What’s Your Role in Big Practice Transitions?

November 1, 2009

Few administrators experience daily upheavals in their practices, but most are presented with a major transition at some point during their career. Are you ready?


Sherry English hasn’t gotten much rest during the last 18 months. And she can’t remember the last time she enjoyed a leisurely lunch break.

In early 2008, Edison Lakes Urology, her three-physician urology practice in Mishawaka, Ind., severed ties with the hospital network it was affiliated with and merged with a privately-owned multispecialty practice across town.

Beyond the financial hurdles of converting to privately owned, English, the practice administrator, also had to oversee the transfer of all the practice’s electronically stored medical records back to paper files to conform to their new group’s more primitive system.

And all the while she was working with an architect to help design and build a new facility on the medical campus near their new practice, orchestrating the move of her 10 staff members and physicians without closing the office even a single day.

“It has been extremely hectic,” says the 14-year industry veteran. “There’s no time off and there’s little sleep because you’re thinking of all the things that need to be done. I’d wake up and leave myself phone messages at work so I wouldn’t forget things.”

Though few administrators experience so many drastic changes at once, most are forced to manage a major transition at some point during their career.

Be it change of ownership, new service offerings, or the implementation of an EHR, such moves can either position your practice for future growth or set it up for failure. And, more often than not, the outcome depends on you.

“The practice administrator brings leadership to the process,” says Ken Hertz, a consultant for the MGMA Health Care Consulting Group. “They are the glue that binds it all together.”

Knowing what your role is throughout the transition, and when to switch gears, is a key element to ensuring success.

Chief investigator

Even before your project gets the official green light, for example, it’s up to you to perform all appropriate due diligence - researching the options available, interviewing other practices that have implemented similar changes, and creating a cost benefit analysis.

“Administrators are the ones who really have to ensure that all of the planning and research is done correctly from the start,” says Hertz.

For projects requiring a large capital expenditure and a high degree of technical expertise, you might consider hiring a tech or business consultant to help develop a list of priorities and guide you toward a product or business strategy that best meets your practice’s needs.

Nancy Feldman Kirsh, executive director of The Birth Center in Bryn Mawr, Pa., wasn’t about to drop $150,000 on a new practice management system and EHR without soliciting help. The nonprofit group, which provides routine obstetrics and gynecological care through a team of 8 midwives, has unique requirements for billing and data capture. “This was a significant investment of time, energy, and financial resources and we did not have the skill or expertise to identify the system out of the hundreds that exist that would be optimal for our needs,” says Feldman Kirsh.

With guidance from her consultants, she says she now feels confident her office will realize a “huge return on investment from this system,” which will be rolled out in phases beginning in August.

Advocate for your staff

As soon as possible, and as early as it makes sense, you should also take steps to actively involve your staff in the process.

“One of the first things I did when I was managing a transition is to inform my staff of all the changes we were making and highlight the benefits of why we were doing it,” says Jennifer Zarate, chief executive of the Professional Medical Staff Association in Olathe, Kan., and a former practice administrator. “They are the ones who will be dealing with this on a daily basis so you want them to be part of it.”


Part of being a good leader, says Zarate, is knowing the strengths and weaknesses of your team. Try delegating responsibilities to those on your staff who are most capable, giving them ownership and accountability. And, where new equipment and computer systems are involved, let them be a part of the testing phase.

It’s a strategy that worked well for English. “You have to get your teams together, all your key players, establish priorities, and work through each one of them,” says English. “During our merger, we assigned tasks and met weekly. We started with an inventory of what we had and what we needed. Then we did equipment lists and then we had human resources meet with each employee to review their new benefits and what the change of ownership meant for them.”

The teams would meet weekly with English and the physicians so direction and focus remained consistent.

Along the way, English hastens to add that she kept an open door policy and met with each member of her staff individually as well, helping to allay fears. “My role with the staff was to try to be the calm in the middle of all this unknown,” she says. “There’s a lot they don’t know during the process. How it’s going to affect them? What are their benefits and what are they leaving behind? Do they still have a job? You have to give them answers.”

Indeed, both English and Zarate agree the biggest mistake you can make is keeping your staff in the dark. “No matter how secretive you are, somehow news always leaks and you’re going to have chaos,” says Zarate, recalling one example where the practice she worked for was being bought out and most of the staff members were slated to lose their jobs. “Do damage control upfront, discuss it with your staff and be honest. I later learned that what was most fearful for them was the unknown of how long they would have a job. That’s the part people can’t deal with.”

When new technology is involved, of course, the onus again falls on you to ensure your front- and back-office staff members are properly trained, onsite or otherwise, and that you’ve developed a schedule to ensure their desks are covered by coworkers during those hours. “Hold several training sessions,” says Zarate. “It’s hard because most practices are busy but I can’t stress how important training really is. Plus, it gives you an opportunity to cross-train your staff.”

Who’s flying this plane?

During times of major transition, however, your most significant role is to maintain business as usual. “You really have to maintain the practice and make sure it continues to operate effectively while managing this process, and you have to do it wearing a fireman’s coat and hat because you’re putting out fires on a daily basis,” says Hertz.

Looking back, says English, that’s what made her practice’s action-packed year such a success. “You’re still seeing patients and you definitely have to keep that in mind throughout,” she says. “The ultimate goal of a really smooth transition is that your patients don’t have any idea that anything is being done. For us, it was a seamless process.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., 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 physicianspractice@cmpmedica.com.

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