In the fast-paced world of healthcare and professional practices, the ability to adapt, grow, and thrive is essential. Yet, as practices expand, many professionals are stretched thin, juggling numerous responsibilities without a clear strategy for success. This situation is where the power of an effective executive system comes into play. Here, we will cover the art of optimizing your practice through the lens of executive management. Whether you’re a practice owner or a manager, this journey promises invaluable insights into executive systems and how they can transform your practice into a well-oiled machine of efficiency, growth, and excellence. Join us as we unlock some secrets to achieving peak performance and success in your professional realm.
How Do We Define an “Executive”?
To describe the executive system, we must first define an executive. While there are many characteristics of executives, there is one we will focus on. The most essential characteristic of an executive is “One who gets others to get things done.”
Every practice always has at least one executive—the owner. In small practices (fewer than five or six staff), a second executive might also be the practice manager. Whether or not there is a practice manager depends on the doctor’s workload. The busier they are, the less time they have for managing the practice. At a certain point, the owner doesn’t have enough time to wear both the doctor and executive hats thoroughly. At that time, one of the hats gets neglected. Since doctors will never ignore their clinical duties, they overlook the management hat. At this critical point in the practice’s growth, the role of the practice manager becomes necessary. (I invite you to read up on the practice manager system so that you have a good understanding of what constitutes it.)
The Ideal Number of Staff for a Practice Manager to Handle
As the practice grows, even the practice manager can become too busy to complete all his duties. This situation usually occurs when the number of staff members increases beyond seven. Why is seven the magic number? There are various viewpoints of why this is so such as from an article by Cedric Chin of Management for Startups. But we will keep this simple. It has to do with how many staff an executive can comfortably oversee. While there are rare executives who can manage more, most executives should manage no more than five people. In this case, we have five staff plus the practice manager and the doctor.
A Common Example of Too Many Staff to Manage
As practices grow beyond the point of seven staff, the practice manager can no longer stay on top of managing all the staff. For example, the receptionist suddenly isn’t filling in the appointment book. Consequently, production begins to suffer. The practice manager needs to debug and get the book filled quickly, even if it means doing the scheduling herself.
Once the book is filled, the manager must discover why the receptionist falters in her duties. Perhaps the receptionist’s area needs to be reorganized so she can get everything done. On the other hand, maybe the practice has grown to the point where an additional receptionist is required. The fact is the manager must find the root cause and remedy it.
But let’s say that in the middle of solving this crisis, another problem arises in another office area. The practice manager must cope and deal with both issues. In such a situation, the manager often runs from one crisis to another but only partially solves them. The practice manager is now stretched too thin to manage the practice successfully. Now, we need a third manager, often called a middle manager.
An Effective Executive System Using Middle Management
“Middle management” in a health care practice would consist of someone overseeing the entire front desk area (assuming there is more than one person up front), a head assistant in the back office, etc. And now, we are back to our definition of an executive: one who gets others to get things done. A middle manager isn’t needed because the executive is lazy and doesn’t want to work. Instead, it is because the executive is in charge of at least one other person besides his duties. At this point, he is now, by definition, an executive – getting others to get the work done.
Let’s take a closer look at this role. The main reason the middle manager exists is to buy precious time for the practice manager. Let’s go back to our example above, where the practice manager attempted to debug the receptionist. Whereas before a problem erupting in the back area pulled the manager away from fixing the receptionist, now, with the advent of the head assistant, we have a new outcome. The head assistant solves that back-office problem, giving the practice manager time to continue working with the receptionist and permanently resolve their issue.
But to do this, the head assistant must be a competent executive. So, now we come to the question, “What is it that the executive does?”
In the main, an executive’s duties are threefold:
- Analyze their area to correctly identify what needs they need to work on (whether it be to solve the most pressing problem or reinforce something that is working well).
- Devise the right plan or solution.
- Get that plan implemented.
These duties are much more complicated and complex than people realize at first. Let’s take these functions apart.
Effective Executive System Point 1: Analyze the Area
There are plenty of potential projects on which one could work in any area. Let’s take the front desk, for example. At any point in time, the following issues could be in play: too many cancelations; clients not paying at the time of service but instead demanding to get billed; swelling accounts-receivable; clients not agreeing to the treatment plan due to not being able to figure out how to pay for the treatment, etc. Any of these problems, and more, could manifest at any moment.
