What steps can you take to ensure you’re leading your practice staff in the right direction?
By John Carruthers, staff writer, April 01, 2011
Becoming an effective leader of a practice requires physicians to master a number of very different roles to achieve professional success. At the same time, most physicians come out of residency with little to no training in core leadership areas such as management, human resources, or conflict mediation. However, mastering a small but crucial roster of skills and practices can help ensure an office filled with efficient, fulfilled employees and happy patients.
Effective staff meetings
A large part of effective leadership, according to practice management consultant Peter Lucash, is looking beyond just the day-to-day to formulate an effective strategy for the week, month, or long term. The staff meeting, Lucash said, is the perfect place for physicians and staff members to compare notes on patients or workflow issues, air concerns, and bring ideas to the table.
“Regular all-staff meetings, when run effectively, can be almost like a huddle before a game. You can get your staff together, go through the day, and ask what things are looking like, are there any patients that staff should be aware of? Are there any special needs that patients have that they should be aware of — say, someone who needs assistance from the parking lot coming in later?” Lucash said. “When you ask if anyone has anything to bring up, sit and listen, count to 10 slowly, like you would after you ask if anyone has questions when you do public speaking. You have to give people time, but you want them to want to open up. They spend more time with the patients than you do, and patients may say something to them that they won’t say to you which could end up helping in their treatment. Your staff is the eyes and ears of your practice in many, many ways. This approach, given a couple weeks for your employees to warm up to it, is very effective. Start by trying it once a week, maybe on Monday mornings.” [pagebreak]
One difficulty that many doctors may have, according to Mary Maloney, MD, chief of the dermatology division at the University of Massachusetts Medical School in Worcester and chair of the American Academy of Dermatology’s leadership development committee, is mastering the transition from talker to listener. Much like Lucash, Dr. Maloney says that the process of soliciting feedback from employees in front of the entire practice can start slowly for awhile before results are achieved.
“Most of the time, we doctors walk in there, and we’re going to make all the announcements and tell everybody everything and okay, meeting’s done right? We never give the staff a chance to tell us what’s going wrong with patient flow or what they could do to make things better. We really need to allow people to talk to us and develop our listening skills. Set aside a time that is specifically for them to talk about their issues,” Dr. Maloney said. “At the end of every meeting, ask the group what we might have missed that was important that can go first on the agenda for the next meeting,” she said.
“By doing that, you give people the ability to think about what was missed or what they didn’t have a chance to say. The first couple of times you try it, everyone kind of sits there and looks at you,” Dr. Maloney said. “But after you say it a few times, and you actually listen and put it on the next agenda, it works really well. By people telling you what they want to hear at the next meeting, they’re telling everybody a topic to discuss and everybody thinks about it and comes in mentally prepared.”
Hiring the right employees for one’s practice is a critical element in laying the foundation for its success. A good hire can not only increase the productivity of a given position, but also make everyone else better. Conversely, one bad hire can have a chilling effect on efficiency, job performance, and the general mood of the office. Yet physicians must be careful, Dr. Maloney said, to not fall into the trap of surrounding themselves with only like minds and people-pleasers. [pagebreak]
“One of the things we tend to do is to surround ourselves with people just like us, which isn’t always a very good outcome. If you put six of me in a room, nobody thinks and everybody does. As I’ve learned more and more about teamwork, I’ve realized that you really want to balance yourself — for me, it’s someone who slows things down a bit, who thinks things out a little more,” Dr. Maloney said. “You have to learn to recognize the value of different kinds of people on your team. While it feels like a problem, it really kind of isn’t. It adds richness and dimension and gives you greater flexibility with the things you do. As I said, it’s the benefit and the problem at the same time. Everyone has to be more flexible and talk to each other more.”
Evaluating a candidate’s potential to fit in to one’s unique practice culture can be a daunting challenge, as not everyone is able to quickly get a read on an interviewee. According to Lucash, a number of successful corporations have found ways to roughly gauge a number of measures which indicate the candidate’s potential compatibility with their cultures.
“It’s vital to hire people with the right attitude. The story is that Southwest Airlines evaluates how many times their candidates smile during the course of their interviews,” Lucash said. “That’s just one gauge, but the idea is there. It’s different hiring for practices than any other business, because it’s such a personal thing to your patients.”
Another part of gauging a potential staff member’s attitude, according to Lucash, is the level of focus that they show on financial compensation. While every candidate can and should seek a fair salary based on the market, Lucash says that an employee interested in cash above all can be bought out from under one’s practice at any time.
