"Positioning Your Administrator for Success"

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"Positioning Your Administrator for Success"

How to avoid mistakes that can render this key practice manager ineffective.

Gil Weber, MBA
Consulting Editor

Adapted with permission from Ophthalmology Management
© Copyright, 2005. All rights reserved.
August 2005


Administrators are the business linchpins of any ophthalmic practice. They must position themselves to work effectively as the bridge between physicians and staff, driving the practice toward efficiency, harmony, and profitability.

Administrators often find themselves caught between the conflicting demands, expectations, needs, wishes, and emotions of physicians and staff. Recently a group of experienced administrators shared their thoughts on the problems they face trying to be effective managers. Here are some of the typical issues that can, and do, adversely impact the critical working relationship between physician and administrator, and administrator and staff.

This article is two intertwined overviews intended to identify potential structural and operational weaknesses, and allow for resolution and repair of issues before any one of them can critically damage the practice.

Where Physicians Sometimes Go Wrong

In some practices, the administrator is fully empowered and made responsible to run the business side of the practice, with oversight from the physician required only when physician review or decision-making is deemed necessary. In this case, the administrator is rightfully responsible for making the required decisions and taking appropriate courses of action.

Unfortunately, in many other practices the administrator's position is one in which an important title comes with complicating, cumbersome, and counter-productive baggage. Too often, the administrator's authority and responsibility are constrained beyond that which is optimally "business-smart," or there is such administrative ambiguity that the administrator's ability is compromised, or made impossible. This is not to say that the physician should cede complete authority to an administrator, for the physician is always ultimately responsible for the practice. But physicians need to avoid falling into the trap of micro-managing and second-guessing even the most mundane tasks.

A physician will run into problems by following either of these two paths when hiring an administrator: In the first path, a physician hires an inexperienced and under-educated administrator and then expects that person to possess limitless business knowledge and management skills. Fortunately, most physicians don't have such unrealistic expectations, and most do not make this hiring mistake.

Unfortunately, a number do make the second mistake. In this path the physician will hire a highly educated, experienced administrator to run a sometimes multimillion dollar businesses. The physician then proceeds to effectively "strangle" the experienced administrator, rendering him or her managerially impotent, by second-guessing and failing to delegate the appropriate responsibility and management authority necessary to do the job effectively.

Below are some of the most common ways that qualified administrators can be forced into suboptimal performance:

• Not supporting the administrator's authority. Nothing is more devastating to an administrator's authority, ability to manage, and resolve personnel and policy issues than when a physician allows the staff to "go around" that administrator and appeal directly to him or her. This ruins an administrator's credibility and can also be a time-consuming and financially wasteful way for the physician to spend time.

• Not allowing the administrator to take risks or to make mistakes. Progress and growth involve taking risks, which sometimes entails making mistakes, abhorrent as those may be to physicians rightly concerned about decreasing reimbursements and increased administrative and bureaucratic hassles. Practices can learn from mistakes, adjust, and then progress, perhaps even faster than if they had not experienced a few bumps in the road. A physician who will not allow the administrator to explore new methods "... because we've always done it that way..." is dooming the practice to mediocrity.

• Blaming the administrator for every little problem and publicly criticizing that person in front of the staff. When a person makes a mistake he or she should accept responsibility for their actions and put in extra effort to make things right. Be careful not to make your administrator a scapegoat, especially in public. Administrators who have not been delegated the proper authority tend to be on the receiving end of this kind of ridicule.

• Not encouraging or providing opportunities for the administrator to obtain advanced management skills and business knowledge. Without question, the administrator faces a constantly evolving set of business, legal, and personnel management issues. Physicians must encourage administrators to pursue opportunities for continued, advanced education - even to the point of making it a mandatory job requirement/performance measurement. Practices that do not cover the reasonable costs of travel and accommodations for courses/seminars, and do not provide administrators with reasonable days off in order to pursue advanced training will find themselves and their practice at a great disadvantage. Dollars invested in quality professional education will return multiples on that investment. Consequently, if your administrator is not growing in competency and making a positive difference to your practice, you may need to search for a new administrator.

• Not recognizing the administrator's accomplishments and initiative. Equally destructive to any working relationship is when a physician-employer seems to take the administrator and her performance for granted. Although the physician is paying the administrator to perform a highly demanding job, and has the right to expect quality performance, he or she should also recognize that everyone needs some form of recognition for a job well done. This is especially important when the administrator has made a special effort on behalf of the practice, exercising initiative above that which is expected.

• Not rewarding exceptional performance with appropriate compensation and/or benefits. In these times when the "business of medicine" is inseparable from the "practice of medicine," it is appropriate and ultimately beneficial for the administrator's compensation to be at least partially performance-based. A senior manager's compensation should encourage and reward individual initiative and accomplishments. While there should not be an associated sense of "entitlement" to bonus payments or other remuneration, the compensation package should clearly and meaningfully demonstrate a physician-owner's recognition of performance growth during an administrator's evaluation period.

