Berning & Affiliates

Leverage Your Strengths

Very interesting recent conversation with a doctor CEO who has had the good fortune to discern the areas that he is very good at and then leverage them. How? He related that through some trial and error and discussions with family and staff he had arrived at a list of his core strengths. For him this included his very warm and friendly personality and when talking with anyone an authenticity that with great frequency translated into a trusting relationship. This particularly helped to build his new patient flow. But his practice skills in the areas of financial management, personnel and regulatory compliance were poor. He for some time has focused on being in the community actively, on charitable boards, on local government panels etc. In his office his accountant and key staff coordinate the financial policies and "run the numbers". He has an outside personnel firm help find staff and administer periodic personnel reviews. He is so pleased and confident of the powerful approach being used that I thought it would be beneficial to share this success story with you! By the way, his "numbers" are impressive.

Overconfident Doctor CEOs

Observing and probing the actions of doctor CEO’s can be instructive as it relates to nailing down abilities that help predict success. One of the most interesting came up again this past week in a consultation. A doctor for the past 4-5 years had been focused on practice building. As most of you know, developing a practice to a pre-designated patient level can involve sequentially tackling facility, equipment, staffing and marketing items with, in many cases, considerable overlap. This doctor was very effective and so her confidence grew with each milestone accomplished. Now, staff and partner doctors report that she is crossing from confident to overbearing. It seems to be a case of only she knows what is best, after all, look what has been accomplished in the past few years. A good discussion raised the need for understanding how to develop a buy-in from the now larger group of doctors and staff, tactics for arriving at joint outcomes drawn from many viewpoints and how to reconcile underlying interests. With a new goal, running what has been built, and having the practice team positive and engaged in the practice the Doctor CEO will continue to be confident but not over confident to the point of overbearing and divisive in the practice

Your Values Rule

One of the most enjoyable books of recent memory is True North by Bill George. I say enjoyable because it is well written and reflects some of my own experience in a nicely developed format. In particular his discussion of becoming an authentic leader reinforces my long held view that values, especially in the health care context, are preeminent for the doctor CEO. Under the stress of daily or larger business related concerns applying and using your values to make decisions and guide the health care organization is critical. Here is a very small part of an interview by Erin White 12/3/07 for the Wall Street Journal with Mr. George. WSJ: What defines an authentic leader, and how do you become one? Mr. George: They lead with their whole selves—their hearts as well as their heads. They don’t get pulled off course by seductions and pressures. Every leader who has failed, that I have seen, has not failed to lead other people, they’ve failed to lead themselves.

Enthusiasm is Magic!

I was recently visiting a variety of practices from Los Angles to San Francisco, and many places in between. In two of the practices it was apparent that there was a fountain of energy powering everyone from staff to patients. It seemed like magic but it was the doctor CEO in both cases! I was reminded at that point of the Bill Gates quote, "What I do best is share my enthusiasm." In the case of the doctors they made the environment friendly, warm and upbeat. They transferred their good feeling to everyone. Talking about my observation and comparing other practices I had seen, one of the doctors said, "It is all about giving and I get it all back double!" Assess yourself doctor CEO, are you enthusiastic or a drag on the practice? From what I witnessed, its far better to be the former!

CEO's Reality Check

In an interesting quote a top CEO, Carl Bass of Autodesk, reflected on his experience as he became CEO of the company. "My IQ jumped 10 points and I became much funnier," as quoted in an insightful Wall Street Journal article, A Different Animal Seeks the No. 1 Post by Phred Dvorak, 10/22/07. Mr. Dvorak wrote, "But the greater deference his employees paid to the intelligence and wit of their new CEO had a downside, too. Mr. Bass says he couldn't be as frank and critical as he had been when chief operating officer. He feared employees would overreact. "When you're CEO, what you're saying is so amplified you have to be very careful," says Mr. Bass. This same experience is one I see in countless practices. The doctor CEO is so often told they are right by staff or not given any real feed back that they begin to believe they are very smart. All attempts at humor are met with laughter. Only when some of the doctors runs into operational or valuation or transition issues is the light shown on sloppy procedures, poor financial management or other areas and then nothing is very funny. Doctor CEO's take heed. Have your practice coach provide at least an annual impartial assessment of your performance. Larger practice CEO's should consider implementing six month reviews. You'll find a lot of benefit in clear assessment and a good strengths and weakness analysis. Check out our Doctor CEO services if you want to gain an understanding of the scope of this type of service.

