June 2010 Archives

There’s a lot of talk about “management” or “staff management”.  One hears that they should be a better manager and pay more attention to management.  Some might even feel guilty because they don’t spend enough time on it.  But with everything else going on, most people are lucky just to get through the day and, frankly, don’t really want to spend a bunch of time on management after treatment hours.

But the fact is, with all this talk of management, very few people really define it or tell you how to get better at it.  It’s almost like it’s a mysterious commodity that few people possess and if you’re lucky enough to be born a “good manager”, then fate smiles on you.  If not… oh well.

Most business owners think, “Okay, okay.  I know I should be a better manager.  Fine.  I’ll try to do better from now on”—as though it’s a New Year’s resolution to “be a better manager.”  Well, if one is going to try to be a better manager, one should know something about it.  The first thing to understand about management is that it isn’t usually adequately defined.  People talk about it, but don’t really say what it is.  So, let’s get a workable definition for “management”—a definition we can USE.

Every business owner has goals—something they’re shooting for or would like to achieve.  Some owners are better than others at actually attaining their goals, but most everyone has got them.  Whether the goal is “grow the business 25% this year”, “save up ____ dollars for retirement by the time I’m 65” or just, “be able to leave the practice at 5:00 PM and not have to worry about it,”… everyone’s got some goal they’d like to be able to attain.

Every business owner also has barriers.  They have things that prevent them from arriving at their goals: problems, confusions, fears, blocks, frustrations, etc.  This is obvious because if no barriers were present, the business owner would already be at the goal—he’d have made it already.

Additionally, every business owner has got his business’s current situation.  This isn’t where he’d LIKE to be.  It’s the situation that he’s currently in.  It involves _____number of patients per week, ______dollars of collections per week, ______hours worked, ______staff employed, etc.  Every practice has a situation or position that it’s currently in, good or bad.  There’s a gradient scale here.  It can be in a bad position now, but it could’ve been in a MUCH worse position before.  The current situation is just how it’s all arranged now and what the business owner currently has to deal with.

So that’s the game.  Overcome the barriers in the practice in order to move it from the current situation to a more desirable one—so that the business owner is achieving his goals.  Simple right?  And it really is—IF one honestly has the know-how of management and organization.  Obviously the solution to almost anything a business owner is running into could be summed up in “overcome the barriers that are keeping your practice in its current situation and preventing you achieving your goals.”  And this…THIS is the problem of management.

So “management” could be defined as “putting the business owner’s goals into effect in the real world” or simply “the subject of how to bridge the gap between the business’s current situation and the attainment of the business owner’s goals.”

Now, this brings us to an interesting point.  Most business owners have a particular confusion.  They think they have only one major job in their company or practice—that they’re the “business owner” or “practice owner” and this sums it up.  But, that’s a pretty vague description and can mean a lot of things.  Thus, it’s actually best to break it down and separate this into what most single practitioners are actually looking at.  Most practitioners actually have three separate, distinct jobs. 

The first job of the single practitioner is just that: a practitioner.  This is due to the fact that they see patients every day.  This is a job unto itself—it’s them as a doctor.  It requires the correct care and technical handling of patients.  As associate doctors are hired on in a practice, the associates have similar duties.  The job of the doctor or practitioner is to provide excellent patient care, and that’s what they do.  A very large portion of every day is spent on this.

The next job is the “business owner.”  This is strictly the “chairman of the board” or “CEO” function.  A business owner has several major duties that include establishing the corporate structure, setting long-term direction, deciding on the overall goals and ensuring that the organization is staying true to those goals.  This is the ultimate “buck-stops-here” overseer, because after all…it is their company—their money and their neck is on the line.  Contained in these “business owner” duties are things like ensuring the ultimate success of the practice as a business, making sure there will eventually be enough for retirement, ensuring long-term “life goals” are being achieved, etc.

