HCPM 341
Introduction
Practice management is one of the least popular jobs among medical practitioners, probably because it leans more on the field of management than in the medical practice itself (Aluise, 2012 p.142). However, done correctly, the organization will produce the profit that is needed in order to continue providing excellent healthcare services to patients. In managing the multi-specialty group of six doctors and three mid-level providers, I will employ planning, organizing, staffing, controlling, directing, and decision-making. Planning is probably the most important of these six elements because without it, there is no order. Even if there are duties and tasks delegated to the staff but there is no planning, then it is likely that time and money will go to waste because there will be no directed action. Organizing is similarly important because even if an organization has a plan, if it is not organized, then confusion will follow because there will be no coordination. I believe that the successful accomplishment of tasks requires an adequate number of people to do the necessary work. This means that appropriate staffing is essential in pursuing the goals and objectives of the planning and organizing stages. It is important to delegate people to tasks that they are able to perform well and, especially while the work is being done by the staff, controlling the effectiveness of the staff in order to ensure efficiency is crucial in achieving better results. This is where monitoring through micromanagement becomes useful. In all of these, good decision making will improve my chances for success as a medical practice manager. I recognize that the work environment may constantly change on a daily basis; for example, there may be twenty patients coming in on a given day yet there may only be two patients on the following day. New healthcare policies and regulations may need to be followed immediately and there may also be various internal and external influences which may require simultaneous adaptation by the organization. All of these factors demand prompt and effective decision-making skills on my part as the practice manager. In light of these, the following sections will present the company’s organizational structure, the technology, the training of staff, working with vendors, and establishing performance benchmarks.
The Organizational Structure
For the organizational structure, I will utilize the horizontal management approach. As a point of reference, I should mention that three different types of management positions have been chosen from: horizontal, matrix, and vertical (Daft, 2007 p.120). Horizontal management is utilized in a ‘flat’ organization wherein there are very few management levels. For instance, an organization may have one boss and everybody else reports to him; this means that there are only two levels within the company. The matrix management position is one where there may be several matrix managers within a single organization, and the managers may have employees from different departments. Thus, a matrix manager may be a project manager with people reporting from the nursing department, finance department, and probably even from building construction. A vertical organization, on the other hand, is where one can find a hierarchy of positions. This will not be suitable in my organization because of the limited number of employees. In the multi-specialty facility which I will manage through horizontal management, people under me will include six doctors equally divided into three teams or departments and there will be three nurses alternately assisting the six doctors. As such, there will be two doctors for respiratory therapy, two doctors for cardiology, and two doctors for pulmonology.
In order to fully appreciate how the organizational structure will function smoothly, it is necessary to emphasize the significance of my role as a practice manager. There will be three levels of management focus that I will address and these will include the management of self, the management of the team, and the management of the organization. Even though I am expected to manage the work affairs of my subordinates, I must also be able to manage myself effectively. The management of self would involve time management. For instance, if I arrive half an hour late for work, it would be difficult for me to observe or monitor the ongoing work of people under me. In managing myself effectively, I can be in a better position to manage the teams in the medical facility. My management will be geared toward directing each of the three teams to whatever team goal must be accomplished, in line with the overall organizational goal. All of these will improve the possibility of success for the company.
For the organizational structure, I will employ management conceptual skills, technical skills, and interpersonal skills (Rowe & Guerrero, 2011 p.82). Conceptual skills involve knowledge of management concepts that are appropriate to the circumstances of the existing medical environment. Although I may be involved primarily in management, it is important for me to similarly possess the technical skills of the staff because it would be very hard to manage the work of other people if I do not know what they are doing or how they are doing it. I am also aware that in a healthcare environment where employees are frequently exposed to health risks, there is possibility of being understaffed on any given day since employees may contract communicable diseases from patients, even if it just a flu, cough, or colds. In order to ensure the smooth flow of operations, I have to step in and do work in sections that are understaffed and this means that knowledge in technical skills, on my part, is important. Overall, I will need to use my technical skills, writing skills, management skills, financial skills, budget development skills, etc., regardless of whether the work is my job or not. Lastly, I will be adept at interpersonal skills. In working with people, it is not sufficient for me to have knowledge in management, conceptual, and technical skills. Without good interpersonal skills on my part, the outcome will still be unfavorable. I can be as smart and knowledgeable as I want to be but without the ability to relate with other people, the employees may despise me and this may lead to organizational failure. Overall, I believe that the above-mentioned management approaches will contribute to the effectiveness and efficiency of the organizational structure.
