By the Numbers

What level of management staff does your practice need to succeed now and in the future?

A short exercise can help determine any holes in the management team.

“The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don’t play together, the club won’t be worth a dime.”
– Babe Ruth

“Good management is the art of making problems so interesting and their solutions so constructive that everyone wants to get to work and deal with them.”
– Paul Hawken

As regulatory complexities rise, profits soften and the size of the average practice increases, there is an increasing obligation to deepen the skills of your practice’s management team. Most practices do this basic business development work haphazardly, not by plan.

It is better when you plan and evolve your management team stepwise to meet the needs of the company and the environment you work in.

Here are hallmarks of ophthalmic practices that report feeling that they are in control of whatever may arise in the future for their organizations:

A lack of dependency on any one manager: “Our administrator could be away from the practice for a month or two, and the practice would keep on running just fine. The administrator has empowered our department heads to make their own decisions and have worked with the managing partner so that this lead doctor can step in and handle any senior management issues while the administrator is away. In addition, each department has a ‘second lieutenant’ so that even if the department head is out of the office, someone is clearly in charge and keeping operations on track.”

Written process documentation: “Everything we do here is put down in writing. There is one agreed best way to check in a patient, take a history and work our open insurance accounts. This makes training easier, and when staff grasp their job duties faster, they are easier to supervise. At the same time, everyone in our practice is encouraged to propose a better way for any of our protocols.”

No managers on overload: “If you observed our department heads and administrator in action, they have a calm, in-control demeanor. They prioritize and pace their work and delegate avidly so they always have reserve capacity for the inevitable emergencies.”

Strategic intimacy: “Our board is aligned about the future direction our practice is taking. And it has shared its strategic plan with the entire management team, so everyone knows the operational priorities and volumetric goals. In addition, the board listens to us and makes sure that plans for the practice are not getting out ahead of what the company can reasonably accomplish.”

Raw tenure: “The average manager has been in our practice for more than a decade. They know what great operations look like and how to turn things around when they get off-track. Because of our managers’ knowledge and tenure, the staff they supervise — as well as the doctors — trust their skills. With the doctors in particular, this sets up a virtuous cycle: more tenure leads to greater skills, and greater skills lead to higher trust by the board, and more trust leads to greater job satisfaction and longer careers.”

How does your practice compare with these optimal hallmarks? Here is an exercise to help you identify — specifically and practically, rather than just theoretically — where the holes are in your management team.

Creating the management team you need

1. Gather the administrator and practice owners. Set a timer to 30 minutes. With this artificial deadline, brainstorm as a group where the practice will be in 5 years. Include answers to these questions:

    1. What will be our service area? (The north/west/south/east boundaries for our operations.)
    2. How many office locations will we have?
    3. In the next 5 years, what patient services will we add/subtract?
    4. What will be our annual collections? Patient visit counts? Surgery counts?
    5. How fast will we grow? (Note: The average practice today is growing about 4% per year.)
    6. How many doctors, and of what type, will we have?
    7. How many staff will we employ in each department?

Do not try to create a polishing strategic planning document with this exercise. Just write down random thoughts arising around the table, even if some of these thoughts are in conflict or if there is an emerging difference of opinion. These can be ironed out in subsequent drafts.

2. Continue your brainstorming by writing down as many details as you can about how your management team will need to adapt to this future plan over time. Here are some questions to consider:

    1. Will we have the same administrator, or will a new senior staffer be required? (Either because of retirement or a gap in needed skills that may arise with practice growth.)
    2. What will be the job scope and role of the managing partner of the practice?
    3. What gaps in basic management team structure and organization do we need to catch up with? Does every manager have a formal position description? Are reporting lines clear or blurred? Are there annual (or more frequent) performance assessments? Are meetings held with appropriate frequency and follow-up?
    4. Whether the practice is static or growing, what new skills will be needed generally in the middle management cohort? A clearer understanding of HR law? Deeper financial skills? Formal supervisory training? Time available? Career commitment? What new skills will be needed department by department?

3. Finally, write down what action should be taken this year to prepare the management team for where the practice is heading 5 years from now. Here are some examples from other practice settings:

  • Recruit a new director of technical services to replace our retiring director.
  • Establish a project tracker so that each new project or initiative has a clear “owner” and deadline.
  • Designate an “assistant manager” for the patient accounts department so that when the manager is away from the practice, staff have a clear supervisor in place.
  • Hold management team meetings biweekly instead of monthly, and make sure the managing partner is present for at least half of these.

Find a more private office for our administrator so she is not constantly interrupted and so sensitive paperwork can be left out and worked on throughout the day.

