Creating Strong Physician-Manager Teams

May 12, 2016

Dyad leadership allows physicians and managers to support each other while dividing and conquering the workload.

Every employee in your practice is critical to its success, but in an era marked by new performance mandates and integrated care, the physician-administrator team plays an increasingly vital role.

The most productive management teams leverage each other's strengths. They collaborate toward a common goal and inspire their staff to deliver the highest quality of care.

But simply pairing a physician and a nonphysician manager together does not guarantee success.

They must work well together, communicate their vision clearly, and be deliberate in fostering an environment of mutual respect.

"This may be the most critical part of a practice," says Ken Hertz, a medical practice consultant with the Medical Group Management Association Health Care Consulting Group, noting the lines that once separated the business and clinical sides of a practice have long-since blurred. "The back office and clinical side are now totally integrated so it's almost become seamless."

To meet performance measures established by public and private payers, he says, physicians and office managers must merge their collective expertise to survive.

"From the clinical side, there is such a large amount of data and information that needs to be captured and analyzed and reported that it's critical for the physician and administrator dyad to be highly functioning," says Hertz.

Indeed, the push for quality improvement is here to stay. Beginning in 2019, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will replace Meaningful Use, Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier system with a single program: the Merit-Based Incentive Payment System or MIPS.

MIPS will reimburse physicians based on their composite score for quality, efficiency (cost controls), Meaningful Use of EHRs, and clinical practice improvement.

"As physicians need to be more involved in business processes, it is essential that one physician or more be delegated as a liaison who works directly with the administrator," says Susan Childs, a medical practice consultant with Evolution Healthcare Consulting in Rougemont, N.C. "When physicians and staff work together, they can continually update processes as well as identify problems sooner, instead of catching them on the back end."

FINDING THE RIGHT FIT

The success of a physician-manager team hinges largely on how well they work together.

Two managers who butt heads are likely to send mixed messages to their staff, which creates unnecessary friction.

To optimize productivity, practice leaders must pair physicians and administrators who complement each other. This requires thoughtful recruiting.

Situational questions are most effective in ferreting out candidates who might be a good fit, says Hertz. Ask how they reacted in the past when faced with an irate patient, how they might handle a disruptive physician, or what they would do if an employee consistently came in late.

In smaller practices, in which the physician owner chooses his own administrator to team with, he should be more introspective.

"Self-awareness is critical," says Hertz. "Ask yourself, 'Who am I? What kind of people do I work best with? What are my expectations of an administrator? Do I have a sense of humor? What do I tolerate and what do I not?'"

Healthcare staffing firms, including American Consultants in Overland Park, Kan., often use personality tests to screen job candidates. The results don't necessarily rule applicants out, says Jeremy Toon, the firm's vice president of executive search, but instead help identify ways in which the candidate may complement the team or existing culture.

"The reality is that people have to be able to work together," says Toon. "A good administrator has to have leadership abilities and be able to lead through strong personalities and not take it personally."

The Advisory Board Company, a Washington, D.C.-based performance improvement consulting firm, offers additional guidance on establishing an effective leadership dyad on its website.

Physician leaders, it notes, should have sterling clinical credentials, top-notch relationship and influence skills with physician peers, and be a systems thinker.

The administrative leader must bring to the table core management skills (finance, staff, and operations), credentials, and a persistent, organized, and detail-oriented personality. She should also relate well to leaders across the organization.

As for shared attributes, the firm suggests both parties be able to communicate effectively, enjoy working as part of a high-performance team, have problem-solving skills, and be respected by their peers.

COMMUNICATE THEIR VISION

Such skills are necessary if the team is to convey its vision, values, and purpose, says Lynn Lillie, a practicing family physician in Woodbury, Minn., and a board member of the American Academy of Family Physicians.

"Even smaller groups need to define where they want to be," she says.

The physician-administrator team must decide what they want to achieve, so they can jointly manage toward that goal. Are they trying to get more patients through the door, lessen wait times on the phone, or improve billing capture?

"Management teams need to be absolutely resolved to having clearly defined goals," says Lillie. "If you can agree on a common goal, the rest becomes tactical."

Giving staff members a purpose is equally important, she says.

"One of the most amazing leaders I ever worked for did not allow the concept of 'that's not my job,'" says Lillie. "If you were a medical director and there was a piece of trash on the floor, you picked it up. You didn't call housekeeping. That empowered everyone on the team to stay focused on the single goal of improving the care of the patient."

The housekeeping staff didn't just "clean rooms." Instead, their job was to keep patients safe. A dirty exam room, after all, means the possibility of infection. "Every member of the team must feel they have a purpose," says Lillie.

MUTUAL RESPECT

The physician-manager relationship must also be rooted in mutual respect. They must trust each other's ability, value each other's contribution, and view themselves as equal partners.

"It's critical that the physician and the administrator have a good relationship and you develop that by respecting the other," says Hertz.

A doctor who barges into the manager's office while she is meeting with a staff member or working on payroll shows disregard for the administrator's role and responsibilities.

Likewise, an administrator who walks into the clinic area while the physician is seeing patients and asks him to sign 12 checks right away shows a lack of respect.

Respect also means resolving differences professionally, using open and honest communication.

"When issues arise, the manager should talk directly to his partner," says Hertz. "The administrator shouldn't talk to physician B about physician A. He should talk to physician A."

Joint managers at the helm of the practice should also solicit input from their staff on a regular basis to discuss direction, and work through any challenges that might arise, says Lillie.

"One of the big lessons I learned in working for a large academic medical center was that once a quarter, if not more frequently, we would close for lunch and everyone would sit down and talk about what's working and what's not," she says. "It's important to listen to the perspective of everyone in the group, because unless you've walked in the shoes of the person answering the phones or doing billing, you don't know what their experience is."

Such dialogue encourages staff members to problem-solve together, reinforces the common goal, and gives all team members a voice.

"It gives everyone an opportunity to be heard and sends the message that everyone in the office is important," says Lillie.

That doesn't mean decision making is a democracy, however. "Everyone's input is important, but it should still be clear who has the final say," she says.

An effective physician-manager team is greater than the sum of its parts. By pooling their expertise and motivating their staff, they can position the practice to not only survive, but thrive in the era of regulatory and payment reform.

"The best model is when you truly do have two equal parts managing the clinical and clerical side of the practice," says Travis Singleton, senior vice president at Dallas-based physician staffing firm Merritt Hawkins. "Blame regulatory changes if you want, but it's just too much to throw on the physician's shoulders these days. Physicians need an administrative counterpart, someone who they trust and is well-trained."

TAKE TIME TO PLAY TOGETHER

In the high-pressure healthcare setting, stress is inevitable.

Physician-manager teams can help let off steam and create bonding opportunities for themselves and their staff, by creating and participating in social outings that let their humanity shine, says Ken Hertz, a medical practice consultant with the MGMA Health Care Consulting Group.

Leadership can organize staff retreats, close the office for a catered lunch, or sponsor a family day at the ballpark, for example.

"This is really first and foremost a workplace of people who are helping people," says Hertz. "If we don't treat our staff and leadership like people, they're not going to treat patients like people."

Hertz says his practice held an annual crawfish boil, distributed an e-newsletter to congratulate staff on work anniversaries and personal achievements, and celebrated birthdays.

"There are so many opportunities to bring people together and the result is, I think, a much happier workplace which results in better staff retention and a higher level of service to the patients."

Shelly K. Schwartz,a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article was originally published in the May 2016 issue of Physicians Practice.