Enhanced practice management through people leadership
Developed by Avant with the support of the Australian Association of Practice Management (AAPM), this paper aims to provoke discussion and practical solutions on evolving leadership within practice management, particularly the critical areas of people and culture.
This paper aims to specifically address the shift of the role from one of transaction with a primary focus on administrative tasks, to a transformational role – one that not only seeks to ensure the practice is effectively managed but leads the team to more effective solutions to problems.
Why is this important? People leadership as an essential part of practice management can promote a number of practical benefits, including:
- Enhanced two-way communication within the practice
- Clarity around practice goals, vision, mission and values
- Improved human resource management including reduced employee turnover, and increased motivation and confidence
- Development of innovative, customised and timely solutions to human resource management issues
- Staff-led innovation
- Better patient care
For some practice managers people leadership principles already form part of their role. For others, this may be an introduction to the benefits of applying the concepts of people leadership to practicsce management.
No matter where a practice or practice manager may be in terms of this concept, the aim is to highlight the ongoing benefits of adapting the principles of people leadership to any healthcare facility.
This is not aimed to be a manual, rather an instrument to provoke discussion within practices, and within the wider industry, to develop custom solutions for each practice that benefit employees, and ultimately, patients. It is intended as a resource for managers to
meet the vision and values of their practice and achieve successful business models. Included are some of the challenges and practical ways in which leadership principles can be implemented through case studies and examples.
Like any industry, the health sector doesn’t operate in a vacuum.
Changes in technology, legislation and customer expectation continue to present challenges and opportunities to adjust current approaches to practice management.
Industry-specific changes such as recent Medicare reforms and the introduction of My Health Record have created the need to update policies and procedures and develop new strategies to manage change.
Tighter margins further contribute to pressures on time and resources of practice managers, while technological risks such as social media continue to change expectation, turnaround and communication between patients and practices.
Furthermore, in relation to human resources and industrial relations, ongoing changes to the Fair Work Act in particular have ramifications for the way we manage and lead teams of people and the legal obligations that we are required to be aware of when making management and operational decisions. In an era of increased employee turnover, there is an equally increased focus on employee engagement and satisfaction. The Australian Human Resources Institute (AHRI) has found an estimated 18%* employee turnover amongst surveyed employers across multiple industries (AHRI 2018). The health sector is not immune to the costs and resource challenges associated with employee turnover.
At a practice level, there has been a shift in recent times towards employment of practice managers from a managerial background to meet the enhanced human resources, strategic and operational requirements of the role. This change in experience and skill set of practice managers moving into the sector is evolving the role from a transactional role (focused on administrative tasks, billing and reception duties) to a transformational role with a greater focus on strategy, innovation and workplace culture.
Whether driven by the need to meet legislative requirements, new and emerging trends or handling disruption, it has never been more imperative for practice principals and managers to scope out their environment to understand current and future challenges associated with the running of their practice.
What is people leadership?
People leadership is about applying innovation and strategic vision to operations and management in order to positively influence the lives of individuals within the practice and the community in which it operates.
Practice managers currently handle issues pertaining to industrial relations, human resources and workplace health and safety in the workplace. However, these issues often have a day-to-day and
‘getting it done’ focus to meet practice requirements and regulation. Often these roles can be that of a firefighter – extinguishing small fires and handling small, urgent tasks. For many practice managers, the role can be one of feeling the need to be across every detail and handling any issue that crops up. This can be exhausting and leaves precious little time for innovation, leadership and strategy.
People leadership is not about adding further work to the already demanding role of a practice manager, instead it is about reshaping the role to empower practice managers to apply a more strategic view to how such issues could be better managed, securing greater outcomes for employees and patients and possessing increased confidence to be a driver of change and innovation within their workplaces.
Benefits to culture, organisation and patient outcomes
In understanding how changes could be made to enhance the role of practice managers, it is important to understand the benefits for individual practices. These may vary depending on factors such as size of the practice, organisational goals and team structure.
- Empowered employees
- Better ability for the practice to innovate and respond to situations quickly
- Improved two-way communication between management and team members creating further engagement and ‘buy in’ from team members
- Enhanced employee satisfaction and morale
- Reduced employee turnover
- Reputation as employer of choice
- Smoother operations and administration
- Enhanced ability to drive innovation
- Reduced risk in meeting regulatory liability
- Improved patient outcomes
Current challenges to people leadership
While the benefits are clearly outlined, and many practice managers would aspire to a leadership role, four key factors that have been identified as a potential reason for a lack of progress:
Practice managers come from a variety of backgrounds. Many have a background in administration and particular experience in managing the day-to-day operations of a practice in comparison to specific human resources, management or business qualifications. Many lack formal education, while others may possess a clinical background, TAFE level certifications and some may have tertiary degrees in disciplines such as business and commerce. Depending on the level of education and experience, professional development and upskilling may be required to equip practice managers with the tools they require to move from operations to a more proactive leadership style.
