The Administrator’s Desk: Building Trust

So when was the last time your board got together to discuss clinical rather than business concerns? If you’re like most practice administrators, the agenda you set consists almost entirely of financials - profit margins, operating expenses, projected growth, and the like. But while financial benchmarks are essential, meetings that focus on numbers alone can leave physician shareholders feeling excluded, resentful, and generally mistrustful of upper management, say industry observers.

“There is some real tension right now between the suits and the white coats at physician practices,” says David Shore, associate dean and founding director of the Harvard School of Public Health’s Trust Initiative. “The perception among physicians is that 90 percent of the conversations at board meetings are about money, not medicine.”

Worse, he says, physician owners believe administrators present the data in a way that is difficult for them to follow, “making them somewhat skeptical of practice managers and other administrators, like CFOs.”

This erosion of trust is no small matter. Physicians who perceive they’re being kept in the dark are less willing to share vital medical information that could enhance office efficiency, improve patient satisfaction, and boost the bottom line. Distrust between physicians and administrators breeds an unhealthy working environment that is unlikely to attract and retain top doctors. “It’s not the dollar; it’s trust that is the currency of all commerce,” says Shore.

Make yourself available

As a practice administrator, you can cultivate a trusting relationship with your physician supervisor by adopting a more transparent communication model. Cut business school babble out of your vocabulary during board meetings. Instead, use language laypeople can understand - without talking down to the physicians, of course. Ask them, “Does anyone have any questions or need clarification on a particular agenda item?” Most importantly, always communicate to shareholders that your door is wide open to discuss any issue further - be it financial, clinical, or anything else related to patient care. Cultivating open communication is all about making yourself available and letting physician owners know you’re all pursuing the same goals. “Transparency is one of the biggest trust-builders,” says Shore.

Joan Wahlman agrees. The president of JD Healthcare Consultants in Houston advises practice managers to hold regular but informal staff meetings - as often as once a week - for both doctors and managers to discuss opportunities for growth, industry trends, and hiring and firing decisions, as well as new clinical treatment procedures or medical equipment that could give the practice a competitive edge. “Normally, the administrator oversees personnel and all the financials, and the doctors see patients and perform surgery, so they’re working in two different worlds,” she says. “It’s important to have a structured channel of communication so everyone is on the same page and can help grow the business together.”

Honesty really is best

Of course, you can’t expect to earn your boss’s trust if you don’t set a good example yourself. Aaron Chatterson, practice administrator for Carondelet Medical Group, a hospital-owned group in Tucson, Ariz., notes that fellow administrators must be honest with their practice’s physicians at every turn, communicating both good news and bad news as quickly as possible. For example, if a top employee quits over a specific issue you could have prevented, take responsibility.

“No one likes to be the bearer of bad news,” says Chatterson. “But bad things happen. As painful as it might be to call attention to those issues, it’s important to communicate trouble spots quickly and honestly, giving you an opportunity to work through those problems together. That’s what builds relationships.”

Clarify your role

If you sense that your physician boss still distrusts your judgment after you’ve spent years on the job trying to cultivate a culture of open communication, you may want to re-examine your role. It may be that you’re chasing the wrong goals, says Wahlman. “Doctors typically have a set of expectations in terms of the role they expect their administrators to play and the duties they want him or her to oversee,” she explains. “But a lot of times that never gets written out, so it’s not clear to the administrator.”

Ask your physician bosses to describe their expectations of you in writing, she says. Then you’ll have a better idea of where you stand and which milestones you must achieve to earn the confidence of your supervisor. “When you see practices in which doctors are constantly micromanaging, it’s because they haven’t developed that level of trust with their administrator,” says Wahlman. “They have to trust that you’re able to manage the practice without them, that they don’t have to be involved in day-to-day operations. It’s in the interest of both parties to document what those expectations are and have everyone sign off on them.”

Cultivate patience

Besides regular meetings and an open-door policy, the best tool for winning the trust of those who hired you is patience. Don’t expect overnight results, no matter how hard you try. “Trust is not a given,” says Chatterson. “It takes several years to establish that kind of relationship with doctors, showing a consistent pattern of trustworthy behavior. It takes hard work.”

Shelly K. Schwartz is a freelance writer in Maplewood, N.J., who has covered personal finance, technology, and healthcare for 12 years. Her work has appeared on CNNMoney.com, Bankrate.com, and Healthy Family magazine. She can be reached via editor@physicianspractice.com.

This article originally appeared in the February 2007 issue of Physicians Practice.