From spreadsheets to strategy, with Melinda Mastel, MBA, MS, of the Medical College of Wisconsin

Strategic thinking is often treated as an executive skill, something reserved for leadership retreats and long-range planning sessions. It does not have to be.

On this episode of Off the Chart, Physicians Practice Managing Editor Keith Reynolds speaks with Melinda Mastel, MBA, MS, FHFMA, CMPE, PMP, a financial adviser at the Medical College of Wisconsin, who argues that strategic thinking belongs on every finance professional's desk on an ordinary Tuesday.

Mastel's case is that medical groups rarely miss budget because of the numbers themselves. The cause is usually a hidden operational shift, a small and undocumented change in how time is spent or how effort is deployed, that drifts a practice away from its projections before it ever triggers a formal review. The fix often starts with one question: what changed?

The conversation covers why reframing the same financial data can change a leadership decision, what a minimum viable product approach looks like in health care finance, why scope creep quietly kills practice improvement projects, how to align cross-functional teams that cannot agree on the problem, and why curiosity is the skill that most reliably turns an early-career finance professional into a trusted adviser. Mastel closes with two tips practice leaders can act on immediately: challenge your assumptions about what can and cannot change, and expand who you are hearing from.

Music credits: Retro Disco Lounge Groove by MotifLab Music, stock.adobe.com; A Textbook Example by Skip Peck, stock.adobe.com

Editor's note: Episode timestamps and transcript produced using AI tools.

0:00 – 0:24 | Sponsor message Copic medical liability insurance.

0:24 – 0:48 | Cold open Mastel on why launching a new program at 50 percent or 20 percent of the ideal scope isn't failure, it's strategy.

0:48 – 1:39 | Introduction Austin Littrell introduces the episode and Melinda Mastel.

1:39 – 2:42 | The first question to ask when someone brings you a budget problem Don't stop at the numbers themselves; ask what changed. Workflow shifts, staffing changes, documentation drift and altered coding standards all show up in the data before they show up anywhere else.

2:42 – 3:26 | The most common reason medical groups miss budget Hidden operational shifts, small and undocumented changes in how time is spent or how effort is deployed, drift practice finances away from projections without ever triggering a formal review.

3:26 – 4:37 | What strategic thinking actually looks like on a Tuesday Strategic thinking is not an executive skill; it is a set of questions anyone can apply to anything on their desk. Do we agree on the actual problem? Who is affected downstream? What decisions upstream are landing here? Mastel argues that asking those questions consistently is what separates finance professionals who execute from those who are sought out for advice.

4:37 – 6:13 | When reframing data changes a decision A growing subspecialty program at the Medical College of Wisconsin was tracked in aggregate with several other programs, making it nearly impossible to evaluate performance. Separating it in the accounting structure, a simple change, gave senior leaders clear metrics and produced more intentional investment decisions almost immediately.

6:13 – 8:54 | Launching something new on a tight budget: the blind spot We underestimate uncertainty and over-commit to the ideal version from day one. Mastel makes the case for a minimum viable product approach: launch at 50 percent or 20 percent, test it, gather feedback and preserve contingency for the things you cannot control. On the revenue side, she points to sponsored funding, organizational partnerships and philanthropic sources as underused options in academic medicine and beyond.

8:54 – 9:58 | P2 Management Minute Keith Reynolds shares practice management tips and invites listeners to submit their own workflow ideas.

9:58 – 11:47 | The project management tools that actually matter in health care Two principles from formal project management apply directly to practice finance work. The first is stakeholder management: bringing the right people, including end users and cross-functional contributors, into the conversation at the right time. The second is scope clarity, because projects that don't define what they are not tackling tend to drift and lose momentum.

11:47 – 13:03 | Aligning a cross-functional team that can't agree on the problem When urgency is high and definitions differ, the instinct is to move fast. Mastel argues for the opposite: slow down, document the shared definition of the problem before moving to solutions, and come back to it when decisions downstream get contested. That investment upfront eliminates far more rework than it costs.

13:03 – 14:33 | The skill that turns a finance professional into a trusted adviser Curiosity, not technical fluency, communication skills or change management frameworks, though all of those matter. Asking questions when there is extra time at the end of a meeting, understanding what pressures sit outside your own role and building a reputation for caring about causes rather than just executing tasks is what moves someone from analyst to thought partner.

14:33 – 16:33 | Two tips for practice leaders Challenge your assumptions about what is fixed. Some things genuinely cannot change quickly, but others can, and they won't unless someone asks the question. Then expand who you're hearing from. Office hours, rounding, an open-door policy, anything that gets the same voices out of the same room and brings in the perspective of people on the front lines.

16:33 – 16:51 | Closing remarks Keith Reynolds thanks Mastel and wraps the interview.

16:51 – end | Outro Austin Littrell closes the episode.