Updating your practice’s internal documents isn’t just an administrative task — it’s a pledge to operational excellence, legal compliance and continuous improvement. It is also necessary for keeping the peace and preserving fairness for partnership issues and succession planning. Neglecting this process is like running a race with an anchor dragging behind you, impeding your practice’s efficiency, legal protection and competitiveness.

Prioritizing the tasks of regularly updating your internal documents shows discipline that not only ensures sound business operations, but also helps promote excellence in patient care.

Think of it as a strategic commitment to the well-being of your patients, the safety of your staff and the long-term viability and success of your practice. These documents — your policies & procedures, department operational guidelines and contractual agreements — form the backbone of your practice’s everyday functioning.

It is becoming increasingly common for practices to have general counsel perform a broad, periodic legal audit covering not only contracts but also policies and day-to-day practices. In many cases, especially in larger, more complex practices, the expense of such audits far outweighs getting into legal trouble that could have been avoided with a proactive review.

Here are 12 documents that deserve periodic review as well as some advice and insight on these processes.

1. SHAREHOLDER OPERATING AGREEMENTS

Too often, this document is created with the best of intentions, then sits on a shelf for years. The shareholder operating agreement should be reviewed at least every 2 years ... more often if your environment is changing rapidly.

First, the administrator and all shareholders should review the document, refamiliarize themselves with its content and discuss as needed. Then, have your attorney perform a brief or deeper review for any needs suggested by owner discussion or changes in local regulations or case law. Document the review in board minutes, and note any continued agreement or changes.

As you can imagine, it is better to review the details of new buy-in and buy-out terms before events arise requiring their application. We have seen the opposite happen too often: a retiring shareholder gives notice. The operating document is dusted off and the agreement, which seemed very fair 20 years ago, is either now deemed unfair by one party or the formulas are unintelligible, having not held up over time. This is a poor time to discover these problems.

2. SHAREHOLDER EMPLOYMENT AGREEMENTS

Based on your attorney’s advice, these documents work hand-in-hand with the operating agreement and are generally reviewed every 2 years as well. The review should include compensation fairness and regulatory review ... and each owner’s compliance with the agreed operating standards.

3. ASSOCIATE EMPLOYMENT AGREEMENTS

Recruiting for a physician associate has become extremely competitive. Practices that recruit regularly keep their employment agreements’ terms up-to-date with market standards and are ready to proceed when there is an interested candidate.

If you haven’t recruited for a while, now is the time to prepare all the documentation you will need. Otherwise, while your team and attorney are preparing terms, the candidate will have been wooed away by the competition. Provider agreements need to be reviewed at least at each contract cycle, typically yearly.

4. EMPLOYEE (HR) MANUAL

This is the holy grail for applying fairness to employees and protecting the practice with risk management. This document needs to be reviewed and revised annually by the management team and managing partner. Once any new policy adjustments have been set, your labor attorney needs to review it for any regulatory updates. Many practices keep a copy on a shared drive for all employees to access and review.

It is important to note that written policies, especially in the HR manual, need to be applied equally to all employees. In addition to the importance of following the rules and law, the goal is to avoid staff favoritism, which leads to low staff morale and reduced patient satisfaction. As your attorney will likely share, it’s better to not have an HR manual than to have one that is not followed to the letter.

5. POSITION DESCRIPTIONS

These are among the most common internal documents to go stale. Make every department leader responsible for annually reviewing the descriptions for each position in their area. The administrator should update their own position description (PD) and those of their department leads. Don’t forget to include a formal PD for the managing partner.

6. STANDARD OPERATING PROCEDURES MANUAL

Each department needs an operations manual that includes policies and procedures. The department operations manual should be reviewed annually and revised as needed. Updated operational procedures uphold standards and pave the way for streamlined workflows, relieving your staff of administrative burdens and empowering them to concentrate on patient care.

This manual should also be used for training. Staff, particularly new hires, depend on up-to-date policies and procedures for effective training and onboarding. This not only bolsters their efficiency but also fuels their job satisfaction. Having written policies to refer back to after initial onboarding training vs using only verbal communication in a department results in very different outcomes.

7. OFFICE LEASE

Review your office lease well in advance of renewal. You may have forgotten about formal notice requirements. Also, some renewal terms that didn’t mean much to you when you signed the lease may matter now.

8. SENIOR ADMINISTRATIVE AND LAY STAFF EMPLOYMENT CONTRACTS

There can be advantages to having an employment contract with senior level staff (eg, extended notice to terminate employment, compensation detail clarity). Renew these at each renewal time, including attorney review.

9. MAJOR VENDOR SUPPLIER AGREEMENTS

Know what these say and oblige you to do, and review annually. You may need to know about automatic renewals or extended notice periods for termination. Also, there could be opportunities to renegotiate terms.

10. ASC MATERIAL FOR RE-ACCREDITATION

For practices with ASCs, staying informed on all aspects of accreditation and regulatory requirements is essential. Use a specialist ASC consultant to stay prepared by reviewing regulatory requirements frequently and avoiding the last-minute rush for documentation preparation and staff training.

11. GUEST OR PART-TIME ASSOCIATE PROVIDERS CONTRACTS

These are typically another document needing regular attorney and administrative review annually, with close attention to payment terms and performance standards.

12. STRATEGIC PLAN

In the best practices we work with, documenting strategic objectives in a written plan is a key success factor. Objectives shift over time. Board sentiments change. Local market conditions adjust. Aligning your goals to owner ambitions and market realities will ensure that your practice owners and managers are aligned. 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 over 30 years of hospital, physician practice management and management consulting experience. Her latest book, co-authored with John Pinto, is “UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction.” For information on how to purchase this book or other inquiries, she can be reached at czwohl@gmail.com or 609-410-2932.

John B. Pinto is the founder of J. Pinto & Associates, Inc., an ophthalmic practice consulting firm established in 1979. He is the most published author in the world on the subject of ophthalmic management and economics. The firm serves organizations worldwide, ranging from solo practices to high-volume market leaders, teaching centers and medical product companies, providing strategic planning, financial benchmarking and analysis, operations enhancement, and marketing counsel. He can be contacted at pintoinc@aol.com or 619-223-2233.