“Your staff can get well-engaged in helping people in the practice if you hire right. They’ll care about what they’re doing and where they’re working. My personal feeling is that if someone’s solely interested in the money, you need to watch them. More often than not, they’re the person who’s going to become a problem,” Lucash said. “My good friend is an attorney, and I recall a story from years ago when he was the senior partner at a 40-50 person law firm. They were paying higher and higher money to get these new graduates every year. My thought was that if these new grads were going to jump for more money somewhere else, it was best to let them go. You don’t want them they’ll be gone when a better offer comes along.” [pagebreak]
Running a successful practice — or a business of any kind, for that matter — requires engagement by staff. Employees must feel not only secure, but valued. Companies like Google and Southwest Airlines have made headlines for their open corporate cultures, while US Airways was known for years for a toxic, negative attitude amongst the bulk of its employees. The first two companies continue to search for new ways to engage employees for the benefit of the organization as a whole, while the latter recently opened up a series of dialogues between employees and executive management in hopes of transforming the attitudes of its front-line employees.
Practice management consultant Mimi Bacilek, who runs consulting firm Success Builders LLC, recommends one of the most time-honored management tactics — drawing focus to a larger purpose.
“I think that one of the best places in which a leader can use their energy is in talking about what it is we’re trying to accomplish. Why it matters. Why it’s an important place for people to work, and why they’re making a difference for patients, families, and their communities through their work in that practice,” Bacilek said. “That gives people a much higher calling, and they oftentimes become much more engaged and begin to see themselves less as hourly employees and more as partners in the practice’s success.”
In addition, physicians must ensure that employees feel free to bring up issues, concerns, and suggestions for improving the practice. Truly engaged employees should feel as if they have a part in the practice’s success. Dr. Maloney finds that using a handful of trusted employees for honest discussion of one’s potential flaws yields exceptionally helpful information. While seeking out criticism isn’t anyone’s favorite pastime, physicians with the determination to keep themselves sharp as managers find it a worthwhile undertaking. This entails not just honestly assessing the practice’s operations, but your own personal management style. [pagebreak]
“The most important thing about running your practice is knowing first how you come across. Who are you? How do you interact with staff yourself? One of the really helpful things to do is have your entire staff complete a 360-degree survey about how you work. For a small practice, if you’ve got a couple of staff members who you get on with well, there’s a lot of trust both ways, you can sit down with them and say tell me what’s working and what isn’t when we get together at staff meetings? How am I perceived?’” Dr. Maloney said. “Give them permission to tell you some stuff that you may not want to hear. If you really get a good response, that helps you connect better with your whole team. Know how you’re perceived, then try and be sure that your style is adaptable enough that people can listen.”
While one can’t always predict what difficulties will arise with staff members — or between staff members — it’s a virtual guarantee that every physician will have to deal with uncomfortable situations. Preventing them isn’t always an option, but how one deals with them as the ultimate decision-maker can show the true mettle of a practice owner.
“When dealing with effective staff management, something I talk about is being prepared for what I call courageous conversations,’” Bacilek said. “By being prepared for, I mean watching for them and the need to have them, and acquiring the skill set for doing it. It’s much more of a mental hurdle to overcome than a technical hurdle. Most of us don’t like conflict, we try to avoid it. In avoiding it, the problem grows and our frustration increases. As our frustration increases, our inability to handle it effectively looms large. Be on the watch for the need to have a conversation with someone, and make sure to be mentally prepared for it.”
In addition to listening to the content of a staff member’s issue, Bacilek finds that she can often plunge to the heart of a problem by listening to phrasing and word choice.
“The trick is to listen to what people say — do they think it, or do they feel it? Do they believe it, or do they know it? There’s a distinction. Help them understand where their behaviors are effective or ineffective through their own language,” Bacilek said. “If you were to tell me that you think so and so is not a very good employee, I’m going to ask you for the data that tells me that so I understand how to address it. If you tell me that you feel like someone is not being kind to others, then I’m going to ask you how it’s impacting people — what they’re experiencing. I want to go after what people are worried about, and it’s either going to be a data issue or a feelings issue.” [pagebreak]
In mediating disputes between staff members, Dr. Maloney said that one’s first instinct is often to just have it out and resolve it as quickly as possible. Yet, she advises, that’s really not the way to the best outcome. Instead, physicians should work on building trust between themselves and staff, as well as staff and each other.