The last job is the “manager,” “Office Manager” or “Executive Director” duty.  This is often done partly by the OM and partly by the doctor, but not one particular person—though it should be.  The duty of any manager is to ensure that the goals of the business owner are achieved.  This is the whole reason he has a job.  This can include the minutia of making sure the phones are being answered correctly, or all the way to things like hiring the right staff.  This is the most key administrative job in the practice.  The reason the manager or executive director is so key is because this person’s job is to ensure the business owner’s goals are achieved.  The business owner makes the goals, the direction, the objective; the manager then runs the show to make sure these actually do happen.  These aren’t actually the same job and they’re often best done by two different people.

Here’s the rub: most practice owners put very little attention on their duties as “business owner” and “executive director” and put their entire focus on “practitioner.”  Now, it is a tribute to their skill as a doctor that this alone sustains many a practice.  You can have a practice with very few goals or oversight, you can be pretty poor at managing (or barely do any at all) and still, just based on the skill and production of the doctor, get by all right in the society.  However, it won’t necessarily be as prosperous as it could be, and it definitely won’t be smooth or worry-free.  In fact, it can be a downright mess.

Thus, the first major tool that can be applied to sort any of this out is just to separate each of these from the other.  First, take a look at your schedule the past week.  Look at how much time was spent seeing patients.  This is your “doctor” duties.  Then, look at how much time was spent running the practice to make sure that it went right.  This is you “manager” or “executive director” duties.  Lastly, take a look at how much time you spent planning the overall direction or making sure things were actually going according to plan.  In fact, while you’re at it check and see how much time you actually spent in the last month on this.  This will give you a pretty good idea of whether or not you’re even honestly doing the separate jobs.  That brief analysis above will tell you a lot.  Whether you’re doing them or someone else is doing them, someone MUST be doing each of those jobs: a) business owner, b) practice manager and c) practitioner (doctor).

The next thing to do is ask yourself if you currently have enough time in your schedule to do these different things.  If not, that has to be changed first.  For instance, perhaps you need to hire an associate so you have enough time as the manager to focus on the organizational health of the practice.  Or perhaps you need to get an office manager in there to really run the show.  Either way, each of these jobs must be done for any practice to really function efficiently.  So, the thing to do is determine if you honestly have enough time in your schedule to function as the business owner, the manager and the doctor all at the same time, then reorganize your practice so that there are people you can trust doing each of these jobs.

For the sake of argument, we’re going to assume that the technical aspects of patient care aren’t an issue for you.  We’re going to assume that you’re good at it and it is, for the most part, under your control.

The area of most interest to us here is the area of being a business owner.  Remember, a manager’s job is to make the business owner’s goals become a reality.  Thus, if the business owner doesn’t have clearly delineated goals, the manager’s job becomes very difficult.  So the next thing to do is sit down as the business owner and look over the practice.  Determine what the purpose of the practice is for you.  Why do you have it?  What are you trying to achieve with it ultimately?  What is its purpose and what is its product?  What are you trying to ultimately achieve in your own life, by having this practice.  Boil this down to a couple of key points that sum up the real-world goals of the practice.  These would have to be extremely practical and would have to really, honestly match up with what you want in life.

Once you have these goals, you’ve now got the standard with which to judge the current management.  So find out: if there is a different person than the owner doing the practice management role—does the practice manager (OM, executive director, etc.) know these goals?  Did they know them before?  Are these goals what they think they’re actually shooting for?  Now, you’re really entering the realm of analyzing your business’ actual management ability.

And, though there is a LOT more to the subject of management—with a lot of skill and know-how available—this at least provides a foot in the door.  Step one is to make sure that goals are set and clearly communicated by the practice owner.  Step two is to ensure there is someone actually running the day-to-day actions of the practice who can really control the practice.  Step three is to make sure this person honestly understands the goals and is really working toward them.

If you just sit down and do the above, you’ll find that the business slowly begins moving in the right direction—because it’s hard for a manager to efficiently steer a boat somewhere if the business owner never set the ship’s destination.

If you have any questions about management as a subject, or would just like advice, please don’t hesitate to call.  We’re always interested in hearing from you and that’s why we’re here—to help.

Mark Hanses

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