Conversely, the projects that the executive must do include reinforcing areas that are doing well. For example, there is a sudden increase in the conversion of shoppers to actual clients, more money is collected at the front desk than expected, or a more significant percentage of clients are returning for their recall exams. Observing any of these improvements, an middle manager would want to investigate the affected area to discover what caused the gain and then work out how to reinforce it so that, later on, those positive factors are not inadvertently dropped out. The reality is that several projects could be in play simultaneously at any point in time. In such an instance, the executive’s job is to figure out what items to work on and in what order to do them.
So, in analyzing an area, the executive is seeking to find:
- What projects should be worked on, and
- In what sequence should the projects be done
A Common Mistake
The common mistake that nearly every executive makes in conducting this type of analysis is that he relies upon intuition or perception rather than statistics and other objective data to help him identify what to address. If a doctor were to diagnose in this fashion, using his ‘gut’ to tell him what’s wrong, rather than turning to objective data like blood analyses, x-rays, MRIs, etc., that doctor would soon have a lot of unhealthy patients.
This concept tells us that to manage the area properly, the executive would need to have a dashboard of statistics that indicates how the area is functioning.
Once he has the statistics, the next step in the analysis is to know how to interpret the stats to determine which area(s) to focus on.
Example: Suppose four situations are hurting the area or practice (e.g., too many cancelations, the book not ever getting filled up, money not being collected at the front desk, and clients waiting too long) and two areas that have improved (shopper conversion improving and more clients accepting their treatment plans). In that case, the executive must know how to read and compare the various stats to determine which ones to focus on first.
There is an actual methodology for statistical analysis; any executive who wants to do a good job needs to be trained on how to take that approach.
Effective Executive System #2: Come Up with a Plan
Once an executive has completed the analysis and the project identified (whether it’s a problem that needs fixing or an improvement that needs to be reinforced), the next step is to work out a concrete solution. For example, what actions must he take to resolve a cancelation problem? Or, if there had been an action that improved something, like a change in how the receptionist talked to shoppers that improved the shopper conversion rate, what specifically needs to be done to keep this new action stably in place? An executive, practice manager, and middle manager must train to identify the various problems they will encounter in a practice and to know how to determine solutions.
Effective Executive System #3: Implement the Solution
Now that the middle manager has a plan, they must get the staff to implement the solutions. This step is deceptive because it is much more complicated than it seems. It has been the downfall of many a manager.
The reality is that even good staff will resist doing new things asked of them. This pushback can happen for a lot of reasons: they don’t think there is a problem in the first place; they believe the proposed solution is worse than what is currently being done; they feel so overloaded that asking them to do something different sends them over the edge; or maybe it’s as simple as “Change is difficult for people.”
The point is that every executive has to be comfortable dealing with resistance to orders given. How one handles that resistance spells success or failure for the executive. Being a bully and shoving back on the opposition doesn’t work. Neither does doing all the work himself, so he won’t have to deal with the resistance.
He can compound the problem by his desire to maintain friendships. Most middle managers were, at an earlier time, regular staff. Now a manager, they must give orders to their friends. If you want that manager to succeed, you must teach them how to navigate this predicament.
When navigating the transition from staff member to manager, a falsehood must be exposed. Some people believe that to be a good executive, one can no longer be friends with their staff. Does this mean you must curtail your friendliness? No. That is ridiculous. The key is maintaining friendly relations with the team while still being effective. This can be done, but it is a skill that must be learned.
Final Words on Having an Effective Executive System
We have intended this blog to demonstrate that, as a practice grows, executives will inevitably get stretched thin. Ask them to manage too many staff; you’ve inhibited their effectiveness. The solution is to start putting middle managers in place. But, when you do this, you must give them the tools to succeed.
The following are some of the most indispensable tools that are necessary for any executive system:
- Development of statistics by which middle managers can run their areas and their personnel.
- An understanding of how to conduct statistical evaluations.
- The ability to solve problems that a manager will invariably experience.
- The ability to issue orders and gain compliance.
Your failure to train the middle manager in these skills will result in having a middle manager in name only. In this case, your practice manager will become too overloaded to be effective. To learn more about how Silken Management Group trains executives, please visit our website: Silken Management Group.
The moral of this little story is, “When you put an executive on the job, whether to manage the whole practice or a fraction of it, take the time to train that person well.”
To your best Leadership!
CEO, Silkin Management Group