Eyeworld

22 May 2018 EW NEWS & OPINION To the point: Simple practice tune-ups for complex times by John B. Pinto and Corinne Wohl, MHSA, COE at the heart of both leadership and followership. 3. Leadership at the top. Physicians are by nature critical professionals, often focusing on the negative or unsatisfactory things. Negative feelings, when expressed in a group setting, are more contagious than positive feelings. So negative individuals can be more influen- tial than positives and neutrals. Because of this, thoughtful group practices choose upbeat, naturally positive individuals to lead the group forward. The best, strongest health organizations (including clinics, hospitals, and research centers) typically have a dyadic leadership model: a strong MD leader and a strong lay leader. Even a two MD practice should designate a formal managing partner or president, who has a 2-year term of office, a written position description, no term limits, and a modest hono- rarium for the extra work on be- half of the board. It typically takes 5 hours or more per week to ef- fectively hold down this job. The managing partner is matched with a skilled lay leader (who usually holds the title "administrator" or "executive director" in a practice this size.) These two meet briefly on a weekly basis and co-prepare for the monthly board meetings. 4. Leadership in the middle. Each department of a practice at this $5 million size will typically have formal department heads, called "team leaders," "coordinators," "managers," or "directors" based on the seniority of each individu- al and the habits of the practice. Each middle manager will have a written position description. These managers will meet individ- ually with the administrator every week or two, and will memorialize the status of their department from time to time. Each middle manager will have limited or full hire-and-fire authority over their subordinates, and will handle their annual performance reviews. holder, partnership or general operating agreement, as well as employment contracts for each partner setting out their rights and responsibilities. In well-organized practices, there will be a written, longer-term strategic plan, which helps to align the owners and pri- oritize tactics undertaken by the management team. There will be a written organization chart (the familiar pyramid with the board at the top), and this will be updated at least annually as the practice grows and develops. There may also be a provider code of conduct and a recap of the practice's core values. 2. Leadership development. In the best practices, there is a realization that leaders are made, not born. Formal activities are in place to develop both lay and physician leaders. MDs are given committee assignments. Managers are ac- tively coached on the progressive development of their careers. Spe- cial emphasis is put on polishing communication skills, which are physician owner is given a fair voice and an equitable chance to thrive. Proper governance of an oph- thalmology practice has to be scaled to practice size and ownership struc- ture. Governance in a solo practice— or even a large practice with a single owner—is obviously different than in a widely held practice with many owners. Let's look at this from the perspective of a typical practice. Imagine a $5 million eye clinic with three equal physician owners, an administrator, and the usu- al mid-level managers: one each for the billing, reception/phone, technical, and optical departments. With that as the setup, what are the fundamental dimensions of proper governance? Who gathers to handle the company's business? How often do they meet? Who's in charge of what? What documents are in place guiding all of this? Here is a simplified synopsis, which you can scale up or down de- pending on the size of your practice. 1. Documentation. A practice this size will typically have a share- "Govern a great nation as you would cook a small fish. Do not overdo it." —Lao Tzu P hysician-owner happiness and overall career satisfac- tion is driven by numer- ous factors. These factors include: • Access to and control over resourc- es—staff, facilities, promotion, etc. • Strategic alignment among part- ners and from the board down through lay managers and support staff • Freedom from undue administra- tive burdens • Total income and control over earning capacity • The responsiveness and fitness of administration • Peer-to-peer and peer-to-staff harmony • Low conflict levels and high trust levels • A satisfactory work-life balance At the core of these factors is a sound governance model: an organized, coherent, legally memori- alized approach to prioritizing prob- lems and solving them so that every Tuning up your group practice governance model

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