The Technology
It is important for managers to have good knowledge of developments in external environments, especially when it comes to the latest trends in medical equipment, medical procedures, and even administrative requirements for new government policies. As the practice manager of the company, it is important for me to pay attention to changes in technological developments such as billing coding, for instance. It can be recalled that Medicare introduced more than 200 changes in 2010 alone (Marcinko & Hetico, 2016 p.49). If a healthcare facility is unable to cope with such changes, then business failure would likely follow. Managing the company’s billing processes correctly will not only save time and money but will also make things so much easier when the time comes for auditing. Because of this, it will be my objective to automate everything as much as possible. Electronic process management software will help me cut costs and let me and my employees do what we need to do most so that we may deliver the quality care that our patients deserve.
All of these factors impact the efficiency and effectiveness of the company and will therefore be constantly monitored under my management. In order to ensure that the constantly changing business environment is monitored, it will be necessary for me to observe developments not only in the internal setting but also in the external environment. These external influences may originate from the community, the city, or the state which the healthcare facility is situated in. In instances when an epidemic is expected to arrive in my community, it is necessary for my organization to be equipped with the appropriate technology to confront such an outbreak because it will directly impact the effectiveness of services in the health facility. As such, it is necessary to be prepared with technological know-how and equipment; there should be enough vaccines and the facility has to be sufficiently-staffed so that corrective and preventive measures to combat the epidemic may be performed well. Sufficient technological resources will also be necessary in accommodating more patients until the outbreak subsides or becomes more manageable.
While it is important to know what is going on in the internal environment of the medical facility, it is equally relevant to be aware of what is going on outside. This includes awareness on the technological capabilities of the competitors, especially in the immediate vicinity (Berkowitz, 2006 p.44). On a broader scale, healthcare-related requirements in the country will directly affect the organization as it may be necessary for organizational budget to be trimmed down in instances where the government may cut Medicare, Tricare or Medicaid benefits. Thus, it will be necessary for me to always be up-to-date on technological advancements and policy changes that will impact the organization. In this manner, the organization will be able to cope with these external changes and the quality of service to patients will not be compromised.
Staff Training
On the issue of staff training, it will first be important for me to reduce staff turnover as much as possible. Every person that I lose will equate to losses in dollars when considering lost productivity and the costs that are actually associated with hiring and training new staff. Of course, it will be part of my job to review employee salaries from time to time because it is important for good-performing people to get paid with at least what other practices are paying their healthcare practitioners in the immediate area. Otherwise, I may lose my well-trained people to the competition.
As a Practice Manager, I will recruit, develop, and retain good people in the organization. In these aspects, training is very important because the level of training will dictate the level of performance. If they are trained wrong, then they are going to perform wrong; if they are trained well, then they are going to perform well; it is as simple as that. Leadership development is also important and this similarly involves the development of employees. In this aspect, it may be possible for other managers like me to be unwilling to develop the managerial skills of their subordinates for fear of losing their own positions. This is not good leadership because holding back the professional capabilities of a subordinate will not benefit the organization. Employee feedback will also be important because without feedback, I will not really know if there are hindrances to efficiency. In other organizations, it may be possible for some managers to dismiss negative feedback from their subordinates; in such cases, opportunities for improvements are missed. Employees may not always be correct in their opinions but sometimes they may really have good feedback that can help the organization. Not providing the employees a way to voice out their opinions, whether positive or negative, will not be good a practice because it will lead to poor employee morale (Williams, 2016 p.140).
In the event that a doctor or a mid-level healthcare provider may be planning to leave the company in the distant future, it is important to have a succession plan in place. Because there are very few employees in the multi-specialty facility, it would be unavoidable to hire new people as replacement. As the employees are being developed, there are always going to be people that will rise above the rest; these are the people that should come to mind when doing succession planning for the position of practice manager. This is what good managers do; poor managers neglect to do succession planning and so when they leave, everything naturally falls apart.