In taking a leadership role, many practice managers may have a good sense of what they would like to achieve but the implementation can be hindered by a lack of confidence, especially if practice managers feel they may lack some of the professional development, authority or education of others in the workplace.
Support of practice principles
Support to move to a more proactive management and leadership style requires support from practice owners, and active two-way communication between practice principals and managers.
Sometimes practice managers may be hesitant to make more strategic decisions or suggest innovation in fear of a lack of support from practice principals. At times, practice principals may not recognise the need for people leadership within the operational framework of their practice.
Time and resources
Practice managers are often trying to ‘do more with less’. Increased regulation such as Medicare changes, introduction of new technology and operational demands can sometimes make leadership seem like a luxury. The balance of ‘rowing’ and ‘steering’ in a practice can be challenging with often limited time and resources (for example administrative support), can lead to a focus on getting the operational elements right ahead of strategic elements.
Overcoming the hurdles
In encouraging the shift from purely an operational focus to leadership in practice management, several opportunities exist, including:
- clear identification of practice values and vision between practice principals, practice managers and employees
- open discussion of the concepts, benefits and barriers of people leadership between practice principals and practice managers
- identifying current issues in the workplace (for example, low staff morale, high turnover or poor two-way communication between employees and management) where a leadership position could enhance operations
- identifying skills gaps to support a more proactive approach to people leadership
- incorporating a more strategic approach into position descriptions for practice managers and employee review procedures
- reviewing current operations and administrative requirements on practice managers. What areas could be streamlined, delegated or automated to enable further time and resources for a greater leadership role
- facilitating and encouraging greater networking between practice managers.
Application: Moving towards best practice
What does people leadership look like in a practical sense? Outlined on the next page are three situations a practice manager may face. The situations are not meant to be a step-by-step guide on how to resolve these issues, but by looking at the issue through the lens of people leadership it is demonstrated how a more strategic focus can improve outcomes for employees, practices and patients.
Scenario one: bullying and harrassment
A practice manager hears from one of the nursing staff members in their practice they have been ‘harassed’ and ‘yelled at’ several times recently by a patient. They believe they are being bullied.
Actions of a practice manager to manage this issue immediately may include:
- containing the problem by listening to the nurse and her version of events
- discussing the issue with the patient’s doctor and deciding what action should be taken depending on the events
- discussing the issue with the patient with the aim of changing the behaviour or more serious penalty, such as ban from the practice.
However, in taking a greater leadership role, a practice manager could also take steps including:
- reiterating the seriousness of the situation is communicated with medical staff including the liability and regulation around these matters but also how the situation fits within the broader values of the practice
- reviewing policies and procedures to ensure that similar issues are prevented or managed correctly in the future
- considering the issue in line with the values of the practice to ensure the strategy meets the needs of employees and patients
- ensuring any signage, patient agreements or other paperwork clearly states the expected behaviour of patients and staff.
Best practice people leadership outcome: leading the people within the practice to a professional resolution of the problem that is compliant, best practice and consistent with the values of the practice.
Scenario two: management of information and patient care
The practice manager hears one of the junior receptionists talking too familiarly with a patient about their private or personal activities, with a full waiting room.
Actions of a practice manager to manage this issue may include privately discussing the issue with the employee, and reminding them of the importance of privacy and appropriate behaviour.
However, in taking a greater leadership role, a practice manager could also consider strategies such as:
- listening to the receptionists reasoning for their actions – they may have simply been trying to create a positive and welcoming atmosphere for patients
- valuing their attempt to create a positive culture
- helping them understand what might be the perception of other patients hearing the conversation
- brainstorming strategies with the receptionist to promote a friendly and welcoming environment for patients, without crossing the line into an area that fails to maintain professional boundaries
- encouraging their input into strategies that are comfortable for them and consistent with the values of the practice
- reviewing on-boarding training materials and processes to ensure employees are fully aware of privacy regulations and other relevant and ethical obligations. Ensure training involves practical suggestions to arm employees with ideas on having conversations pertaining to confidential information.
