In honor of Mother’s Day and Father’s Day, I thought we could address that sometimes awkward, frequently familial, management triangle that often occurs in a physician practice. You know the one, the doctor works closely with assistant/nurse(s) so there is a management relationship between the two of them.  All the while, there is also a management relationship between the office/practice manager and the same employee(s). 

Big companies might pay expensive consultants to dub this “Matrix Management.” Matrix management is a technique of managing an organization (or, more likely, parts of an organization) through various dual-reporting relationships rather than the more traditional linear management structure. Different from most other managerial structures, which arrange employees and supervisors by function or department, matrix management is a dual authority system.

Larger organizations have experimented with matrix management, with varying degrees of success, for many years now, often in an effort to create and benefit from cross-functional strategies in highly complex projects.  The term “matrix” management was assigned because in larger organizations the diagram depicting the many and varied managerial relationships accumulates to a rectangle rather than the triangle that a standard organizational chart becomes.  In the case of physician practices each matrix management relationship is best shown with the inverted triangle, like this:

In physician practices, matrix management is implicit.  The reality and impact of matrix management is most frequently present in the medical assistant or nurse role in the practice.  Some practices also have schedulers, billers and other staff who are in a matrix management situation.  That is, there is a manager or supervisor who oversees the entire practice. 

The physician expects and depends upon that manager to achieve and maintain smooth operations.  At the same time, the physician works very closely with one or more employees and depends and expects that they are going to make each patient encounter go smoothly.  The physician is responsible for the patient care for each and every individual from visit to visit AND is the overall practice leader.

Read the following example. Surely you have had a similar moment in your practice:

You’ve had a smooth, productive clinic.  Collections are up.  Your partners seem content.  Your clinical assistant has been spot-on anticipating your needs.  Just as you are savoring your good fortune, your clinical assistant says, “Can I talk with you for a minute?”  (Uh oh.) 

Aside, she asks to take off the same week that you will be away on vacation.  What do you say?

a)     “Oh is that all you want?  Phew, I thought you were going to quit.  Yeah, sure take the week.”

b)     “No way!”

c)      “Maybe.  I’ll think about it.”

d)     “Let’s talk with our Practice Manager and decide what will work best.”

Does this situation remind you of another one, say a bit closer to home (literally)?  Think about parenting.  Even if you do not have children, you were once yourself a kid.  So you know that if you asked mom and got a “no” (or did not bother to ask mom because you knew she would say “no”) and went to dad to get the “yes” you were seeking, ultimately there was a problem – either for you or between them.  Parenting might well be the oldest matrix management relationship.

Let’s explore what made mom and dad’s matrix management successful in order to improve our approach in the practice.

1.     Acknowledge the matrix management situation.  Married or divorced, moms and dads know there is someone else with managerial responsibilities and input in the picture.  The manager should not try to manage every aspect of the work and employment, nor should the physician.  Recognize there is dual authority.  Seemingly small permission requests/grants can turn into big issues in a matrix management situation especially if repeated (knowingly or unknowingly).  Be aware of your responsibilities in the matrix management relationship.  Also, as illustrative as the familial analogy is, the employee is by no means a passive child in all of this.  The employee needs to recognize the situation as well and actively participate in a successful matrix management relationship.

2.     Distinguish the respective managerial purviews.  The physician is in the best position to manage the clinical aspects of performance and interaction with patients, while the manager or supervisor is better suited to manage employment aspects such as attendance, interaction with other employees and overall operational flow.  There are many areas where the managerial purviews may overlap.  For instance, implementing a new clinical process, such as an element of EMR, will involve both managerial purviews.  All three individuals will need to actively work together to ensure a smooth transition while maintaining quality care, service orientation, operational efficiency and overall esprit de corps. 

3.     Co-manage and maintain a united front. There is a correct answer to the multiple-choice scenario described above, it is d) “Let’s talk with our Practice Manager and decide what will work best.”  Variations of this correct response include: “Since attendance is overseen by our manager, please check with her/him.”  Or, “How about if you check with our manager on that, you may be needed to help cover while I am away.”  Best not to give a “yes” or “no” and then have to change the answer.  There is a reason our parents said “We’ll see…” it was non-committal, they could check with each other first rather than give an answer and be overridden or usurped by the other.  And while the physician and the manager do not have to agree 100 percent on every decision that is made, it is best if they remain united and consider additional information that may change a decision together.  “I was going to let you do it, but she said ‘no,’” is not effective co-management.  The co-management alternative is to focus on the reasons for the decision rather than assign blame or origin for those reasons.

4.     Communicate.  As with most of the more challenging managerial situations success is dependent on clear, frequent, polite communication and this one is no exception.  If the manager needs to discuss a conduct issue with the employee, it is probably best to chat with the physician first just so that he/she can be aware and supportive of the situation.  With e-mail and texting available, we can easily give each other a heads up when issues arise.  A text like, “Nancy might ask 4 Monday off, let’s discuss b4 u say yes,” will serve the matrix management challenge well.

Jennifer O’Brien has been in practice management for 24 years and is currently the executive director at Arkansas Specialty Orthopaedics, in Little Rock where fellowship trained orthopaedic surgeons help Arkansas’ physicians help their patients.   She is not a parent but she was a kid once upon a time.  Email her at jobrien@arspecialty.com or visit us at www.arspecialty.com .

Tags:

Bookmark:

Facebook

Technorati

Newsvine

Google

Related: