Do You Need An Office Manager?

Having an office manager can bring increased efficiency and sanity to your podiatric practice, freeing you to focus more on the care of patients. This author details how an office manager can streamline operational systems, boost productivity and promote increased teamwork.

   The bills are piling up. Staff is out of control. Policies get ignored. Patient flow becomes compromised. Efficiency is lacking. The front desk goes unsupervised. Stress is becoming the symptom du jour.

   Do you resent being put in a position of having to deal with some of the same problems in your office over and over when, in reality, you should be concentrating more on caring for your patients? Perhaps it is time to consider hiring an office manager.

   My years of consulting work have taken me into a lot of podiatry practices, some of which employ an administrator or manager, and some that do not. Within minutes of experiencing the environment and overall operations, I can tell whether a practice is under proper management.

   When there is poor management (or no management), it bubbles over into almost every aspect of the practice. The signs may range from disorganization and inefficient patient flow to financial negligence, from insubordination to failed policies.

   While mismanagement definitely raises some red flags, not all red flags are due to mismanagement. True, mismanagement may be a contributing factor but not necessarily the sole cause of a practice’s problems. There are other dynamics at play that you need to consider. For example, if you hire the wrong employee or he or she does not have the proper tools to succeed, it is unrealistic to expect management to step in and turn things around instantly.

   In preparation for this article, I asked two people this question: “When do you know it is time to hire an office manager?”

   The first response was from a colleague who holds a management position. “When you have more than one employee,” he said and he could not have been more sincere.

   The second response was from a friend who works for a manager. She scowled and said, “I am not sure but I can easily tell you when you need a new manager.” We both chuckled in spite of her angst.

   On the other side of the spectrum, those practices that insist on healthy leadership qualities tell quite a different story. Those practices that hire good office managers can potentially reap the benefits of:

• enforced policies;
• improved staff morale;
• optimal staff productivity;
• teamwork and professionalism;
• focus on practice goals;
• structured systems and operations; and
• fewer mistakes and more attention
to detail.

Pertinent Insights On Enforcing Office Policies

I have seen far too many problems caused by lack of policies or un-enforced policies in the workplace. There are a number of reasons why this happens.

   First, the practice may have an office manual with rules that should help address certain situations. The existence of this manual may be news to the staff and is sometimes even news to the doctors. Without knowing what they can and cannot do, staff members make up their own rules. If no one corrects the staff, they assume they are right.

   Second, doctors are afraid to enforce the rules for fear of losing their staff. When I point out to the doctors that policies are being broken, they say to me, “Well, what can I do?” My usual response: “If I were you, I would tell their boss.” It is a reality check.

   If you consider the policy or employee manual the “law enforcement rule book” in the office but no one is in the driver’s seat of those rules, they get abused, redefined or completely avoided. What is worse is the perception that the behavior is acceptable.

   You would not think coming in late, leaving early, running out for a smoke or coming to work in shorts would be acceptable in any practice. Yet if the doctor does not have time to deal with it, does not even realize it or does not want conflict, employees brush aside compliance and “the rule” suddenly becomes “no rule.”

   That is where the office manager comes into the picture. It is his or her responsibility to review the policies of the practice with each staff person and see to it that the staff understands the rules and carries them out. The manager does this by enforcing the written codes of conduct including sanctions for non-compliance and by following grievance and disciplinary procedures. The staff might think twice if there is a consequence attached to poor behavior.

How A Manager Can Improve Morale

I visited a manager-less office where the doctor was the sole driver of the morale of the staff. Unfortunately, the doctor fell short in this area. It seemed the doctor mostly focused more on the staff’s inefficiencies as opposed to their competencies, offering very little praise for good work outcomes.

   Upon learning the error of her ways, with good intentions (and a lack of time), the doctor composed a quick e-mail and really made a point of saying some complimentary things. She sent the same letter to each of her staff members with great expectations. However, when the staff received her rubber-stamped commendation, there were disappointed reactions such as “Why did she bother?”

   This not only ended up de-motivating the staff but the doctor resented their response and refused to extend any future praise. Bad move. As you can imagine, it only accelerated the downward spiral with the end result being unnecessary turnover.

   The office manager knows that building a positive, high-energy environment takes time and effort. It requires high levels of praise, open communication and fair doses of diplomacy.

   However, the responsibility in this area does not fall completely on the manager’s shoulders. He or she can do and say all the right things to win staff over. The attitude of any organization begins with the doctor.

   When the doctor can walk into the office, smile, say hello and demonstrate enthusiasm, the enthusiasm filters down to the patients directly through the manager and staff. Never underestimate the good and bad ripple effect, and its impact on the success of a practice.

Maximize Staff Productivity

In many ways, staff productivity could be a direct offshoot of the morale benefit because after all, a happy staff is a productive staff. Unfortunately, if you put eight different doctors in a room, you will get eight different versions of what it means to have a “productive podiatric staff.”

   This is partly due to the fact that podiatry has no nationally agreed upon standards to measure productivity of podiatric staff. Still, it should not be a guessing game within each individual office.

   A manager needs to work closely with the doctor(s) first to define the level of effective staff productivity. Does productivity involve more hands-on care by the clinical staff, a staff that anticipates tasks and more involvement in practice marketing? Does productivity for the front desk mean collecting all the balances or are doctors satisfied if their staff just collects the co-pays? What is the accepted standard?