“The way a team plays as a whole determines its success. You may have the greatest bunch of individual stars in the world, but if they don’t play together, the club won’t be worth a dime.”
– Babe Ruth

“Good management is the art of making problems so interesting and their solutions so constructive that everyone wants to get to work and deal with them.”
– Paul Hawken

As regulatory complexities rise, profits soften and the size of the average practice increases, there is an increasing obligation to deepen the skills of your practice’s management team. Most practices do this basic business development work haphazardly, not by plan.

It is better when you plan and evolve your management team stepwise to meet the needs of the company and the environment you work in.

Here are hallmarks of ophthalmic practices that report feeling that they are in control of whatever may arise in the future for their organizations:

A lack of dependency on any one manager: “Our administrator could be away from the practice for a month or two, and the practice would keep on running just fine. The administrator has empowered our department heads to make their own decisions and have worked with the managing partner so that this lead doctor can step in and handle any senior management issues while the administrator is away. In addition, each department has a ‘second lieutenant’ so that even if the department head is out of the office, someone is clearly in charge and keeping operations on track.”

Written process documentation: “Everything we do here is put down in writing. There is one agreed best way to check in a patient, take a history and work our open insurance accounts. This makes training easier, and when staff grasp their job duties faster, they are easier to supervise. At the same time, everyone in our practice is encouraged to propose a better way for any of our protocols.”

No managers on overload: “If you observed our department heads and administrator in action, they have a calm, in-control demeanor. They prioritize and pace their work and delegate avidly so they always have reserve capacity for the inevitable emergencies.”

Strategic intimacy: “Our board is aligned about the future direction our practice is taking. And it has shared its strategic plan with the entire management team, so everyone knows the operational priorities and volumetric goals. In addition, the board listens to us and makes sure that plans for the practice are not getting out ahead of what the company can reasonably accomplish.”

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Raw tenure: “The average manager has been in our practice for more than a decade. They know what great operations look like and how to turn things around when they get off-track. Because of our managers’ knowledge and tenure, the staff they supervise — as well as the doctors — trust their skills. With the doctors in particular, this sets up a virtuous cycle: more tenure leads to greater skills, and greater skills lead to higher trust by the board, and more trust leads to greater job satisfaction and longer careers.”

How does your practice compare with these optimal hallmarks? Here is an exercise to help you identify — specifically and practically, rather than just theoretically — where the holes are in your management team.

Creating the management team you need

1. Gather the administrator and practice owners. Set a timer to 30 minutes. With this artificial deadline, brainstorm as a group where the practice will be in 5 years. Include answers to these questions:

    1. What will be our service area? (The north/west/south/east boundaries for our operations.)
    2. How many office locations will we have?
    3. In the next 5 years, what patient services will we add/subtract?
    4. What will be our annual collections? Patient visit counts? Surgery counts?
    5. How fast will we grow? (Note: The average practice today is growing about 4% per year.)
    6. How many doctors, and of what type, will we have?
    7. How many staff will we employ in each department?

Do not try to create a polishing strategic planning document with this exercise. Just write down random thoughts arising around the table, even if some of these thoughts are in conflict or if there is an emerging difference of opinion. These can be ironed out in subsequent drafts.

2. Continue your brainstorming by writing down as many details as you can about how your management team will need to adapt to this future plan over time. Here are some questions to consider:

    1. Will we have the same administrator, or will a new senior staffer be required? (Either because of retirement or a gap in needed skills that may arise with practice growth.)
    2. What will be the job scope and role of the managing partner of the practice?
    3. What gaps in basic management team structure and organization do we need to catch up with? Does every manager have a formal position description? Are reporting lines clear or blurred? Are there annual (or more frequent) performance assessments? Are meetings held with appropriate frequency and follow-up?
    4. Whether the practice is static or growing, what new skills will be needed generally in the middle management cohort? A clearer understanding of HR law? Deeper financial skills? Formal supervisory training? Time available? Career commitment? What new skills will be needed department by department?
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3. Finally, write down what action should be taken this year to prepare the management team for where the practice is heading 5 years from now. Here are some examples from other practice settings:

  • Recruit a new director of technical services to replace our retiring director.
  • Establish a project tracker so that each new project or initiative has a clear “owner” and deadline.
  • Designate an “assistant manager” for the patient accounts department so that when the manager is away from the practice, staff have a clear supervisor in place.
  • Hold management team meetings biweekly instead of monthly, and make sure the managing partner is present for at least half of these.

Find a more private office for our administrator so she is not constantly interrupted and so sensitive paperwork can be left out and worked on throughout the day.