The Administrator’s Desk: When You’re the Bad News Bearer

October 1, 2007

Here’s how to say what the boss doesn’t want to hear.


If you stay in the field of practice management long enough, then you’re bound to experience your fair share of office-related mishaps, from unexpected budget shortfalls to Medicare audits to patient lawsuits. This is business, after all, and things that can go wrong eventually will. It’s the reason physician owners need you at the helm.

That said, being the bearer of bad news is never any fun. Fearing disappointment or blame, many practice managers try to sweep office troubles under the rug or quietly resolve them on their own - which can makes matters worse. Should the problem escalate, the doctors to whom managers report will want to know why they weren’t involved earlier on. They may even blame their manager for letting the situation get out of control.

Be open and honest

According to John McDaniel, chief executive of Peak Performance Physicians in New Orleans, full disclosure is always the best policy. “The important part is to be direct, be honest and try to offer some solutions to correct the problem,” he says, noting a carefully considered action plan helps cushion the blow while instilling confidence in your ability to lead. “It’s the same way physicians deliver bad news to their patients. It’s not, ‘You have cancer and you’re going to die.’ It’s, ‘You have this type of cancer, these are the treatment options, and this is what I recommend.’”

Bobbie Crawford agrees. As practice manager of Cardiopulmonary Associates, a seven-physician specialty group in Ft. Lauderdale, Fla., she notes there’s no substitute for candor when hitting your boss with an unpleasant surprise. “Where possible, I try to temper the bad news with the good, but you can’t always do that,” Crawford says. “Either way, my physicians want me to shoot straight from the hip. Tell it like it is and don’t sugarcoat.”

A healthy professional rapport between Crawford, who has been with the practice for 24 years, and her doctors makes that part of her job infinitely easier. “I’ve noticed some managers aren’t able to talk openly with their managing physicians, and that’s something that needs to be established early on,” she says.

Do your homework

Before approaching your physicians with any negative news, it’s also wise to do some digging to determine what triggered the problem to begin with. “If volume has fallen off the last few months, look at the number of no-shows or, for specialists, review the referrals and find out why they’re down,” says Randy Bauman, a practice management consultant for Delta Health Care in Nashville, Tenn. “If collections are down, maybe the insurance companies are slow to pay or billing got delayed. Have answers, not just problems.”

For Lucy Flores, office manager at Victoria ENT Associates in Victoria, Texas, there wasn’t time to gather all the facts before delivering news of a former employee’s suspected criminal activity to the physicians. “I had just fired my bookkeeper and brought another person on board to balance our bank statements, and there was obviously something wrong,” she recalls. “We kept coming across checks with the previous bookkeeper’s name on them from the company account. I realized I had to tell my managing physician right away.”

Knowing her boss is a “show-me guy,” Flores says she walked into his office, laid copies of the checks on his desk and said, “It appears we’ve got big problems.”

“We didn’t have enough time to conduct a full investigation yet, but I didn’t want to delay passing along our discovery any longer,” she says. Ultimately, it was determined the former employee had taken $329,000 from the company coffers. She was charged with embezzlement.

When it’s your fault

Delivering bad news, of course, is harder still when the problem is a result of your own mismanagement. Perhaps you inadvertently paid a bill twice and now there’s not enough cash to make payroll. Or you discovered too late that the new billing clerk you hired has an impressive criminal record. “A good manager, above all, will take responsibility,” says Bauman. “If you really screwed up, there’s nothing to be gained by trying to hide it.” You may lose your job either way, he notes, but you’re far less likely to lose it if you ’fess up from the start, apologize, and suggest a plan to correct it.

Physicians, he notes, are usually more understanding of honest mistakes than office managers believe: “There’s not a doctor you can work for who hasn’t himself made a mistake.”

Make lemonade


While sharing bad news with the boss is an unpleasant part of your job, bear in mind that such challenges mark an important opportunity for positive change. If collections are down due to higher no-shows, for example, that’s your chance to implement reminder cards for patients, which helps stimulate volume and provide patients with better preventive care.

When patients complain about a doctor’s bedside manner, that’s your chance to help sharpen the physician’s people skills. “I’ve had instances where patients have been unhappy with a doctor’s handling of a question, and I try to go back and tell that doctor how the patient felt,” says Flores. “It’s usually a surprise to them. They get so involved in going from patient to patient that they don’t realize individual people are going to be emotional about things they wouldn’t even think twice about. It helps them in dealing with future patients.”

Shelly K. Schwartz is a freelance writer in Maplewood, N.J., who has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Healthy Family magazine. She can be reached via editor@physicianspractice.com.

This article originally appeared in the October 2007 issue of Physicians Practice.