strengths (such as a skilled employee cohort), develops written and well-communicated policies and procedures for financial growth and control and makes data-driven decisions. Conversely, financial success falters when disrespect abounds within the management team, customer service is not prioritized and miscommunication throughout the practice is common.

In this two-part column, we will contrast common management styles observed in our work and how these styles can be modified for practice improvement.

THE “HAIR-ON-FIRE” ADMINISTRATOR

This administrator’s daily focus is on the problem of the hour, often frustrated that larger projects and long-term planning lag behind. He feels stuck and frustrated at being reactive rather than proactive. It may feel like there is no way to change the behaviors and practice culture that result in this cycle.

Here are some common drivers for this caught-in-the-whirlwind environment:

1. Weak mid-level managers, which result in under-delegation. This first item is the most common driver and often looms larger than the next six items combined. Without an organizational chart that clarifies management team responsibilities and a strong middle management team to carry out those responsibilities, the administrator has to orbit every small issue.
2. High annual practice growth rate. A rate of 10% or more can generate operational errors and inefficiencies.
3. Lack of a company vision or strategic business planning. It’s hard for a practice and management team to make improvements and reach for goals if the goals are not clearly determined. Without a target, it is too easy for the management team to get stuck in day-to-day operational challenges.
4. Poor organization and time management by the administrator or mid-level managers. Practices have a tremendous number of moving parts. Strong skills in prioritization, organization and delegation are required and, with a concerted effort, improvable.
5. Lack of alignment by the owners and/or the managing partner and administrator. Agreed upon, supported, clear direction from leadership is the only way a practice can excel to its fullest potential.
6. Poor communication throughout the practice. Excellent communication includes meetings of the proper frequency for a practice’s scale, written policies and procedures, department operations manuals and email communications that reinforce verbal discussions.
7. Lack of clearly defined position descriptions. Roles and responsibilities are unclear, which leads to confusion, lack of accountability and need for overly close supervision and management intervention.

HOW TO IMPROVE

If you are a “hair-on-fire” administrator, the first step to improving is to acknowledge that you have fallen into this pattern and understand that you need to improve your mid-level management team. From there, you can apply these next steps:

1. Have an open discussion with your managing partner. For example, you may start with, “I feel that I’m treading water and finding it hard to get ahead of the task curve. I think the most important reason is that my middle managers are under-developed. I’m going to spend the next 90 days getting the team up to speed, and I need your support. Some projects and activities may be temporarily delayed, and we may need to replace or reassign a manager or two.”
2. Take an inventory of mid-level management talent. Draw up your organization chart. This should resemble the typical pyramid-shaped structure of who reports to whom. Then, ask three simple questions about each person:
   • What is his current global job performance on a 0 to 10 scale? (Write down your first impression, and don’t overthink it.)
   • What is his potential performance on the same 0 to 10 scale?
   • How could he achieve that potential performance? (Be specific, and include reasonable deadlines.)
3. Develop a plan. Ask yourself, “What is the minimum global performance level needed by a member of my management staff?” For managers whose potential falls below your minimum score, write out a replacement plan. For managers who can rise to the required level, launch a coaching program. For managers who are already excellent, make sure they are being appropriately praised and rewarded, including compensation at competitive market rates, benefits or bonus commensurate to the position and, most importantly, communicating recognition of excellent performance
4. Reevaluate the common drivers. Finally, go back to items 2 through 7 above, and address any that remain as drivers for your hair being on fire, too. Management teams tend to follow the examples and rhythms set by senior leadership. OM

In part two, we will continue to review management styles and ways to improve them.

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 over 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.