Key Factors to Improve Medical Practice Organizational Structure

Key Factors to Improve Medical Practice Organizational Structure

The U.S. Department of Health & Human Services reported, “On March 31, 2015 about 10.2 million Americans had paid their premiums and had active coverage through the Health Insurance Marketplace. Millions of which had previously been uninsured.”

With the Affordable Care Act has come what many believe to be a historical opportunity for change and improvement in the healthcare industry. However, along with opportunity has come ambiguity and confusion. Navigating new regulations and deadlines leave little room for error, making clear and robust organizational structure essential to any medical practice’s success.

In order to establish whether a practice has an optimal organizational structure, leaders should consider these key factors:

    • Does the practice have a chain of command clearly outlined within its structure? And, is the chain of command appropriate for the practice? Clerical staff typically report to managers and supervisors, answer to physicians and nurses, and take orders from directors and owners; often causing confusion and limiting productivity. While linear operations within a medical practice have become more challenging to maintain, a conventional chain of command is not impossible, and effectively implementing such a system will give each employee, regardless of their position, the opportunity to focus more clearly on their job description and responsibilities. Outlining a strict reporting protocol will enable staff members to resolve issues quickly, provide timely and informed updates, and ensure proper communication.
    • Do providers follow the provider / management / staff chain-of-command? And, do they have conduct provider meetings? The hierarchy of the practice has to be firm and best practices have to be established at every level in order for the practice to operate functionally. When the providers themselves are not a united front, the practice can seem disjointed and unorganized. The leaders have to demonstrate team-work at the top to ensure team-work down to the bottom.
    • Does your practice conduct full staff meetings? And, do providers attend the staff meetings? Overbooked physicians, physician assistants, and nurse practitioners may find staff meetings a nuisance, and have little patience for issues they believe are unrelated to their medical career. However, their presence is often a fundamental aspect of keeping the chain of command in tact, and employee morale high. Keep the meetings organized, timely, and positive in order to maintain staff engagement and provider focus. Allow for clerical and clinical staff to offer ideas and input with specific and well thought out questions, while avoiding open-ended, loaded questions. By setting all members of the staff up with an opportunity to provide constructive criticism but driving the meeting in a progressive direction, the staff will come away feeling positive, valued, and empowered.
    • Does the practice have management meetings? And, do managers meet with providers? Managers should collaborate and develop strategies to keep the lines of provider / manager communication open without causing additional provider workload. Different physicians have different preferred methods of communication, and when these preferences are established early on, leaders can work more effectively as a team.
    • Do providers have a good working relationship with the clinical staff? The clinical staff of a medical practice are crucial to its functionality and success, and where they fall in the organizational structure of the practice can sometimes be unclear. Because the spectrum of education and qualification levels can be so broad among the clinical staff, hierarchies often develop within the hierarchy. To prevent confusion, or employee rivalry, establish levels, titles, and frequent performance reviews so that everyone is clear and working together.
    • Do providers have a good working relationship with the provider extenders? Do providers have a good working relationship with upper management? The provider extenders are one of the most vital tools in a medical practice’s toolbox, and play a key role in keeping the provider’s workload manageable. A great working relationship between providers and provider extenders will help keep the practice feeling balanced.
    • Does the practice have a way to monitor their providers and provider extenders by productivity? And, are the productivity reports over-viewed and discussed by the owners and all providers? According to the Texas Medical Association, “Many practices use productivity as a basis for compensation and bonuses, and often find that monitoring physician productivity can be a useful element in tracking a practice’s financial health.” The association also details how RVUs (relative value units) are an effective way to monitor and quantify a physician’s productivity level. Each RVU has three components: physician work, practice expense, and medical liability. Benchmarking is another way to track and articulate productivity. By comparing your practice to other practices, and physicians, managers can see how well the practice is performing within the industry, and providers a clear perspective . Collecting information, and monitoring productivity are only beneficial when the data is reviewed, discussed, and analyzed. Owners and providers should be open about any employee monitoring, give each other full understanding of the methods being utilized, and value these tracking practices but maintain that they can not always provide a comprehensive view.
    • Does the practice exhibit proper segregation of duties? According to the Finance Department at Yale University, “Segregation of duties is critical to effective internal control; it reduces the risk of both erroneous and inappropriate actions.” A certain level of respect is established when professionals work together and allow one another to do their job, and when jobs are delegated appropriately. A provider shouldn’t expect a provider extender to do a task he/she is not certified or qualified to perform, while a physician need not being doing the work a scribe, technician or medical assistant can do.

Without established best practices, and a clearly defined structure employees, even managers, are more prone to costly mistakes, low productivity, misdirection, and low employee morale. Physicians and medical practices are facing tighter and more complicated regulations, handling more challenging insurance claims, and compensating for higher operating costs every year. Please contact us for any additional information on how to improve your practice’s organizational structure, while achieving optimal financial and operational efficiency.