Leadership in a Medical Practice What to look for when hiring an executive

by Sherry L. Migliore, MPA, FACHE Director of consulting, PMSCO Healthcare

A strong management candidate for a medical group executive position is not always easy to find. While there is no “perfect candidate,” the attributes to look for when hiring an executive to administer a medical practice are summarized below.

Leadership
Most important, an administrator must be a good leader of both staff and physicians. He must be able to gain the respect of both groups and should have a demonstrated track record in doing so in other organizations.

In a medical practice, leadership involves providing guidance to the physicians in defining a clear vision and strategic plan for the organization. The administrator then must be able to communicate the vision and strategy to the practice employees and obtain their buy-in.

Being a leader also means being a role model for both staff and physicians—the administrator must be “caring” yet “professional.” Many times, administrators find they need to help physicians relate more effectively to each other and to their staff.

Communication
A leader must be a good communicator, able to develop and maintain a strong communication structure—something often missing in medical practices. This includes establishing a decision-making process among the physicians that provides for implementation and follow-up on a timely basis. Depending on the issue, implementation may occur among the physicians or at the staff level. In either case, the administrator must facilitate communication between the physicians and the staff. A leader must maintain confidentiality with the physicians and realize that some issues should not be shared with the staff.

Strategic Thinking
An administrator must be able to take the organization beyond its day-to-day, operational, “fire-fighting” focus. He must guide the practice through a process that is oriented toward the future—where is the practice going and how is it going to get there? A strategic vision and plan provide a map for the organization by providing a connection between the decisions employees make every day in their work and the direction the practice is heading.

Change Management
Developing a vision and plan for the practice often involves making changes within the organization. It is the administrator’s role to manage these changes. This can be challenging because most people resist change.

This is particularly a concern when physicians hire an executive-level administrator for their practice for the first time. The physicians often do not understand the impact this change will bring to the practice. Employees often resist the new administrator because they have become accustomed to going directly to the physicians for resolution of their issues. If the practice has midlevel managers or other professionals, they also may be resentful of a new “authority figure.”

All of this poses a challenge to an administrator, who must be sensitive to the issues and handle them with finesse. It is important that the physicians not undermine the administrator by allowing employees to circumvent the administrator. This defeats the goal of the physicians becoming less involved in the practice’s daily activities and renders the administrator ineffective.

Team Building
An administrator must be able to build and manage a team—a team comprised of the practice’s employees as well as the physicians. In many practices, physicians do not function well as a team because they are independent thinkers and decision-makers, both by nature and by virtue of their medical training. Physicians may be in the habit of making organizational decisions without consulting each other, creating chaos within the organization.

The administrator must help physicians and staff work together to solve problems. Team building often involves conflict resolution and, ultimately, finding alternatives everyone can live with. When conflict arises, the administrator must look for middle ground by focusing on points of agreement.

Negotiation
Negotiations occur every day in a medical practice. Administrators must be able to negotiate effectively with payors, patients, vendors, landlords, referring physicians, hospitals, regulatory agencies, and the community in general. The complexity of today’s healthcare market requires the ability to work with a variety of stakeholders to accomplish the practice’s goals. An administrator who understands the importance of creating “win-win” situations is a true asset for the practice.

“Firm but Fair”
A good administrator handles employee situations with both fairness and firmness. He must be able to listen to all sides of an issue and make a decision based on what is best for the organization as a whole.

When a medical practice has no authority figure in the organization, there often is a temptation to make decisions on the basis of how they impact one person in the practice. However, what may appear to be fair for one employee may not be fair to others or appropriate for the organization overall. The administrator must balance the needs of individuals against the needs of the organization and make his decisions accordingly.

Technical Skills
An administrator should possess technical skills, including:
• Financial management and analysis—budgeting, forecasting, cash flow, debt structuring, accounts receivable, cash flow, capital expenditures, reimbursement, fee setting, accounts payable
• Personnel management—developing and implementing policies and procedures, including position descriptions, organizational structure, performance evaluations, and knowledge of legal issues impacting human resource administration
• Computer skills—proficiency in the use of computer software such as Word and Excel, and knowledge of practice computer systems and generation of reports to use in management of the practice

Balance of Professional and Personal Life
Although physicians may be tempted to hire an executive who will spend 60 hours at the practice, this generally is not a good sign. Physicians should look for administrators who have a sense of balance in their lives, who enjoy spending time with family and friends, and who have outside interests and hobbies. Research shows that the most effective executives are those who balance their work and personal lives.

Spending so much time at work often is a sign of poor organizational and delegation skills. This may cause resentment by sending a message to other employees that they also are expected to spend all their time at work.

In conclusion, finding a medical practice executive who has to know “a lot about a lot” can be a time-consuming and complex process, particularly for newly created positions. A practice should take time with the process and ensure that the candidate has the “right stuff” to lead the organization into the future.

About the author: Sherry Migliore is director of consulting at PMSCO Healthcare Consulting, a subsidiary of the Pennsylvania Medical Society. She can be contacted at smigliore@consultpmsco.com or www.consultpmsco.com.