Katherine Martinson is the office manager for Dr. Michael Collins, a family practitioner in a group practice in a metropolitan area. The office usually carries a full schedule of patients each day. Katherine has been instrumental in the seamless operation of the facility. Before joining Dr. Collins, Katherine worked for a physician in the same group of doctors, Dr. Grant Bradley, who retired last year. She worked as an administrative medical assistant for 6 years before that. Her strength and ability to motivate employees led Dr. Collins to approach her about becoming his office manager once Dr. Bradley retired.

Katherine is a consummate professional, but she knows the importance of treating each employee as an individual. At weekly staff meetings, the employees offer input on the various procedures followed in the office. Katherine regularly consults with the staff members and always asks for input as to how the office can function more effectively. She implements many of the staff members’ suggestions in the day-to-day activities of the office. She knows that employees need to feel a part of the team, and by trying the procedures others suggest, she validates them as an asset to the facility.

When a position is open, Katherine is careful about whom she hires, always checking at least three references per applicant and verifying each previous place of employment. She trains each employee in every aspect of the job and keeps checklists that reflect that the employee has been given instruction in certain skills.

Katherine makes sure each person has the tools needed to do his or her job. She also explains overhead costs to employees and helps them understand what is involved in the daily operation of the practice. With this information, the employees are more conservative about using supplies and more careful with equipment. Major changes are presented to the entire staff, and although Dr. Collins makes the final decision, he and Katherine seek the input of the employees. The cooperative attitude between management and the employees of the office provides a good atmosphere for teamwork, and Katherine and the physician are pleased with the results.

While studying this chapter, think about the following questions:

• How friendly should office managers become with the staff members?

• Why is checking references important when hiring a new staff member?

• How should negative employee evaluations be handled?

• How can the office manager promote an atmosphere of teamwork?

The management of a professional medical office can greatly influence the success of the operation. Good management allows the physician to see and treat patients in a functional environment with the confidence that the business side of the facility is operating as it should be. A well-managed office is not something that just happens. Great effort and teamwork are necessary to ensure that the day-to-day activities are carried out efficiently and that the many details needing attention are handled expeditiously.

Although most medical assistants do not enter office management right after graduation, they certainly want to succeed and to advance their career. The information in this chapter can help the medical assistant understand what makes a good manager. Those traits can be developed as a new employee after graduation. Additionally, the medical assistant will learn the employment process from the office manager’s point of view. This information also is valuable to a new medical assistant who is applying for a position. By studying office management, the medical assistant prepares for future management positions, but also learns to see both sides of the coin and understand why managers make certain decisions and enact policies.

Today’s Office Managers

The office manager in today’s medical facilities must be versatile and able to perform several tasks at one time. The office manager is responsible for many more duties if the office is small and has a smaller patient load. These professionals must know how to complete almost all the tasks in the office and have good people management skills. In larger offices, human resources duties may be performed by a separate office, or an accountant may take care of all financial management issues. However, the more duties the office manager can perform, the more valuable he or she is to the clinic. Always be open to learning management duties, because taking on management positions usually results in an increase in salary and benefits. A sharp medical assistant who is ready to learn will advance quickly and find a variety of opportunities in the healthcare industry.

Who’s in Charge?

If the office has only one medical assistant, that person must be able to assume many management responsibilities with cooperation from the physician. When the office has two medical assistants, one administrative and one clinical, the administrative medical assistant often is expected to assume management duties. In an office with a larger staff, a chain of command must be established.

A facility with three or more employees should designate one person as supervisor or office manager. This individual needs management skills and the ability to deal with personnel matters. Other employees answer to the office manager, and the office manager answers to the physician or physicians. A chain of command allows the office staff to consult with the physician regarding administrative or clinical problems, complaints, or grievances; however, it prompts employees to allow individuals whom the physician has placed in charge to have the first opportunity to solve problems. It also allows the physician to check on the operation of the office, disseminate information on policy changes, and correct errors or grievances by dealing with one person instead of all employees.

Qualities of an Effective Manager

• Uses good judgment

• Has good health

• Has the ability to organize

• Is willing to learn

• Possesses original ideas

• Has leadership ability

• Is fair with all employees

• Is flexible

• Has a sense of fairness

• Cares about employees

• Remains calm during crises

• Is open to constructive criticism

• Has good communication skills

• Uses good listening skills

• Is approachable

A medical assisting career is challenging and offers great opportunities for advancement. A recently graduated medical assistant, whose first position may have been as a receptionist, can be given more responsibilities based on good work and eventually may become the office manager of a large staff.

Management problems often can be prevented by defining carefully the areas of authority and the responsibilities of each employee. Many physicians say that friction among workers is their most common personnel problem. The importance of the chain of command cannot be overemphasized, and the physician must not undermine the office manager’s authority by circumvention. When employees know what is expected of them, they can plan both their daily and long-term work more effectively.

Duties of the Medical Office Manager

The duties performed by medical office managers vary from place to place and practice to practice. Some physicians take a much more active role in office management than others. The best management plan for the physician is to hire a trustworthy, reliable office manager and then allow the person to run the business aspects of the office. This frees the physician to concentrate on taking care of patients.

Some of the tasks performed by the medical office manager include:

• Preparing and updating the policies and procedures manuals

• Making sure employees follow the policies and procedures manuals

• Developing job descriptions

• Recruiting new employees

• Performing orientation and training

• