Leadership

STAY FLAT AND STAY FIT: How to create a responsive leadership team

By Suzanne D. Bruno, COE, MBA

Fueled by regulatory changes and economic realities, ophthalmology practices are continuing the trend toward consolidation that has occurred for several decades. As practices grow into large multi-site organizations that may employ hundreds of ophthalmic professionals, several leadership-focused questions naturally arise:

■ How should the leadership structure in growing practices evolve?

■ Is the current leadership structure effective?

■ What type of leadership structure works best for practices that desire continued growth?

While the answers to these questions often depend on the individual practice, one thing is certain: To gain and maintain a competitive advantage, growing ophthalmology practices will need to maintain speed and flexibility in decision making. In other words, practices should consider an organizational structure that is as “flat” as possible, avoiding the hierarchy of decision makers found in traditionally tiered organizations.

This article will discuss the major benefits of a flat structure, including those that impact costs and patient care, and provide tips on how your practice can develop an organization successful in meeting the dynamic demands of today’s healthcare environment.

Left to right: Suzanne D. Bruno, MBA, COE, Administrator; Manny Afifi, MBA, Director of Marketing & IT; and Kim Quam, Director of Patient Services.

The Traditional Tiered Hierarchy

In many practices, the management structures tend to follow the template of other larger organizations. (See “Flat Vs. Hierarchical: Understanding the Organizational Structure” on page 14.) Check classified advertisements and you will often find employment opportunities for practices looking to fill positions for CEOs, CFOs, etc. In hiring for these positions, many ophthalmology practices are creating a hierarchical structure. There are advantages to this structure. For example, defined levels of leadership and responsibility are usually easy to understand, even by those outside the organizations.

However, the hierarchical approach also presents challenges. Those organizations—led by a chief executive officer at the top, followed by a chief operating officer and chief financial officer, followed by department managers and project leaders—may face many layers of processes to flow through when making decisions. When waiting for the approval of several levels of management, often it can take the practice weeks or even months (what seems like forever) to approve and implement a new initiative. This protracted time in decision-making can have significant financial consequences if the organization misses windows of opportunity, or does not react quickly enough to a competitive threat.

Suzanne D. Bruno, MBA, COE, Administrator; Howard J. Gross, M.D., Physician & Founding Partner (standing); and Matthew K. Perez, M.D., Ph.D. , Physician & Partner.

Consider the steps that may occur when a hierarchical ophthalmology organization weighs the benefits of acquiring new equipment that has come onto the market with a time-limited, discounted introductory price. A project manager might be assigned the task of gathering information about the equipment and providing it to a manager whose job is to evaluate its reimbursement level and return on investment. This manager passes off the data to the CFO who researches financing options for the equipment, while the COO projects changes to the practice workflow as a result of this information.

These officers prepare a report for the CEO who then presents it at the next monthly or quarterly shareholder meeting where the owners vote yes or no, or worse, “table it” until the next meeting. By the time a decision has been made in this scenario, the offer of a low introductory price may have expired, or worse, the practice’s local competitor may have already purchased the equipment and begun to advertise the services of this new “latest and greatest” gizmo.

If you doubt that this can happen in ophthalmology, look back to when LASIK first came to market. Too many practices were slow or failed to react appropriately causing them to lose significant market share to corporate vendors. Or consider the introduction of optical coherence tomography (OCT), which enjoyed high reimbursement just long enough for the early purchasers to achieve a speedier return on investment. Could this same scenario be developing around femtosecond technology?

Creating a Flexible Organization

The good news is that practices can create a strong leadership structure that is both agile and flexible enough to respond quickly to a femtosecond laser buying decision, or any of the other issues facing ophthalmology practices today. Here’s how:

Step 1: Take a hard look at the practice’s current management structure and create departments and department leaders. Most ophthalmology practices have fairly clear work segments—receptionists, technicians, billers, possibly opticians and surgery center staff as well. The specificity of duties within each of these areas naturally supports the creation of departments. Each of these departments requires a manager or leader. Even if the department consists of only two or three people, someone must still be charged with responsibility for smooth operations in that area.

