A recent Physicians Practice Pearls article by Judy Capko discussed what to expect from your medical practice manager. The article describes expectations and communications, which are very valuable and will contribute to manager success. I would like to take a different approach and suggest that most important is matching the style of the manager with the needs of the practice.
My experience has shown that there are really two distinct styles of management— interventional and collaborative — and that each has a distinct place in the evolution of the medical practice business.
The interventional manager (folks like me), are change agents. They are valuable during transformative periods in the practice life cycle such as significant growth, performance improvement, or shifts in strategic focus. Their skills lie in the ability to assess what is working, what isn’t, and what changes are needed to assure future success and to manage the change process. Once the goal has been achieved, however, they might get bored in a well-run environment. If your practice is in such a stage you might consider interim leadership or even someone who has retired from active management and might be open to a year or so of effort. It is likely that the interventional manager will move on after reaching the organizational goals that were established, so knowing this up front may make the transition smoother.
The collaborative manager, on the other hand, is great at team building, process improvement, and generally creating a positive culture. They are not always good at managing change. These are the individuals who will become long-term employees so long as there are no dramatic events that impact practice operations.
Practice size does not change this differentiation. I have been involved in restructuring practices as small as two physicians and as large as 600 physicians, but, in all cases, once that process was complete I assisted in the recruitment of managers that were able to build on the changes that were made and assure continued success. Most have remained with their new practices for many years.
One example of a failed marriage was when the board insisted on a candidate who had worked in a number of settings but, typically, they were during periods of organizational change. They felt that they needed the skills that helped bring them from the verge of bankruptcy to a top performing practice. He stayed six months and left by mutual agreement.
All practices, from time to time, face challenges. Some of these may be beyond the skill set of current management. This does not mean, however, that management change is indicated. Hire for the norm and this likely means that things work fine 90 percent of the time and that justifies the value of the current manager. Using an outside advisor for those special projects not only makes the best sense financially but underscores your commitment to current staff. Loyalty pays dividends.
One key question in this discussion is, "How do you tell the difference between interventional and collaborative"? As you recruit for practice leadership, ask questions such as, "Can you describe some of your successes?" or "What challenges do you enjoy handling?" Answers to these questions may reveal the underlying interests of your candidate. If they helped turn around a troubled practice by changing the staffing model and replacing staff with technology they may like transformative challenges. Someone who describes staff development and helping create a cooperative environment might well be that long-term employee.
Most important, however, is understanding which skills you need. I once spoke with a group of physicians who decided they needed a manager with "an MBA." They hadn’t listed what skills such a person might have they needed but the degree seemed seductive. They ultimately decided to promote a long-term employee who actually had started at the front desk and, nearly 10 years later, they are thrilled with her performance. Their style of governance would have been like oil and water with their proposed MBA. They simply didn’t need those skills.
Judy’s advice is spot on, once you have the right match.