'Managing Up' a Critical Part of Practice Management

Keep your practice financially fit. Mentor your staff. Ensure compliance with regulatory mandates. It's all there in your job description. But you'll never secure the results you seek if you don't know how to "manage up." A much misunderstood concept, managing up means working with your physician shareholders to deliver the best possible outcome for your practice, yourself, and your boss. "You need to be perceived by the physicians as being their advocate," says Barbara Sack, executive director of the seven-physician practice Midwest Orthopaedics in Shawnee Mission, Kan. "They need to trust that when they want or need something, you are going to do whatever you can to make that happen."

What color is their parachute?

Successful upward management begins with learning who you're working for - their personality type, their preferred style of communication, and how they react under pressure. Some physicians want bullet points, others want details. Some are perfectionists who don't take kindly to loose ends. And others expect you to be self sufficient, leaving them to the practice of medicine. How does that mesh with your professional style?

"It's in your best interest to know these things about yourself and your boss in order to best deliver the management that they expect from you," says David B. Yoho, office manager of the Eye Care Center of Napa Valley in Napa, Calif., who has worked in the industry for 25 years. Similarly, he notes, you should get to know their areas of weakness so you can work around them most effectively. What pushes their buttons? Do they get stressed at the end of the day? Are they uncomfortable communicating by e-mail or text?

"Many physicians are motivated more by fear than by the ability to expand the business, so if your goal is to purchase a new computer system or add an addition to the back of the building you have to paint the worst case scenario and tell them what it could lead to if they don't act," says Yoho. By altering your communication style to suit their needs, he notes, you'll help to cultivate a healthy working relationship and be far better positioned to advocate for your practice - new computers, additional staff, a promotion for your billing clerk.

Not a yes man

That's not to say you should blindly follow their lead, or become a yes man, notes Debra Phairas, president of Practice & Liability Consultants, a practice management firm in San Francisco. Be prepared to counsel your physicians on ways that they can improve their own standing within the practice. "They may need coaching on productivity issues, on running staff into overtime, or not getting charge tickets in on time, which affects the rest of the group," says Phairas. Likewise, doctors who are introverted by nature, or bring Starbucks in for only their medical assistants, may need to be reminded of the benefits of interacting more with the staff, she says. And those who make inappropriate comments to your team should be promptly informed of the potential for legal ramifications. In short, it's your job to save your boss from himself. "No manager should be so worried about their job that they fail to make the right recommendation," says Phairas. "If it's a matter of Medicare fraud, or something the organization could really get in trouble for, you have to step up and communicate the risks."At the same time, she notes, you should never be afraid to lead. "An effective manager is a great sales person," says Phairas. "They are persuasive and confident and they believe in what they're trying to communicate. They have a desire for change."

If you're trying to win approval for a new phone system or a new hire, for example, emphasize the benefit to the practice and arm yourself with information to contest the inevitable objections. "Just say, 'Can I ask you to commit to trying to do this for the practice? I'm here to help every step of the way,'" says Phairas.

Just say no

Sack agrees, noting the practice of managing up sometimes means telling your boss, "no." "Your job is to protect the corporation and situations do come up where you may have to explain why they can't do something they want to do because it could get the practice into trouble," she says. For example, she notes, a partner may wish to reduce her call duties, fire a nurse practitioner, or change her weekly hours despite the other physicians' objections. "They may believe that because they are a partner their preference should take precedence over the group," says Sack. "That is why a good employment contract for each physician is worth its weight in gold." A contract that spells out the legal terms of her partnership, she says, gives you the documentation you need to enforce the will of the group. "They won't be happy about it, but they will respect that you're acting in the best interest of the practice," says Sack.

Just the good news please

There are some bosses who aren't interested in the negatives. They expect you to problem solve on your own. That can be challenging when there's a financial problem to discuss or a human resources situation that must be brought to the shareholders' attention. You need not inundate them with the minutia, but as administrator it's your responsibility to keep your bosses in the loop, for better or worse, says Phairas. In that case, let them know clearly and concisely what's afoot and, more importantly, what you're doing to resolve it.

Establish trust

Effective upstream communication, however, doesn't happen overnight. It takes time. Your honest opinion, competency, and evidence of loyalty to the practice will eventually help to establish a foundation of trust. That, in turn, puts you in a position to help drive both innovation and performance. "You have to understand the personalities of the people you work for, find out what motivates them and shape the way you present information to them," says Yoho. The biggest benefit to managing up, he notes? "You get to stay employed."

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the March 2012 issue of Physicians Practice.