File: Management Binder \ Management
Memo to Office Managers and Administrative Directors:
(copy to Clinic Director, File in Management Binder)
Six Sources Of Extra Work, And What To Do About Them
The information by Stephen Covey on how to be effective is very good for individual effectiveness. The following points can be useful in improving organizational effectiveness.
- INCREASED WORK LOAD. The patient volume of your office may have been increasing over the past months. Review your statistics and graphs by monthly trend, and compare averages for the last two months with the prior 4 months. Also, the paper volume may have increased due to changes in insurance policies, and managed care plans that have become more specialized, detailed, and generally more difficult. The solution may be to simple get more help.
- DISORGANIZATION. Organization usually includes specialization and compartmentalization that enables many different activities to occur without jamming into each other. For example, in your clinic, you may have billing spread out between the front desk, office manager, and other staff. This can increase interruptions and distractions, and therefore create double work. For instance, you start to do a claim follow up by getting acquainted with the case, then get interrupted, and then when you return, you have to again get re-acquainted with the case. This is instant double work.
Try to maintain separate departments in your office with separate job descriptions, policies and procedures. Cross training is excellent, but cross duties continued too long can create confusions. Besides the relegation of work activities into separate departments, there is also the delegation of your work into these departments. In larger offices or multiple offices, assign a particular staff member in each department the additional role of “Coordinator”, and delegate to them some of your managerial duties. The “Coordinator” position is very part time and not all that formal, but allows you to delegate some of your duties to others.
Good organization also includes proper communication procedures and channels. Lack of these can create undue interruptions, poor coordination, and misunderstandings between staff and doctors. Make sure communication times are scheduled and kept, as in meetings, and that communication is put in writing where possible, as in notes and proposals.
- LACK OF QUALIFIED AND COMPETENT PERSONNEL. Having sufficient qualified people doing the work increases your capacity to get work completed. An increase in work load or a loss of staff, without adding more people means extra work that may not get properly completed. The solution is to have clear job descriptions, hire as many qualified people as needed, and train. If, after a month or two, the new employee isn’t meeting your standards, do the both of you a favor and let her or him go and hire someone new. It is often hard to tell just how a new staff member will work out until you get her or him going. It is much easier to let the new employee go earlier than later.
- STANDARDIZED WORK MATERIALS. Office policies, procedures, patient protocols, mission statements, system checklists and job descriptions form the basic agreements that help doctors and staff work together in harmony. Not only do these materials help make a team, they also help train the team. Further, by regularly referring to them, you can help keep the team together and in agreement with all of its activities. As the office manager, rather than coming up with new solutions or getting into a personality conflict with a staff member, you can simply refer the staff member to the relevant work material. You can train the staff member on any part of the office binder that may be at issue until the staff member can get it right.
- LACK OF TRAINING. People not knowing what to do, or unsure of what to do, will go slow and get in the way, or just do the wrong actions which you have to later correct. This slows you down and gives you extra work. Willing and capable staff often can act badly if they don’t know, or are unsure of what to do.
If the raw talent is there, then, as with any coach, train, train, train to make your staff into experts. It is too much to assume that all have read their work materials. Even if the staff say that they have read their materials, many have trouble reading and understanding what they read. They have to be trained and tested on them, not once, but regularly. Continual training is necessary in your staff meetings, during special meetings, at seminars, special study assignments, and with consultants. Schedule it and do it.
- NON-COMPLIANCE WITH PROCEDURES AND POLICY. A sixth major, but often undetected source of extra managerial work comes from seen and unseen non-compliance with office policy and procedures. Examples may include: doctors not complying with notes on the cards, staff meeting notes not initialed, recalls not being done, first visit and Health Care Class confirmation calls not being done, less re-exams being done than needed, non-compliance with certain requests by insurance plans that the office has decided to be a part of, doctor paperwork sometimes not locatable, poor management coordination before staff meetings, staff leaving their position frequently during the day for personal reasons, staff giving the patient on the phone only part of their full attention, etc.
You can deal with the first five points above through training, planning, hiring, restructuring workloads, defining duties, procedures, policies, patterns and flows. However, failing to face up to and deal with non-compliance will sabotage all the best laid plans. Usually, this reason is what makes bosses (and parents) yell, pound the table, and curse. Keep in mind that if the earlier reasons are consistently addressed and kept on top of, non-compliance rarely appears. However, every now and then it does need to be addressed.
Unfortunately, sometimes the only reason people do what they are supposed to do is because they will get in trouble if they don’t. Personally, you can see this in your own life that this is true. We all have to do things we don’t like to do but do them because the consequences of not doing them are more uncomfortable. Who likes to brush and floss their teeth? But, it’s cheaper and less painful than the prospect of root canals and teeth implants. Even so, it may take some scolding from our dentist to remind us of our oral hygiene duties!
What are the consequences in your office for non-compliance? Nothing…right? Sure, sooner or later your doctor may get mad…but he won’t address all the items that many people can get away with, and may drop the subject after a while.
This is a defining point for an office manager. Can you get compliance from your doctors and staff? Can you get people to keep their agreements? You have many tools for discipline, not the least of which is your own personal challenge of and ill temper towards the poor performance of others. Comfortably facing up to people on the specifics of their actions or inactions is a very powerful tool. Like putting them on trial, it gets them to confront the truth of the evidence before them.
Most office managers work very hard and are very productive. Sometimes, however, it may seem like they are taking three steps forward and four backward. To avoid dealing with work overload, you must work aggressively on the first five areas above. In spite of this, if there is too much work to do, too much difficulty in making the practice run smoothly and efficiently, it may be because of non-compliance. What is behind this non-compliance? Only very minor bouts of laziness or momentary fits of defiance and negativity. The best organizations don’t always run smoothly because it is the “nice” thing to do. It usually also takes a hard nosed manager demanding policies and procedures are complied with, or else!, to make a business go.
Petty, Michel & Associates 12/18/00Memo to OM's-Extra Work.doc1 of 3