Working with Vendors
The latest release by the World Health Organization [WHO] of the International Statistical Classification of Diseases and Related Health Problems [ICD], or the ICD-10, classifies diseases and other related health circumstances into codes (Luesley & Kilby, 2016 p.12). This impacts not only practice managers like me, but also vendors. Today, there are fundamental concerns that must be confronted because of ICD-10. The first of these involves determining if the vendor has adequate inventory to supply the needs of the medical facility. Secondly, it is important to know whether the vendors who need to have a successful implementation in their hardware or software or processes are actually successful in their implementation or not.
As a practice manager, I will make sure that vendors do not lead the company into a path that leads to non-compliance of the ICD-10. To this end, I will constantly be aware of which vendors are capable of providing hardware, software, and processes that are compliant with ICD-10. I will also set into motion my plan to interface with the vendors, making sure that I am aware of their dates, milestones, and checkpoints so that my in-office implementation plan can be synchronized with the vendor implementation plan. Next, I will have a regular schedule to communicate with the vendors, making sure that the communication is forthright, especially if the vendors are falling behind in the agreement. If things are not going well and there are a lot of excuses on the part of the vendor, then I will act forcefully and quickly in order to cut probable losses to the company. In this aspect, a plan that is going badly is not a good plan; thus, if Vendor 1 is failing, I will be prepared to shift to Vendor 2. The vendors should acknowledge that my success will be their success and vice versa. This means that we need to depend on one another in order to be successful and this can only be achieved if I work more closely with my vendors.
Establishment of Performance Benchmarks
In managing the performance of the organization, there is a need to emphasize efficiency and quality. For instance, if I require a certain task to be completed in about 20 minutes, that is an example of trying to aim for efficiency. As far as quality is concerned, not only should the work be completed within the time frame required but it should also be done well. When managing performance, I intend to highlight the people who go above and beyond the expectations. In assigning tasks, I will first ensure that the required work is achievable and worth the effort; otherwise, it will not produce a desirable outcome. It is for this reason that I will set reasonable and appropriate goals and targets, utilizing benchmarks or organizational comparisons when managing performance. Setting a benchmark is the act of comparing the performance of an individual, or the output of the entire group, against a target standard (Summers, 2005 p.107). This will reveal whether the performance of an individual or a group is below par, equal, or better than another individual or organization. For example, it would be good to point out that another healthcare organization achieved a similar goal in about one month; this becomes the benchmark and the people under me should work toward accomplishing the same task with the same efficiency or even better.
It is also important for me as an effective medical practice manager to conduct rounds and office visits as this will enhance the probability for success in meeting performance benchmarks. I recognize that I may have a lot of paperwork at the office and may even feel overwhelmed at times but I am fully aware that conducting rounds is very important. For one, it will allow me to be more visible, giving the impression that I am an approachable person. If I always remain inside the office, employees may feel ill at ease to approach me and share issues that are causing personal or team problems and preventing them from doing their job correctly. The rounds will also allow me to gather information that can improve the overall effectiveness of the group; perhaps a new type of toilet paper may be needed for the toilets because the one being used clogs up the pipes. It would benefit the organization if the employees see my face regularly beside them and know that I am an approachable person whom they can talk to regarding different matters. In this manner, I can more closely monitor if performance benchmarks are being targeted by individuals and by the group, allowing me to effectively perform my responsibility as a Medical Practice Manager.
References
Aluise, J. (2012). The physician as manager. Berlin: Springer-Verlag.
Berkowitz, E. (2006). Essentials of health care marketing. Sudbury, Massachusetts: Jones and Bartlett Publishers.
Daft, R. (2007). The leadership experience. Mason, OH: Thomson Learning, Inc.
Luesley, D., & Kilby, M. (2016). Obstetrics & Gynaecology: An evidence-based text for MRCOG. Boca Raton, FL: CRC Press.
Marcinko, D., & Hetico, H. (2016). Risk management, liability insurance, and asset protection strategies for doctors and advisors: Best practices for leading consultants and certified medical planners. Boca Raton, FL: CRC Press.
Rowe, W., & Guerrero, L. (2011). Cases in leadership. Thousand Oaks. CA: Sage Publications, Inc.
Summers, D. (2005). Quality management: Creating and sustaining organizational effectiveness. Upper Saddle River, NJ: Pearson Prentice Hall.
Williams, C. (2016). MGMT: Principles of management. Boston, MA: Cengage Learning.