“What I’d really like to do as the boss — and this never works — is to lock them both in a room and see who’s still standing at the end. Trust and respect are the basics for all relationships. Physicians and co-workers need to get to know their colleagues as individuals and begin to build trust and respect. Ninety percent of the time, if one or both people are willing to work on that, they may not become best friends, but most of the time you’ll get people who are able to work together. They’ll trust that the other person isn’t trying to throw them under a bus,” Dr. Maloney said. “People work differently, and have different values. But if you get to the end of the day and people can respect and trust each other, then the office works. If you get to where there is no trust, then something’s got to give. In many instances, both parties are very important to the practice. In larger offices, you may be able to separate them and have them work in different areas. If it’s the boss and someone else, and I don’t feel like I can trust them, that’s not a way to continue a relationship, and it’s time to reconsider having that person working there.”
Employee engagement is more often than not about rewarding productive behavior and celebrating achievement. Lucash advises taking extra steps to show one’s gratitude for a successful year, or an improvement in practice efficiency. Expense need not be a deciding factor — according to Lucash, as well as a legion of contributors to the practice management literature — as the real reward at heart is the recognition and gratitude, far more than any concrete award.
“There’s a legendary story about Hewlett-Packard where a number of years ago, an employee there had solved a difficult problem that the group had been working on for weeks. The manager, looking around for something to give him for praise, only had a banana from lunch. He handed him the banana, said congratulations, and the incident became a piece of company lore,” Lucash said. “There’s now a golden banana award at HP for that kind of standout service, and it’s one of the highest honors you can get. The point being, your reward could be a banana or whatever else you have around. It doesn’t have to be valuable so much as recognition of someone’s contribution.” [pagebreak]
When high achievement is the result of the entire practice, it’s important to include everyone in the recognition. Such an event, while it may take some time out of a workday, pays dividends in the continued engagement, involvement, and fulfillment of one’s staff.
“When you have cause to celebrate, celebrate,” Lucash said. “Maybe bring in some lunch, or get breakfast for everyone — and that means on your dime, not a pharmaceutical rep’s. Gift cards are appreciated a lot. Several years ago, my then-94-year-old aunt was on home care in New York City, and the aides paid for their own transportation. We thought a lot of this one particular aide and wrote a letter to her boss. They have a program in place, and gave her a transit pass,” Lucash said. “This person was so appreciative that we took the time to acknowledge the hard work and care she gave to our aunt. To her, that was worth more than anything else. The notion of recognition doesn’t have to be big stuff. That works. It all comes back to the theme of appreciation.”
Ultimately, Dr. Maloney said, success as a leader is gauged in the attitudes of everyone involved with the practice, from partners to patients.
“It’s really the question Do the people that you work with come to work and enjoy it?’ The vast majority of time, do you go home saying I had a good day, I worked with people that I care for, and my patients are happy’?” Dr. Maloney said. “That’s the best way to judge the success of your practice. All the other measures can be somewhat artificial. You and your staff should go home comfortable with a good day’s work, and feeling fulfilled.”
The American Academy of Dermatology provides a number of resources for members seeking to bolster their management skills through its Leadership Institute. In addition to a recommended reading list, the Academy offers networking receptions, mentoring, and a core curriculum based on seven core competencies of leadership. The Academy also hosts an annual Leadership Forum and offers a variety of Leadership Institute courses at its annual and summer meetings. Visit www.aad.org/leadership/ for more information.
The 'fabulous five’: keys to leadership success
Management consultant Mimi Bacilek, owner of Success Builders LLC, focuses her management advice on these five key steps a set she refers to as the Fabulous Five.
- 1. Listening — Fully engaging in each conversation, rather than letting one’s mind wander to the next interaction or task. “It’s not an auditory function, it’s a cognitive function,” Bacilek said.
- 2. Asking — powerful questions Asking employees how you can help them better achieve the desired goals. For instance, “help me understand why this is taking so long, or this many steps,” rather than “I need you to work more quickly.”
- 3. Delegating — Do your employees clearly understand their goals and responsibilities? Are they aware of the resources available, and the expected timeline?
- 4. Feedback — Giving meaningful feedback on performance. When people do well, tell them what you’d like more of. When they’re underperforming, be clear about what you expect and secure a commitment from them in their own words, not yours.
- 5. Situational Leadership — A concept pioneered during the 1970s by Paul Hersey and Ken Blanchard, as illustrated in the books The Situational Leader and The One Minute Manager. It involves adapting one’s leadership style to individual employees in different situations.
“When an employee is in a situation that is different than their normal one, they may need different leadership. For example, I hate details. Don’t ask me to balance your checkbook. I am capable of it, but I won’t pay enough attention to your details. If you’ve got me managing your books, you need to stay really close to me, or I may not do a good job,” Bacilek said. “However, if you want someone to go and tell the world about the wonders of our practice, I do lots of public speaking, so I’d be fine stepping out and doing that without any guidance at all. So it’s taking the situation the employee is in and leading against that situation.”