How Administrators Can Create Trouble for Themselves

The administrators also had many thoughts on ways in which they can, and sometimes do, create their own preventable problems:

• Not clearly defining and agreeing on areas of responsibility and control prior to taking the job. Sometimes an administrator takes a job assuming that he or she will have certain power and authority to make decisions and manage issues. If that assumption is fundamentally incorrect or conflicts with the physician's assumption, it is a sure sign that their working relationship is headed for confrontation and, likely, breakup.

Few issues have the potential to sour a working relationship more quickly than for an administrator to feel that his power is being usurped. It is essential for an administrator to ask up-front for clear delineation of responsibilities and authority. Of course the job will evolve over time, but there must be a clear definition of the position and daily responsibilities at the start of employment if there is to be a solid foundation set for a mutually beneficial, long-term employment.

• Not understanding the physician(s). It is important to understand what drives your physicians. What are their expectations professionally and personally? What are their goals for the practice in both the short and long term? What makes them "tick"? What are their positive and negative "hot-buttons"?

Many of these expectations and behaviors can't be fully understood until the administrator has been on the job for some time, but gaining this understanding is absolutely essential to each administrator's success and happiness in the job.

• Being inconsistent. Once an administrator (in concert with the physician) has set practice policy, it is essential that it be applied equally and consistently to all. Being inconsistent is a sure way to stir up resentment and create petty rivalries within the staff.

• Being friends with employees. One administrator expressed this situation perfectly: "This has disaster written all over it. You cannot manage your friends." It is a delicate balance maintaining a cordial, effective working relationship without creating any sense of favoritism within the staff.

Remember that an administrator is part of management. An administrator must try to avoid socializing outside the office with the staff. Creating this distance is necessary, especially when it comes to the unpleasant matter of disciplining employees.

• Not delegating when appropriate. Just as it is essential for the physician to delegate to the administrator, so too the administrator must put certain power and authority in the hands of key subordinates. Department heads should manage those subsets of employees and tasks as defined by the administrator. This might include scheduling and tracking paid time off, performance evaluations, wage and bonus decisions, etc.

Just as the staff should not go behind the administrator's back to the physician, they must not to go behind a department head's back to the administrator. Allowing this behavior will destroy the department head's credibility.

• Not communicating with subordinate managers. Subordinate managers must have clearly established lines of communication. The administrator should meet with each subordinate manager on a regular basis, certainly weekly, to discuss pertinent concerns and issues, and to provide input/guidance to help that manager achieve his or her goals.

In this way the administrator is effectively and appropriately off-loading many of the smaller and often time-consuming issues that do not require the administrator's level of expertise. Shifting decision-making and implementation down to the managers closest to the issues should mean faster and more effective resolutions.

• Not keeping one's mouth shut. The administrator is responsible for daily activities in the practice, and so must be tuned-in to everything and everyone. Much of what an administrator sees and hears throughout the workday will require a level of confidentiality. As one administrator put it: "Not everything you see or hear is for all to know." The physician(s) and staff must know that they can speak in confidence to an administrator.

• Not admitting when you're wrong. When an administrator takes to heart the empowerment to run someone else's multimillion dollar business, the result can be a manager who becomes too confident or overly self-reliant. While it is essential for an administrator to take risks, exercise initiative, and occasionally make difficult decisions, this inevitably means some mistakes will be made. When a mistake occurs, the administrator must be willing to say "I'm sorry; I was wrong." This demonstrates to everyone, particularly staff, that you are human.

• Not thinking far enough ahead; not planning for the worst-case scenario. Administrators are responsible for keeping the practice moving smoothly no matter what the problem. Whether it's a copier going down, a flooded parking lot, or a monumental power outage, the administrator must be ready with constructive solutions that will allow the practice to continue functioning. It is essential that an administrator's strategic planning include the staff and physician.

• Letting any job become so important that it clouds your judgment; staying in the field if you don't enjoy the work. Sometimes the fear of termination so impairs an administrator's judgment that it affects his or her ability to be an effective manager, or creates untenable working conditions. Never forget that a job is only a job, and there are other positions out there for top-flight administrators. It is essential that employees in the working environment feel that they are growing professionally, and remain confident that they have the trust and support of their employer.

If any of those essentials are absent, it may be an indication that it is time to move on. Remember that no position is worth risking happiness and health, and if things are not right then be prepared to move on to bigger and better things.


Gil Weber, Ophthalmology Management's Consulting Editor, is a nationally recognized author, lecturer and practice management consultant to practitioners and the managed care and ophthalmic industries, and has served as Director of Managed Care for the American Academy of Ophthalmology.

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