Practice 911

October 20, 2006

What you can learn from three medical office emergencies.

Stat! This abbreviation of the Latin word meaning "at once" describes a quick response to a medical emergency.

We asked three veteran consultants for their favorite stat story from the world of private practice. What they share here are case histories of successful turnarounds-practices brought back from the brink. As if they were charting a patient, each consultant diagnoses what got the practice in trouble, describes the short-term fixes, and outlines the long-term changes needed for ongoing prosperity.

Judy Capko

Thousand Oaks, CA

Inconsistent, quarrelsome leadership

"I think I have a mutiny on my hands. My staff is ready to revolt-or bolt."

The phone call came late in the day from the senior doctor of a three-member ob/gyn practice. Demand for their services was growing at light speed. Fortunately, they had four nurse practitioners who handled 70 percent of patient visits. But the NPs were close to quitting, and if they left, the 15 or so support staff probably would follow them out the door.

When a colleague and I visited the practice, we discovered that the NPs felt undervalued and overworked. The support staff felt the same way. True, a few malcontents created dissension, but the greatest source of unrest lay with the practice's physician leadership, which didn't inspire trust or respect. When revenues slumped, salaries were frozen with little explanation to staff. Employees asked for performance reviews that never materialized.

One of the biggest problems was the CEO. He'd promise the moon to staffers without considering whether he could deliver. When he couldn't, he made excuses. Plus, he was condescending toward women-most of the staff. He discounted their value in none-too-subtle ways with comments like "It's that time of the month again, eh?" The other physicians not only turned a blind eye to this sexism, they interfered with how the practice was run, sometimes creating willy-nilly exceptions to the CEO's directives. This angered the CEO, who took out his anger on the staff.

The next major issue was a lack of structure. There were no job descriptions, no established expectations, no way to measure job performance. Nobody knew if they were doing good work. The only feedback was punitive.

Not surprisingly, there was quarreling, finger-pointing, and insecurity. Turnover was escalating to the point of mass desertion.

To build a team, I got people talking

The first step toward averting disaster was to establish communication channels so that everyone could pitch in to solve the practice's festering problems.

My colleague and I interviewed each employee and asked them to discuss their responsibilities and set realistic performance goals, such as how many insurance claims a billing clerk could get out the door each day. We then crafted job descriptions that staffers reviewed and approved. This process gave them a sense of job ownership. They also explored how they could improve the work environment and support their co-workers.