Guidelines for Reviewing the Practice Manager's Performance

How Your Practice Will Benefit

Most practices conduct performance reviews with their employees. However, we have found that the great majority of physicians, whether solo or group practices, do not undertake a periodic and thorough review of the manager's job. This can result in the following problems that we encounter in our consulting assignments:

1. The manager does not have a clear definition of her criteria for performance. In these instances, the manager establishes the criteria that seem most suitable to the job at hand. The problem is there may be areas meriting managerial involvement that become neglected. We have been to practices where the manager regards the job as, almost exclusively, personnel management. This can result in a lack of oversight regarding billing and collections activities - the financial lifeblood of the practice.

2. The physician(s) does not have a clear definition of the manager's job. For example, we have witnessed recent cases of physicians looking into EHRs without manager involvement. The rationale: This is a clinical exercise best undertaken by the clinicians. Yet, when investigating EHR, the possible integration of these systems into the A/R system - perhaps even meriting a new A/R system - carries a high priority in EHR investigation. The practice manager definitely should be part of the study, if not heading it.  

And, in some settings the physician attitude is, that as long as the practice is performing well, the manager's job is assumed to be functioning properly. But when this is not the case, it is not unlikely that the physician(s) will put some of the blame on the manager. In a group practice, we often observe that different partners have differing interpretations -not only of the manager's job - but also regarding the manager's performance.

The evaluation form should not be taken as the final definition of your practice manager's performance criteria. In the smaller practice, some of the tasks listed may not be the responsibility of the manager. In these instances, the non-qualified tasks should be eliminated from the evaluation form. However, for the tasks that are part of the manager's job at your practice, the goals indicated are realistic and generally agreed upon by practice management consultants.

An Important First Step

Both the manager and practice physician(s) should spend time reviewing the guidelines. Are all of the guidelines relevant to your practice's manager position? For example, in some smaller practices the manager does an annual budget. Yet it is listed here, not for the smaller practice, but for the larger group. Again, some smaller-practice managers are very much involved in negotiating with managed care plans. And a few practices have the accounts payable work being done by a part-time bookkeeper, even a practice owner's spouse. Therefore the guidelines should be modified, as seen fit for your practice

Advantages for Managers

Practice managers will find the evaluation form very useful for their work. First, they can get a better picture of goals related to each of the many tasks in the manager's job. Second, they can use the guidelines for self-evaluation. Third, they can feel comfortable that their physician bosses will use the same criteria in evaluating the manager's performance.

Physician Involvement - Initial Study of Guidelines

Physicians should closely review and study the guidelines. Then, in conjunction with the practice manager, they should modify any of the guidelines for their practice. Once that agreement has been concluded, it would probably be feasible to consider an initial evaluation in three to four months. Subsequently it could be done annually.

Physician Involvement in the Manager's Review

In a group practice, each physician should be provided an evaluation form to review, study and complete. In a group, one physician should be the coordinator of these evaluations. Caution: do not calculate a composite "total score." The purpose of the review is not to provide a report card. Rather it is, first, to recognize those tasks that are "meeting goals" and "better than goals." These merit being acknowledged and commended to the manager. Second, and most important, special attention should be addressed to any tasks "not meeting goals." These need close study. The physician(s) should seek answers to help solve the low-performance tasks. For example:

A. Many managers are also involved in non-managerial tasks (billing, collections, medical assisting, etc.) as well as managing. Are the non-managerial tasks interfering with the manager's performance? If so, can some of the manager's non-managerial work be delegated to someone else? Example: Can payroll be done by a service?

B. Does the manager need to do a better job of planning the work? Perhaps the manager allows too many interruptions from co-workers. Or, is the manager micro-managing employees who are capable of working under less supervision? In a group, one physician should be delegated to conduct the manager's annual performance review.