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The organization of an operations team for efficiency

by Ira Kirschenbaum , Chairman, Orthopaedics, Bronx-Lebanon Hospital Center
From the April 2012 issue of DOTmed HealthCare Business News magazine

Physician groups have operated with the same hierarchal structure for years — the physician with the most experience and history of success is naturally followed by fellow physicians, or the owner/employer/founder of the group is designated the leader. Of course, the strictly medical side of the team will need a physician decision-maker to lead that aspect of the practice, but in today’s climate where groups are seeing similar variables and stresses that corporate businesses face, this is not enough. For operational effectiveness, it is vital that medical groups establish a nonphysician manager or management team within their infrastructure.

Whether it is a small office or a large medical practice, it still appears that
few physician leaders are graduating from medical school with an MBA. Practice management is beginning to be taught in select schools, but the curriculum lacks basic business strategy and design — which may be why the medical industry does not have the best track record of operational effectiveness. Every health care practice is, in reality, a business and must be knowledgeably run by administrators who understand the complexity of such an organization. Many medical groups have attempted to fill this obvious void by hiring office managers to handle the books — supervising the accounting, booking appointments, and more. Still lacking in this structure is the necessary leadership to bring a practice to the next level through skill sets such as research and development, market analysis, negotiation tactics, revenue management, and just about any other business strategy essential to the success of the group.
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Many business schools offer medical management curriculums to specifically train their students how to run health care practices and medical delivery systems. Many of these schools also offer courses in corporate strategy for practicing physician managers providing them with a foundation in business. But until more physicians take up this type of opportunity and the medical management field is better assimilated into current medical practices, physicians need to look to the business community for administrators who will rank as leaders of their group. That is not to say that the owner of a practice should delegate a non-physician manager as CEO — the key is that the two are a team, working symbiotically to achieve the physician leader’s mission and goals upon which the practice was founded. Non-physician administrators should be hired based on their compatibility with the group’s objectives, not based on how they look on paper. The most crucial component in the relationship between the two leaders is a strong mutual sense of trust, as the physician must be able to comfortably forfeit control of a significant portion of his practice in the areas in which he lacks the necessary amount of expertise. This is perhaps the number one factor inhibiting the prevalence of non-physician administrators in medical practices today — physicians are hesitant to lose authority over the group’s activities. The first step in integrating a non-physician manager into a team is to make sure the physician leader accepts the idea of relinquishing power over areas of his practice. These areas need to be defined for both parties to avoid conflict. Another challenge facing the leadership is being able to efficiently direct a group of people with an extraordinary talent base — the physician workers. Every doctor within a practice has his own patients, performs his own surgeries, and is essentially his own entity regardless of his group affiliation. The administrator and physician leader must be able to mutually establish a strategy to run the practice as a cohesive team instead of an assortment of independents who happen to be under one roof.

Though non-physician managers may theoretically have all of the tools to lead a practice to economic prosperity, in order to work harmoniously with a physician leader the two must be able to speak the same “language”. The administrator must be well-versed on the basics of health care, but more importantly, as aforementioned, the physician leader needs to be formally trained on the fundamentals of business and entrepreneurship. Neither side of the team will have as extensive an education in the expertise of the other, yet the ability to understand one another will create an interdependent relationship that is crucial for efficiency. By being on the same page, both physician and non-physician strengths can be brought together to creatively solve problems and successfully make decisions.

About the author:
As Chairman, Department of Orthopaedic Surgery, Bronx-Lebanon Hospital Center, Dr. Ira Kirschenbaum runs an innovative program overseeing a staff of surgeons who deliver care to one of the largest clinic populations in the country. Kirschenbaum recently launched ViaVisit, a doctor-to-doctor “referral social network” that allows primary care physicians to book appointments directly into specialists’ schedules – furthering his dedication to increasing operational effectiveness in the medical field.

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