Determining the right person to lead each department is often easier than it seems. Generally, a reliable, dedicated person steps up to the plate in times of flux. Usually, co-workers gravitate to this person for answers, because even if the answer is not readily available, this person persists until a solution is found. This person is perfect for the department manager position. He/she usually looks to move up in the organization and gain more responsibility. If you provide ongoing leadership training for these managers, they will bring an energy to running their departments that will help create new ideas and support smoother running processes.

Step 2: Find a practice manager who is compatible with the ophthalmologist(s). The title of this position (manager, administrator, executive director, etc.) is not as important as the job description. This person is primarily the liaison between the physician owners and the department managers. Their primary role is to implement the strategies that will realize the owner’s vision for the practice by supporting the department managers. While experience, talent, and education are important elements of this position, a personality match between the ophthalmologists who lead the practice and the administrator is critical. For example, a practice with an empathetic visionary ophthalmologist at the helm, a doctor who seeks fresh ideas and constantly looks for improvements, needs an administrator who can quickly adapt to change. Too many practice managers fail in their role because their personality is vastly different from the owner(s).

Maintaining Leadership Amidst Growth

Once the core management team is in place, a growing practice must continue to watch its management structure. As the practice grows and establishes a stronger position in the market, it must add staff to adequately care for the increased patient volume. What happens when that growth reaches a point where there are too many people in the department for one person to manage? In business this concept is often referred to as “scope of control.” Theorists postulate that 1 person can personally manage no more than 7 workers effectively. In a mid-size or large ophthalmology practice, there could easily be 25 technicians. How will one department manager effectively manage so many workers?

While the prospects of managing a large group may appear daunting, resist the urge to add another layer of management by either creating sub-departments within departments or by splitting departments into smaller fragments. Remember, the goal is to keep the hierarchy as flat as possible to maintain flexibility and speed in decision making. Return to the original plan of identifying the reliable and dedicated individuals within each department who consistently step up to the plate. Encourage the existing department managers to delegate responsibility for routine managerial activities to these new managers. For example:

■ As the technical manager gains increasing responsibility, he or she might offload the supervision of equipment repair to a tech who has shown some technical or mechanical aptitude.

■ Responding to an increased workload due to growing patient volume, the billing manager delegates the organizational aspect of insurance contract renewals to a staff biller.

■ If a practice needs to evaluate a new piece of equipment, the technicians who will be operating the equipment could be asked by their manager to research and make suggestions on which piece of equipment would work best for the organization.

In these examples, the solutions allow the practice to foster the growth of leadership with the general staff as well as keeping the hierarchy flat.

Top row, left to right: Dr. Perez; Erik Ziegler, MBA, Optical Manager; Ms. Bruno; Track Kirk, RN, Director of Nursing; Gloria M. Barone, Director of Technical Services. Seated from left: Ms. Afifi, Dr. Gross and Ms. Quam.

Additional Benefits

Having a flatter management structure has more benefits to an ophthalmology practice than speed and flexibility. It also helps to hold the line on administrative costs—layers of management are expensive. And it seems counterintuitive, especially in cases where the management structure may slow down the performance of a practice to spend more money on administration only to slow down growth and development. In the face of economic pressures, a larger management team can make it more difficult to increase revenues.

However, perhaps the most important reason to develop and maintain a lean leadership profile is that it allows the physicians and management team to remain close to the pulse of the practice and the single most important aspect of the practice—the patients. Isn’t the goal of every ophthalmology practice, indeed every medical practice, to provide for the needs of the patients in a way that demonstrates excellence? If the practice adds more layers of management, the physicians and managers may become further removed from the patients’ wants and needs. It’s a situation we can all avoid. OP

Suzanne D. Bruno, MBA, COE is Administrator of Horizon Eye Care in Margate, NJ. She has been involved in health care management for more than 20 years authoring several articles on the subject.