Strategies for When the Boss Has a New Pet Project

Almost every practice manager at one time or another finds himself or herself suddenly saddled with a new program, system, or other major contract commitment signed by a physician. If you’re lucky, the doctor made a wise choice that makes perfect sense for the practice. But sometimes, you’re not that lucky.

Even in the best-case scenario, you’ll spend a potentially large amount of time playing “catch-up” to understand and accommodate the new gizmo. But in the worst case, you’ll have to go through all those same efforts more than once—trying to find a way to salvage what you can out of an ill-timed or poor purchase decision. At the same time, you could find yourself spending time and money to extricate the practice from a bad deal, while doing your best to avoid blame for the failure.

Pounds and Ounces—Prevention Trumps Cure

It seems to happen most often in solo or single-owner practices. But managers for small and mid-sized group practices tend to deal with it more often than those in practices with 10 or more providers. That’s because physicians in smaller practices tend to be more materially involved in day-to-day management than those in larger organizations that have shifted toward more delegation due to growth in practice size and complexity.

Size matters, but the real driver for this kind of behavior reflects the group’s culture. Less structured leadership and governance contributes to an egalitarian atmosphere in which individual physicians don’t feel accountable to the group. And that can leave more than one “loose cannon” rolling around the corporate ship’s deck.

Administrators can apply a few ounces of prevention to help protect themselves from unwieldy surprise projects.

In a perfect world, your group would have the integrity and honesty to establish some guidelines to prevent individual physicians from obligating the group to any fiscal expenditures over a certain amount. Talk to your legal counsel and accountant to figure out where to set such limits and how to document them in a way that protects the organization. After that, it’s generally up to vendors to perform due diligence to verify if a company’s member, partner, or shareholder has “signing authority.”

Administrators can apply a few ounces of prevention to help protect themselves from unwieldy surprise projects, too. Practice managers often operate with a lot of “gray areas” surrounding the limits of their responsibilities and authority. Carefully structured employment agreements and job descriptions will help clarify the boundaries, and written policies about purchasing and contract negotiations should complement them.

Even the best-written rules won’t substitute for properly functioning governance and management. Often a rogue purchase happens when a doctor feels he or she has to take matters into his or her own hands. Cultivating trust and teamwork requires consistently delivering in the areas of strategic planning, financial management, and operational control that engages every owner-physician.

When It Happens Anyway

Nevertheless, managers inherit unwanted new projects all the time. So what can you do when Dr. Entrepreneur returns from that national society meeting with a signed contract? Clearly, you have to do your best to make it work for the practice. And here are some tips to help you make that happen:

• Get a grip. Schedule a sit-down meeting with the physician who made the acquisition or contractual commitment as soon as possible. Ask him or her to help you understand the products or services involved and what the physician expects from the vendor, from you, and from the purchase. What benefits should accrue to the practice?

• Contact the vendor rep. At the same time, reach out to the vendor and establish your own relationship with the company and the rep who sold to your doctor. Notice any discrepancy between what your doctor says and what the rep says, then discuss those differences with both. In this way, you begin to align expectations—helping to prevent paralyzing disappointment down the road.

• Get up to speed. Tell the vendor rep that you want to know as much as possible about the deal. If you find yourself charged with implementing a major system or piece of equipment, ask for a list of contacts among present users and (if possible) arrange for a site visit. This is the fastest way to learn about the implementation process.

• Report to the physician. Keep the doctor informed about what you’re doing, what you’re learning, and the obstacles or challenges you face. Ask him or her for advice and direction when you’re searching for solutions and making decisions. Keep the doctor in the loop—even if he or she shows signs of losing interest!

• Document the process. Keep good notes and records. Not only will this help everyone remember expectations and instructions, but they can serve as a basis for the policies and procedures you need to have in place to maintain the system or program.

• Track performance. After deployment, keep good records to show any benefits or improvements brought about by the new program or equipment. Even if it’s something as simple as a purchasing agreement, create spreadsheets to compare expenses before and after the deal went into effect.

Notice that these tips focus on the following three principles that can improve your chances of success (and avoid shouldering the blame for less-than-optimum results):

1. Communication—Open communication with the doctor and vendor keeps information flowing.

2. Accountability—Reporting to the doctor at every step preserves his or her sense of control and helps you understand what the doctor wants and expects.

3. Diligence—Even if you don’t really agree with the doctor’s choice, remember your commitment is to him or her. Demonstrate that commitment by throwing yourself into the project and making the best of it.