   After defining that critical piece, the second part involves firsthand monitoring of staff productivity by having a presence on the floor. Walking around, being available to staff and stepping in where needed sends a supportive, positive message as opposed to sitting in an office barking orders.

   Additionally, being able to oversee office productivity from the floor allows the manager to immediately address any situation that appears to threaten efficiency, whether it involves employees slacking off, personal problems in the office, an emotional crisis, a lack of focus, procrastination, unsuccessful methods or unsatisfactory outcomes. Additional follow-through entails the evaluation of a staffer’s performance or an annual written performance review.

   Office managers have been trained to conduct these reviews in a positive way. They help correct bad habits. They do not ask “What did you do?” They can approach this in a more positive way. For example, they can ask: “How can we learn from it and make it better?” Managers learn the strengths of the employees and place them in positions in which they can best utilize those strengths. They coordinate staff with set treatment protocols in order to help ease the work of the doctor and increase efficiency.

   One of the biggest gripes I hear from staff is that their doctors do not conduct performance reviews while the doctor’s gripe is not having any time to do a review. How can employees be expected to improve if no one tells them how? Good managers take the time to help them discover how to improve.

Why Building A Team Starts With A Manager

With all the different personalities and perspectives joined together in one place, how does one create a work environment devoid of useless, non-productive bickering? Who will handle the internal complaints, unwillingness to change and bad attitudes that develop during the course of the day? Who will be the glue that holds the practice together while the doctor does not miss a beat, darting from room to room, trying to keep to a schedule that
even Superman might find challenging?

   It is none other than the office manager. The manager is accountable for bonding all the links together with the understanding that patient satisfaction and care lie in the balance. While this is a tall order, it is not one that the manager can accomplish alone.

   Knowing how to generate an inspired synergy amongst the players that allows them (and the practice) to reach their potential is just one characteristic of a skilled manager. Additionally, office managers understand that job satisfaction is key in getting there. Just one disgruntled worker can derail a team.

   To this end, a supportive manager steps in to resolve differences, reduce conflict, help find solutions and initiate change to point staff back in the right direction. It is not easy to get everyone on the same team. Without a manager, internal strife usually has the doctor (begrudgingly) assuming the role of referee. The late Casey Stengel said it best: “Getting good players is easy. Getting them to play together is the hard part.”

Keeping The Staff On Track To Reach The Goals Of The Practice

Aligning staff goals to practice goals makes the difference between setting goals and reaching them. Not aligning staff goals to practice goals can create two separate directions and that proverbial fork in the road will prevent you from arriving at your preferred destination. One thing is for sure. If you do not know where you are going, it does not matter what path you take.

   Committed managers who share your vision can successfully help align or keep your team on track, and directed toward your practice goal. You cannot do this by demanding that everyone memorize your mission statement but that they live it. Staff members understand that setting the course through their actions, beliefs, values, ethics and words is what will ultimately connect each employee to the preferred destination. The doctor needs to understand how having his or her employees on the same page is a nourishing environment that encourages practice improvement.

Addressing Issues With Operational Systems

There is no doubt that the employees need to be managed but what doctors sometimes forget is that often it is the failed systems, not the people, that are the source of breakdown. My visit into private practices starts with a review of operational systems. It is not surprising to hear the following responses to the questions below.

   Q: Do each of your staff members have written job descriptions?
   A: They do not.

   Q: Do you have financial and collection policies?
   A: Neither.

   Q: Is there a system in place to prevent embezzlement?
   A: No.

   Q: Does your staff review charts in preparation for patients?
   A: Sometimes.

   Q: Do you approve of the things your staff says to patients on the phone?
   A: I have never really listened to what they say.

   Clearly, the doctor cannot be everywhere nor can he or she see or hear everything. Still, I have heard their cries for help after accidentally overhearing a phone conversation and gasping in surprise at what they heard.

   This is a perfect example of why it is important that the office manager be in the midst of activity to oversee all operations. The manager should not only have a trained ear to listen to information over the phone, at the front desk and in the treatment rooms, but also correct unprofessional behavior and monitor staff-patient interaction. It is his or her responsibility to delegate tasks to staff effectively. This ensures that the schedule flows smoothly, patient referrals get tracked to determine the return on marketing investment, recall systems are in place and billing protocols are effective. The manager also oversees inventory and updates credentials, registrations and licenses.

Correcting Mistakes Before They Become Problems

Human error is to be expected every now and then, but an effective manager can help catch small staff errors and correct them before any of them become big problems. Additionally, effective office managers can take the time to make the error a learning experience for the staff and insist on more attention to detail to prevent repeat mistakes in the future.

   It is important to know that the practice is catching and correcting slipups as opposed to brushing them under the rug in the hopes that no one ever finds out. The latter is too dangerous even to think about.

Final Words

Ask yourself what success means to you. Does it mean having more time to spend with family and friends, not taking charts home every night, or being able to engage in hobbies that you have had to push to the back burner? Maybe it is offloading some of the stressors in your life, increasing revenue or both.

   If one or more of these define “success” in your life, then the question is not whether you can afford to hire an office manager, it is whether you can afford not to.

   Ms. Homisak is the owner of SOS Healthcare Management Solutions (www.SOSHMS.com) and has a Certificate in Human Resource Studies. She is a Fellow and Past Vice President of the American Academy of Podiatric Practice Management, and is recognized nationwide by many in her profession as an expert in staff and human resource management.