E-Book Excerpt: How to Manage a Successful Integrative Practice

As an owner or leader of your integrative practice, you will have to understand effective management. Successfully managing a practice improves productivity and reliability, mitigates legal and financial risks, improves patient satisfaction and quality of care, and allows you more personal freedom.

For providers, it can be challenging to manage staff, mainly because providers are typically out of the office or in an exam room with the door shut, with limited opportunities to observe office or clinic operations. In addition, there’s a wide gap between providers and staff in terms of training, perspective, and job function. Typically, providers prefer to focus attention on patient care.

Six Elements of Employee Motivation

As an integrative practice leader, address the following questions to ensure employees are motivated to perform well over time.

1. Purpose. “Why am I here?” Managers must align organizational and individual purpose.
2. Expectations. “What am I to do?” Managers must clarify specific expectations.
3. Competence. “How do I do it?” Managers must build the needed competence.
4. Feedback. “How am I doing it?” Managers must give feedback on desired performance.
5. Support. “Will I succeed?” Managers must provide support and encouragement.
6. Rewards. “What’s in it for me?” Managers must link rewards to desired performance.

Staffing Considerations

Whether you are managing two or twenty staff members, you must set expectations and standards. Make sure staff members know what their job function is, what they need to do, and how to do it—even if something seems obvious. Provide staff with references to help them stay on track. An operations manual, checklists, and forms can help standardize routine activities.

Observe and comment on behaviors and results. Even with training, it can take time for staff to internalize what that means in a particular office. Compliment positive efforts, and provide instruction and context when unusual situations arise. When errors occur, supply correction aimed at avoiding subsequent errors.

Regular staff meetings are also a useful tool for keeping in touch with office concerns. In addition to providers meeting daily to discuss cases and treatment collaborations, schedule all-staff meetings at least once a month to go over any logistical updates and offer individuals the opportunity to provide updates on their work. Smaller clinics may opt to meet more frequently, briefly at the beginning or end of the day.

Management by systems is another way to leverage time and attention. Systems have three primary purposes: to avoid, detect, and provide warning of problems.

Avoidance systems can be as simple as having the person responsible for the mail or bank deposit keep their keys in a designated space where it would be impossible for them to leave the office without being reminded of the task. Detection systems commonly require the initials of the person completing a form. If information is omitted, it is immediately clear who is responsible for any error. In addition, employees tend to be more careful when they must physically sign their work. Finally, a warning system indicates symptoms that could be potential problems, such as the pattern of staff absences. Others relate to trends in office supply costs, equipment repair costs, patient scheduling, and productivity measures.

The idea with systems is to avoid looking to avoid looking over shoulders and appearing to be distrustful or micromanaging. It is demoralizing for staff and a waste of the physician’s time. The necessary information appears essentially automatically as needed, and supports corrective action.

Ethics

Ethics are a system of moral principles that define the difference between right and wrong. Where this statement ends is the point at which philosophers start arguing the differences between right and wrong.

During the decision-making process, ask yourself the  following questions:

• Is it the truth?
• Is it fair for all concerned?
• Will it build good will and better friendships?
• Will it be beneficial for all?

The answers to these questions will tell you if that decision complements your principles.

Time Management

In today’s busy and complex world, it is more important than ever before to set priorities and manage time well.  This is especially true for health practitioners who face personal as well as professional pressures and responsibilities while serving as guides and mentors for patients and families that are often dealing with serious, or even life-threatening, challenges. This demanding work must also be performed within the context of an uncertain, highly stressed, and even dysfunctional healthcare system that is undergoing constant change. In this light, assessing the purpose of your life and your most important goals can be an extremely meaningful and empowering process.

The parable of the mayonnaise jar is a story about goals and priorities that is often told in time management seminars, with many variations. It is a metaphor to help you remember to set priorities and create time for what matters most. When life seems too much to handle, when 24 hours in a day are not enough, remember the mayonnaise jar.

A professor stands before his philosophy class and picks up a large, empty mayonnaise jar.  On the table beside the jar are separate containers of golf balls, pebbles, sand, and water.  The professor fills the jar with golf balls, and asks the students, “is the jar full?”  Half the class says, “Yes.”  But half say, “No, there is still space between the golf balls.”

The professor then pours the pebbles into the mayonnaise jar and shakes it lightly so the pebbles settle into the open areas between the golf balls. Again he asks the students, “is the jar full?”  Once again, half the class says, “yes.”  But half say, “no, there is still space between the pebbles.”

The professor now pours sand into the mayonnaise jar and shakes it so that the sand fills up the remaining spaces between the pebbles.  He again asks the students, “Is the jar full?” This time, most of the students agree, “yes, the jar is full.”  But one insightful student says, “No, there is still some space between the grains of sand.”

The professor smiles.  He then pours a significant amount of water into the apparently full mayonnaise jar, filling all the invisible empty spaces between the golf balls, pebbles, and sand.  The students laugh.  Now he doesn’t have to ask if the jar is full.  Instead, he says, “What if I had put the water in first, or the sand, or the pebbles?  The golf balls wouldn’t have fit into the jar without something overflowing.

“Pay attention to the big things that are most important to your life and happiness.  Play with your children.  Spend time with your parents.  Visit with grandparents.  Take time to exercise, eat well, and rest, too.  Spend time in nature.  Hold hands with your spouse.  Take time for yourself.

“Take care of the big things — the golf balls — first.  If you put in the big stuff first — the stuff that really matters — the small stuff will find a way to fit in.  And if it doesn’t, it is just sand, or pebbles, anyway.”

Self-Care

While management is often about facilitating the success of others, the most successful practitioners take the time to care for themselves. Providers must have a self-care practice, or start one immediately, that incorporates movement, mindbody, food, environment, relationships, sleep, and spirituality. Practitioners need to be honest about their physical activity, diet, stress management, environmental exposures, sleep, relationships, and spirituality, specifically what areas need to  be improved.

Once a provider has addressed their own health and selfcare, then they can turn to their patients and adequately offer programs and practices in each of the wellness areas.

Editor’s Note: This is an excerpt from the e-book, The Five-Step Guide to Practice Management. To access the full text, click here.