Mentoring: A Key Way to Improve Medical Practice Performance

Managing a busy practice is harder than you think and the skill set needed to be successful is growing as the business of healthcare gets more complex. Whether part of a hospital-owned network or a practice owned by the physicians, managers have to balance the wishes of the physicians with the needs of the patients and the skills of the staff.

I have been assisting practices improve their operational and financial performance for more than 20 years and during that time have learned two things: 1.) every practice regardless of size and ownership can improve; and 2.) regardless of the issues identified, the blame falls to the manager. Sometimes that blame results in practices and managers parting ways.

Hospitals and physicians invest more than they realize in the development of their practice management professionals. This may not take the form of formal classes and seminars but the months and years it takes for on-the-job skills development certainly equates to a sizeable investment through lost opportunities and skills development.

If we accept that operations can improve, then how do you achieve that improvement without the loss of key staff? Use part of the savings that result from operational improvements and invest them in the further development and refinement of key practice leadership. Many managers were elevated to their current positions because of their loyalty and longevity or, in the case of hospital practices, the academic credentials listed on the position description. Leverage that experience and knowledge by identifying gaps in the manager's capabilities and using more senior managers or outside consultants to enhance those weaknesses.

I've coached folks from a two-physician practice and a 600-physician network. The approach is the same. Create a non-threatening environment where mentor and mentee can have a frank discussion of identified gaps and then identify a curriculum to fill those gaps. One thing my experience has shown is that the problem is not always the manager. Physicians have been known to make unreasonable demands, delegate responsibility but not authority, or not invest in the technology needed to reduce operating costs and enhance owner incomes. Both manager and physicians (or hospital leadership) need to approach the assessment process as an opportunity and not a tool to assign blame.

There are two questions that need to be answered before deciding that coaching/mentoring is something that will help your practice:

• What is the goal of the mentoring process?; and, perhaps more importantly,
• Is the practice leadership committed to allowing the process to work?

Implementing operational improvements often requires cultural change, therefore, the commitment to the change process is critical. Identification of the goal of the mentoring process follows three steps:

• Operational assessment
Unless you know where you are going you can't know when you get there. It is important to get an unbiased overview of practice operations and identify areas of opportunity. It is equally important to utilize someone that has done this in the past. Just because someone has managed a medical practice doesn't mean he has the skill set to produce the result you need. While this step requires a financial commitment, the potential for improvement should return this investment in a short timeframe. Ask your consultant for a guarantee. If they balk at that they don't have the depth of experience that you need or else they would quickly agree.

• Goal identification
Using the assessment as a guide, identify those recommendations that are financially significant or which will enhance the patient's experience. Trying to achieve every recommendation will risk loss of focus. Pick those things that will have the greatest return for the effort and celebrate those achievements.

• Skills development
Once you have a list of functional improvement targets, asses the capabilities of the current practice leadership (physician as well as management) to accomplish the task. Any skills that are missing are the focus of the mentoring process. It is always possible that the best attempts at the transfer of needed knowledge and skills will not be successful. Difficult decisions must then be made.

Few people like change and it is likely that staff will view this process as threatening. The fact that the organization has chosen to coach rather than replace will go a long way to reducing the fear factor and build staff loyalty and commitment. Consider adopting this process today, you really have nothing to lose.