Secrets of Success

October 1, 2009

What are the secrets of success in an ever changing practice-management climate? Veteran administrators dish.


Organization. Vision. Self-forgiveness. According to industry veterans, those are among the key ingredients to managing a successful practice. “The administrator of a practice is where the buck stops,” says Kathy Collins, an administrator for more than 20 years who is currently with Salem Emergency Physicians Service in Salem, Ore. “It’s a very challenging job because the regulatory and human resources rules keep changing.”

Indeed, in a leadership role where you’re the one responsible for everything from payroll to compliance to profitability, it’s the little things that set your practice apart.

Anita LaMonica, longtime administrator for The Woman’s Clinic in Little Rock, Ark., says she makes it work by giving her staff her undivided attention during regular working hours. “I try to push a lot of my housekeeping tasks to the back burner and do them before 8 a.m. or after 5 p.m. to make myself accessible to my staff,” she says, noting she often puts in long hours. “When I’m planning my week, I arrange it in a way that I can be available to deal with patient complaints or work flow issues.” Non-urgent e-mails, payroll, and return phone calls all get done during off-hours. “When you have an office with 25 women and five male doctors, it can get kind of hairy sometimes,” says LaMonica. “I have to be the momma, the mediator. If one department isn’t working well with another department, like billing, nursing, or the lab, I first talk to my go-to person in each department, and then I sit everyone down together to work it out. But I need to be available to do that.”

You must always act as an advocate for your team, LaMonica adds. But you can’t be their best friend, either. “You have to be willing to be the bad guy and not beat yourself up over it,” she says. “You have to be able to let someone go and do what’s best for your practice.”

Over the years, LaMonica says, she’s learned the importance of cutting herself some slack - particularly when things go wrong. “You can’t be too hard on yourself,” she says. “You have to realize that you’re not perfect. Sometimes you can make a decision about how you think things will flow, and it causes complete chaos and you realize it wasn’t a good idea. You have to go back, regroup, and come up with a new plan.” Just remember what you did so you don’t repeat the same mistake, she adds. “Every day is a new day,” she says. “You don’t stop learning until you’re in the grave.”

Communication is key

Managing expectations is another trick of the trade, one that keeps the practice operating on an even keel, says Craig Gillispie, administrator of Commonwealth Urology, a 21-physician practice in Lexington, Ky. “Communication is key,” he says. “You have to always honestly communicate and set realistic expectations for your doctors so they don’t wake up in six months and have this picture painted of some great 20 percent increase in reimbursement and that didn’t happen. That way, when something great does happens, it’s a surprise and not the other way around.” Weekly meetings with your physicians and monthly meetings with your board of directors, in which performance data are disclosed, are the most effective ways to keep everyone in the loop. An extra tip? When scheduling those meetings, spend a few extra minutes organizing your agenda and e-mail it to the physicians in advance. Not only does that give them ample opportunity to consider new proposals, but it makes your meetings more productive.

Open communication between you and your staff, of course, is equally important. Like the physicians, Gillispie says employees should be kept informed of how the practice is performing - all the more important these days given the growing number of industry challenges. “With decreases in reimbursement and increases in patient-due collections, the entire team has to understand that collections are not just a billing staff function,” he says. “Everyone should have ownership in the expenses and costs of the practice.” Often, Gillispie adds, the staff has great ideas for how to cut costs. “You just have to ask them.”

You must also keep your staff apprised of their individual performance through written annual evaluations that highlight their contributions and target areas for improvement. “Then there are no surprises and the employee can work toward those goals,” Gillispie says. “As a manager, if you aren’t clear on what’s expected, then you can’t fault the employee for not performing.”

Stay organized

As you juggle the many responsibilities of your post, organization is another secret to success. “You can get completely overwhelmed by looking at the piles on your desk and how they spill over onto the next cabinet, so you have to stay personally organized,” says Gillispie. “I use [Microsoft] Outlook to do everything. I keep contact information in there. I have task lists. I keep a running list of talking points for the next meeting, and I document every important conversation I have with an employee or upset patient.”

A simple two-sentence summary of what was said, when it was said, and how he responded, under the header “patient complaints,” comes in handy 12 months later when a physician or lawyer wants to learn more about the long-forgotten conversation you had. “The more you can document, the better,” says Gillispie.

A focus on the future

For her part, Collins says she’s learned that the most successful administrators invariably share a unique skill set - the ability to manage day-to-day operations while simultaneously looking ahead for ways save money, enhance revenue, and roll with the regulatory and reimbursement punches. “It’s like runway models,” she says. “They don’t have to look down at the stairs when they walk. They look straight ahead. As you learn more and put in your time, you no longer have to look at the stairs because you already know what’s there. You keep your focus on the future. It’s a balancing act.”

Collins says she regularly reviews upcoming regulatory changes that may affect her practice, while also exploring ways to streamline efficiencies. “It’s up to me to be sure the corporation is kept risk-free and contemporary for rules and regulations,” she says. But paying close attention to details doesn’t mean micromanaging. “It means being aware as a leader of what’s going on underneath you, as well as in front of you. Some people can do that and some people can’t, and the difference between them is someone who looks down and someone who looks out.”

The role of administrator is a taxing one, indeed. Those who succeed, and help elevate their practice, are ultimately the ones who communicate most effectively, stay organized in the face of chaos, and learn to straddle the line between what makes their practice competitive today and what will grow their bottom line going forward. “In a well-functioning practice you usually work pretty autonomously, where the doctors don’t get involved in the corporate side because they trust you. So you have to know what you’re doing,” says Collins. “They rely on you.”

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

This article originally appeared in the October 2009 issue of Physicians Practice.