The Administrator’s Desk: Rolling With the Changes

To you, it’s a simple matter of economics. New billing software equals fewer mistakes, faster collections, and higher profits. But to your physicians and staff, it’s three weeks worth of training that takes them away from their jobs.

Practice administrators face no shortage of opposition when it comes to implementing new ideas - from changing procedures for patient scheduling to using new forms for capturing charges. Part of the reason is that clinical and clerical staff are already drowning in paperwork from payers, patients, insurers, and regulators. Any new mandates threaten to stretch their limited resources too thin. There’s also the “if it’s not broke, don’t fix it” attitude that prevails in many practices.

“A lot of doctors resist change because they feel they’ve ‘always done it this way,’” says Lori Wyvill, office administrator for Allergy, Asthma and Clinical Pharmacology in Houston. “They don’t realize it’s broken or has become outdated as their practice has grown.” What worked great when you had 50 patients a week and one staff member may no longer be effective when you have 150 patients a week and 10 staff members. For good or ill, it’s your responsibility to coach them along.

Get them involved

According to Wyvill, the trick to getting your office to change its ways is instilling a sense of ownership. “I don’t always have all the answers, so I try to get the physicians to help brainstorm the solution,” she says. “They often have really good ideas and the mere process of discussing the issue usually helps them understand why it needs to be changed.”

Merrilee Severino, administrator for Ali Harake’s internal medicine practice in Ft. Lauderdale, Fla., agrees. “If they choose the solution, they’re much more likely to enforce it,” she says.

In some cases, especially where work flow changes are required, it also helps to win the approval of your staff before approaching the physicians. “I try to get feedback from my staff first and put that into perspective and then bring the idea back to the employer,” says Tina Marie Stevenson, office manager for Surgical Associates of Ithaca, N.Y., a four-physician general surgery practice. “If the staff is totally against your plan, your physician is never going to want to do it. You have to get everyone involved and make them feel they own a portion of it.”

Identify the problem

The decision-makers in your practice, of course, must also understand why the changes you’ve proposed are necessary. “If I want to change a process, I’ll normally start out with examples of why it’s an issue,” says Severino. “I identify the problem and offer at least two solutions with the pros and cons of each.”

Recently, after convincing her physicians that it would help improve work force retention, Stevenson won approval to start a medical reimbursement plan for her staff. “The doctors couldn’t even participate in the plan in a meaningful way themselves, but when I showed them how much it meant to the employees, who could put money away for healthcare costs pretax, they approved it right away,” she says. “It made a world of difference to the employees and their paychecks.”

It helps, too, to break larger goals down into smaller bite-sized pieces. As your practice grows, for example, you may wish to divide the check-in and check-out responsibilities between two employees. Rather than flipping the switch one afternoon, try designating a few hours each day in which the jobs are handled separately. “You have to allow time for everyone to get adjusted,” says Severino.

The old college try

If you still face resistance, adds Wyvill, ask the physicians and staff to give your plan a temporary try, assuring them that nothing is set in stone. “I just ask them to try it this way for awhile and see how it goes, and if it really doesn’t work we’ll sit down and figure out why,” she says. “It’s like getting your kids to try new foods.”

Finally, notes Severino, who recently changed the forms her physicians fill out for capturing patient charges, office managers should be prepared to accept something less than full commitment from their coworkers - at least in the early days of implementation. “There are days where they can’t do it all 100 percent your way right away,” she says. “I’ve had projects that took more than a year to implement. Stick with it. Everyone has a learning curve.”

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., 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 November 2007 issue of Physicians Practice.