Even healthy mid-phase or late phase practices are typically overly dependent on the primary doctor’s physical presence in the office and on the personality and energy of the doctor. This is certainly a critical piece of the puzzle, but over-reliance on the primary doctor is actually a weakness when it comes to creating value and creating smooth practice transitions. For healthy mid-phase or late phase practices, here are few key points to get in place or to improve if already in place.
If you ever find yourself repeating instructions or dictating the same procedure repetitively, you know you do not have a standard for that particular aspect of the practice. There are two key features to this type of standardization:
- Policy handbook. This document outlines the rules of being an employee of your company. Common features include pay details, dress codes, conduct codes, vacation rules and coordination fraternization rules, etc.
- Procedural manual. There are a few different forms of this, but the absolute minimums include the administration roles and the doctor’s case management roles. This should be a playbook about how to best do any particular job in the office.
Having standard procedures that are written down and actually followed gives strength to the practice in a few different ways:
- No loss of consistency and continuity during absences (scheduled or not).
- Faster and more consistent training in case of employee turnover or from practice expansion due to growth
- Reliable and consistent delivery of services in multiple locations or from multiple providers in the same location.
Regular meetings and group communication pipelines
In a small practice with one doctor and 1-2 admin staff members, this comes easily and naturally, because you are in close proximity for the vast majority of the time. Even in this type of work environment, regular meetings with a short agenda and minutes will give a record to the practice directives and will give accountability to performance. Biweekly is usually a good time frame for this size practice.
As soon as the practice grows to the point where patients are being treated without the presence of the clinic director, these meetings become critical. It’s too easy for misinformation to get propagated or for procedures to become sloppy or to drop off completely. This is not usually malicious in intent; it’s just a feature of common practice pressures and routine distractions.
If the practice has multiple locations or extended hours in the same location, private publication of the minutes will help in keeping everyone on the same page. This can be set up easily and automatically through group email using the company’s domain name, or through a web-based solution such as google groups. If you prefer the web-based solution, groups.google.com will get you going. Either of these formats is private and the information can be kept confidential.
Use of agendas and minutes will help when employee reviews are due. Without a timeline and a history of accountability for an employee, the doctor will usually rely on subjective impressions and most recent actions, whether positive or negative in nature.
Expansion of production through new personnel
This is a complex area that involves a new level of managerial skills from the doctor, but is a key feature in making the practice more valuable and more transferrable to a future purchaser. If not managed well, the doctor may find that the overall production of the office is about the same, with increased payroll and managerial demands. There are three key hiring areas to consider:
- Rehab/exercise/modality assistant
- Massage therapist
- Associate doctor
Each of these areas requires a set of detailed expectations and revenue projections, which will be described in future blog posts. The overview of all of these is that a successful hire and implementation means that the revenue production responsibility is now spread out over more providers, and the financial health of the company is now less dependent on the physical presence and energy of the primary doctor.