Management of a medical practice often depends on the partnership of an administrator and a physician who share decision making and problem solving.
“I’ve taken the words ‘command and control’ out of my vocabulary for many, many years,” said Bruce Bagley, MD, who once led a family practice and is now senior advisor to the American Medical Association (AMA) for professional satisfaction and practice sustainability. “It’s all about influence and education.”
Bagley teamed up with Allison Winkler, MPH, a senior practice development specialist at the AMA to present strategies for improving teamwork at this year’s Medical Group Management Association (MGMA) Annual Conference in San Francisco, California on Monday (Oct. 31).
The balance of power is shifting in medical practices because physicians no longer control all the information, Bagley said. The advent of smartphones and other handheld computers has allowed administrators quick and easy access to clinical data.
But many practices have not caught up to the new reality, he said. “We’re still operating on the ‘hero model’ where the doctor is the source of all information.” In this model, the physician’s authorization is required for most orders, and the staff works to optimize the physician’s workflow and throughput.
This approach stems from the assumption that the physicians’ clinical expertise translates to expertise in leadership and management, said Bagley. Administrators are seen as employees, setting up a dynamic that can discourage them from taking initiative and innovating.
Instead, successful practices will move to the “team model,” in which the physician supplies clinical expertise, everyone makes decisions appropriate for their level of work,
and the entire team participates in optimizing outcomes for patients, Bagley said.
“In family medicine, probably 30% of what the family physician does every day can and probably should be done by someone else,” he said.
He proposed a simple test: If the physicians in your practice use the phrase “my patients” and the staff uses the phrase “Dr. So-and-so’s patients,” then the practice is not operating as a team. One hallmark of a team model is that everyone refers to “our patients.”
Bagley and Winkler recommended a “physician administrator dyad model” in which both leaders work together to create an integrated model of care, sharing responsibilities for all strategic objectives. The keys are trust, communication, integrity, and positive attitude, they said.
Winkler introduced the AMA’s “Steps Forward” website with instructional materials in video and text on creating such strong teams within a practice through such measures as team meeting “huddles,” and effective team meetings.
In the oncology practice where Winkler worked, the huddles brought together representatives of every part of the organization, she said.
“It was an opportunity for us to meet and really have detailed discussions of issues that were going on in the practice.”