How management by committee can help your growing practice
How management by committee can help your growing practice
When too many cooks spoil the broth
Ten years ago, Orlando (FL) Orthopedics was a six-physician practice that managed itself through bimonthly strategy meetings. "But as we grew now we have 10 physicians and are adding four this month we found that group decision making was getting more and more difficult," says Page Sturgill, director of marketing for the practice. "There were so many questions the physicians had that couldn’t be answered by them they needed non-medical staff involvement."
Fortunately, the physicians had a policy of empowering staff and were not averse to giving them authority to make decisions or involvement in the decision-making process. The result was a committee structure which has helped smooth the path of growth, says Sturgill.
Many practices find that once they get beyond a certain size six physicians seems to be the breaking point they are unable to manage themselves without breaking down the decision-making process, says Bette Waddington, CMPE, a consultant with MGMA Management Consultants in Englewood, CO. "If you have six physicians, there seems to be a complexity that exists which demands a formal committee structure," she says. "Smaller practices can get by without one, or by using ad hoc committees that are not ongoing."
There is another impetus for practices to form committees, says Waddington, and that is the increasing need for physicians to be involved in the business aspect of their practices.
"Doctors need to get involved and need to feel involved, and committees offer a way to utilize their time effectively," she says. "They can be involved in decisions but split the workload. They also don’t have to spend all their time running the practice but can maintain the medical aspect of their practice and have a hand in the business."
Start with the basics
The three basic committees that Waddington says a practice should start with are as follows:
- finance budgets, investment, equipment and supply purchases, and forecasting;
- professional affairs compensation and recruitment;
- operations personnel, accounts receivable and payable, and patient satisfaction.
"As you grow, you can split out these topics into their own committees," Waddington says.
At Orlando Orthopedics, Sturgill says there are currently seven committees:
- accounts receivable/accounting;
- branches (the practice has four locations);
- marketing;
- outcomes;
- utilization review and quality assurance;
- personnel and scheduling;
- physician recruitment.
Sturgill warns, however, that when you plan your committees, keep it simple. "Look at the problems your practice has," she advises. "Use your patient surveys as a guide; start there. You don’t need seven committees to start with. Just follow the issues that are important to your practice."
For her practice, the seven-committee structure works well. "We have bimonthly board meetings and bimonthly committee meetings. Those committees are then broken into subcommittees when needs arise." For example, if there is a need for new equipment, the branches committee can appoint staff to get involved in the project. Often, they pull in those not involved in the committees. "That helps us to use expertise that makes decisions come faster."
Other practices find that too many committees means too many physicians are not practicing medicine. For them, a committee structure modeled on large corporations might be more appropriate. (For more on executive committee structure, see related story, p. 99.)
Sturgill says her physicians initially chose their own committees. "Each physician has a gift, and they are all involved in a committee that uses that gift," she explains. But new physicians have to prove themselves. After two years, then they can "make a pitch to the owners" about what committee they want to serve on and what they could contribute to it.
Waddington agrees that the desires of the doctors will help determine what committees they work with.
Money is always an incentive
Sometimes you have to convince physicians to participate, although Waddington says with falling reimbursements and squeezed incomes, physicians are more willing than ever to become involved in making their practices efficient and successful. "They may not be interested in being on a finance committee until revenue squeezes take a bite out of their income," she says. "Then, they will suddenly care about budgeting."
You may also have to provide some financial incentive for participation. Waddington says smaller practices she works with offer $2,000 to $5,000 administrative stipends while others may get more. "If they have to see fewer patients in order to contribute, then they need some incentive for being involved," she says, noting that even if meetings are held at night or before the practice opens in the morning, physicians’ time and energy will still be occupied by the administrative work.
There is occasionally the opposite problem of having physicians who want a finger in every pie. Sturgill says one physician wanted to be on every committee. "It was really gumming things up," she recalls.
The solution was to make him responsible for one committee but limit his participation in other meetings to attendance only without voting privileges. "He feels involved," says Sturgill, "but it doesn’t undermine the authority of the other physicians."
Practical benefits can ensue
Benefits should go beyond getting physician involvement and buy-in for decision making. Sturgill says you can expect to see some concrete results from implementing a committee structure in your practice. "We had a situation with our utilization review committee that led to a study of wait times for patients," she says. "After looking at the numbers, we decided to invest in a computer system that allowed us to see how long each patient waited in the lobby, how long they spent with the physician, and how long it took before the patient left the facility," she says.
"We could even break this down by type of patient. That information was taken, talked about, and physician wait times were compared. It has led to some real changes in behavior and a decline in waiting times for patients." (To see how other practices deal with patient wait time, see Physician’s Marketing & Management, June 1997, p. 72.)
That, in turn, translates into better patient satisfaction surveys and improved morale among staff who deal with far fewer complaints, Sturgill says. There is also a better collaboration between medical and support staff. Employees who may have been wary of expressing their opinions to physicians are more likely to speak up, she explains. Doctors, as well, are more willing to listen to non-medical staff.
"We have much better rapport since we started with the committees," Sturgill concludes.
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