Discipline

Comparing practices on an on-going basis as we do teaches a great deal. What do we find? One of the most telling aspects we find is the consistency or not of delivering growth and meeting patient expectations. We find that without explicit procedures to reinforce how staff and doctor(s) are to interact with each other and accomplish the core care delivery of the practice, operational performance suffers. Further, if there is not a built in mechanism to check performance and then, when it is off track get it back on, difficulties multiply. I often say that our study of practices teaches that delivering consistent results is the result of the doctor CEO's discipline in stating the path of the practice and then fostering growth toward the desired result(s). In short, it is the discipline of the leader that will repeatedly make one practice more successful on multiple levels than another.

Personal Attention and Feelings

Congratulations, you are the CEO of a growing and dynamic practice. One of the benefits of the larger practice is having personnel to assist you accomplish tasks or implement practice objectives. In a word, you have the luxury to delegate. Warning! Anything that makes staff or patients feel faceless, not personally cared for has the seeds for rude lessons both organizational and marketing. In health care, it is my experience, that the doctor CEO must not only accelerate effective systems and marketing but also must seek to maintain a personal relationship with staff, knowing who they are as individuals and as members of the team. By doing so, turnover is minimized and loyalty is improved. With patients, no matter how big or important the practice, personal attention, quality interaction of the doctor and patient must be preeminent or dentistry and your practice will suffer in a manner similar to the larger group physician practices.

Is Your Partner Giving You Heartburn?

It happens. There is no question that periodically, and sometimes chronically, a partner rubs you wrong. Sometimes it is because issues that should have been discussed at the start of the relationship never were and now keep coming up. Other times it is for the most diverse set of temporary or passing reasons. For whatever reason if you, in the words of one of my clients, feel like "leaving the party", but the practice and your interests and income are satisfactory - resist! It is far easier to work to resolve matters or issues than leave and work to start over or to push someone else out. Using trained facilitators or mediators is a proven way to get issues out and work to resolution. Don't keep dealing with heartburn when you can reduce your stress and move beyond the problem(s) with a focused mediation.

"From Nordstrom to Wal Mart"

A long established doctor recently sold his practice to an energetic younger practitioner. The seller had an established reputation based on the care provided, personalized attention to patients and a business format provided by the excellent front desk staff. It is approximately two months since the practice transfer. Despite the seller providing suggestions, a guide to policies and procedures that have helped the success of the practice over the years as well as and daily experienced based perspectives to the purchaser, the practice is in upheaval. The seller received a call from a long time employee at home recently that was shared with me. The employee related that almost all systems are being changed, the schedule compacted and many other changes. The employee noted that one adult patient stated "the practice is being changed from a personal Nordstrom type caring environment to a more performance based Wal Mart type" environment. Every doctor has a right to develop and present their practice as they see fit. In CEO parlance this can be seen as a part of branding and also of course marketing. In the health care context it also relates to the subtle indicators of more or less doctor attention and care. One of the things this purchaser bought was the goodwill of the patients, a portion of which as the expectation that patients would return for care as needed. But care can be secured in many places today and big changes are often not welcome by patients. My view is that it is too drastic for this new owner and CEO to switch the practice to a very different brand so soon after the transaction and he will pay a price in lost patients and production.

Should A CEO Doctor Play Jokes On Staff?

One of my clients asked this question in light of the protracted and costly case, Woo vs. Fireman's Fund. The case was recently decided. Dr. Woo, an oral surgeon, decided to temporarily place in an assistant of his, Tina Alberts, fake boar tusks and then photograph her while she was under anesthesia in his chair. She brought suit against Dr. Woo, based on malpractice and invasion of privacy. Dr. Woo wanted his malpractice carrier, Fireman's Fund, to defend. They declined indicating that they had no duty to do so, because the dentist's conduct was outside the normal scope of dental practice. A a state appellate court and four supreme court judges agreed. But, on July 27th a majority of the Supreme Court of Washington sitting En Banc decided in Dr. Woo's favor. The Court reasoned that because Dr. Woo's conduct was "conceivably" within the realm of dental care, the insurer had a duty and should have covered him under his professional liability policy. The Court reinstated a $750,000 jury award to Dr. Woo, which also included a $250,000 settlement he paid the assistant. My response to my client was that, "No CEO in a health care setting should play a practical joke on any person, patient or staff, when that person is under anesthesia." Further, in today's more circumspect practice environments with staff of different ethnic backgrounds, ages and perspectives on appropriate vs. inappropriate behavior, great care should be taken before any joke should be played on staff. See Robert C. Woo, DDS, and Anne M. Woo vs. Fireman's Fund Insurance, NO. 77684-9, July 26, 2007. Read also David Ammons, Associated Press story July 27, 2007, 10:39AM