Transforming Your Organization

"I don’t seem to get to some of the work I should be doing as the doctor."
"I have to explain the same thing over and over to my staff."
"I have trouble designing care plans for patients, because I don’t know how long things will really take."

The first step of improving a small office is to think of it as an organization, where services are provided in a sequential fashion. Even though there are lots of variations in the individuals we are providing care to, there is an operating standard of how the care is delivered, and who is responsible for the different parts. If this is in writing and jointly understood, the quality of care goes up.

1. Our target is to get to the point where 19/20 patient encounters have scripts and standard procedures attached to them. Decisions about the 20th encounter will be made in concert with our values and mission. Detailed procedural manuals for the staff and doctor are provided.
2. Overview of clinical pathways based on patient typing: 4 box patient typing per SCSI. Overview of treatment goals and concerns
3.  
   Written manuals for SOP: general shared and agreed knowledge. We provide and customize office policies, pay and bonus schedules, review formats and other necessary employee management items.
4. Defined roles and responsibilities: we provide and develop job descriptions, procedural manuals, and information on how to set up and keep employee files properly.

"Both staff members think they are in control of the patient accounts."
"Nobody is in charge of patient accounts."
"My staff meetings are boring or blaming sessions. We decide things and then do not execute."

Once an office is busy enough to require more than a single staff member, we now have a division of labor, and a need for standard communication and operations.

Trust is critical, and ways to iron out snags without personalizing problems is crucial. The doctor’s role as an employer is expanding and the rules and requirements of this role must be honored.

1. 5 dysfunctions and gaining the critical levels of development
   • The Five Dysfunctions of a Team: A Leadership Fable, by Patrick Lencioni
    
2. Staff meetings and communications: all staff meetings should be about governance and result in actionable decisions.
3. Staff reviews: all employees need formalized feedback from their employers. Use of a standardized form help you to be consistent and to give and get feedback in a non-threatening environment. Proper use of bonus plans allows a separation of review from raise.

"My staff is underproductive."
"My associates do not take practice as seriously as I do."
"I’d like to expand, but I don’t know how to hire or train good associates."

A multiple doctor office, or one with a developed massage department requires a significant amount of team building and structure attached. The form of the larger offices varies quite a bit. We have outlined the typical pathways, understanding that there is plenty of room for individual variation depending on the goals and desires of the client.

1. Expansion hiring and training associate doctors: this is a critical hire and the contractual details and pay scales are critical. The object is to create a high-functioning, well paid team member, not to squeeze or exploit a labor source. Turnover of associate doctors is a common problem, and we have solutions to address this.
    
2. Expansion hiring and training massage therapists and other adjunctive staff: Massage therapists need a different structure and management style than other staff members may need. Understanding how to structure the details of the agreement and how to create the proper company culture are critical.
3. Any professional staff: our object is to increase company loyalty, reduce turnover, and create high functioning teams.