Best practice people leadership outcome: working with the receptionist to develop strategies that are consistent practice policies and procedures while ensuring their efforts are valued.
Scenario three: billing and administration
A practitioner is verbally informing the receptionist team of what to bill patients. The practice manager notices there have been some incorrect and inaccurate billings.
Actions of a practice manager to manage this issue may include checking the matter to ensure that billing has been handled correctly and in-line with recent Medicare reforms.
However, in taking a greater leadership role, the practice manager could also consider strategies such as:
- ensuring all employees are current and up-to-date with any billing and administrative regulations to minimise risk to practice
- seeking to fill any gaps in knowledge with industry resources, such as education of team on Medicare reform
- ensuring an adequate paper trail that the doctor has instructed the billing
- reviewing policies and procedures, and ensuring sign off from all staff as to billing instructions
- monitoring adherence to policies and procedures on a regular basis
- ensuring all employment paperwork is reflective of role requirements
- induction and reviewing processes, allowing for individual growth.
Evolving the role of the practice manager: what does best practice look like?
The application of the principles of people leadership is not to replace the current role of a practice manager – their roles are essential in the operations of a practice, however, they are aimed to empower practice managers to drive change, enabling practices to enhance communication, human resource management practice and team development.
Diane is a practice manager of a small clinic in Melbourne’s Eastern suburbs. She is experienced within the healthcare industry, starting her career as a receptionist and over the years, increasing her knowledge within the area to become a practice manager.
Her role is largely operational, focused in areas of recruitment, human resource management and rostering. Her directions are largely driven by the practice principal as part of the broader practice strategy.
Diane’s focus on best practice within her department achieves good outcomes but she is often faced with hurdles in managing the needs of her stakeholders – medical staff, patients and administrative support. While she can advocate for good outcomes with the practice principal, her ability to be a driver of change, is limited.
Her time is scarce. She is often focused on dealing with urgent and pressing situations. It can sometimes feel like she has to be the ‘superhero’ of the practice – sorting out problems and knowing how to handle anything that comes across her desk. At times, she may try to approach problems with a new idea or innovation but finds staff can be reluctant to change or there isn’t simply the time to implement the idea effectively.
In approaching Diane’s situation, there are several key factors that can be considered to move her role from that of purely operations to that of a leader within the practice.
- A discussion with the practice principal of the values and vision of the practice and how Diane taking on a leadership focus could further support development of a proactive business model with goal setting and measurable targets.
- Identification of tasks within Diane’s role that could be automated or delegated to other staff members to free up further time to focus on the broader picture.
- A focus on not just ‘handling’ the issue at the time but consideration to how the issue might be addressed at a broader level to avoid similar issues in the future.
- Identification of professional development and networking to increase Diane’s skills and knowledge in order to equip her with additional strategies to manage people, culture and strategy, and support her in driving innovative ideas.
- AAPM: Nicholas Voudouris | CEO, Cathy Baynie - President, Danny Haydon - Board
- Avant: Marianna Kelly – Senior Risk Advisor, Angela Mason-Lynch – Practice Management Specialist (Avant and PracticeHub), Lucy Charlesworth – Senior Solicitor (Employment Law), Kristie Steggles – National Relationship Manager
- Practice managers: Narelle Supanz – AAPM WA Committee Member and Practice Management Consultant
- References: *Australian Human Resources Institute, 2018, Turnover and Retention Report, accessed 19 September 2018 - www.ahri.com.au/resources/research
People leadership in your practice: next steps
A series of potential actions is provided below aimed at facilitating discussion within your practice about the role of the practice manager and the potential to move to a greater strategic and leadership position.
- Discuss the benefits and opportunities of people leadership with practice principals.
- Review and systemise operations and policies and procedures using industry resources such as the Avant PracticeHub.
- Consider membership of relevant industry associations and professional bodies.
- Assess current skills and knowledge of practice managers in taking on this role. What gaps may exist and how they can be filled?
- Review available professional development courses and support such as the Avant/AAPM Scholarship Program.
- Assess current job description and tasks to determine potential for delegation or automation.
- Review two-way communications within the practice to ensure staff have opportunity to discuss issues pertaining to the practice.
- Review the practice vision and values – are these understood and known by employees?
- Identify networking events for practice managers to develop contacts to further identify opportunities for innovation such as the range of AAPM networking events.
- Identify tasks that can be delegated and promotional pathways for all support staff within the practice.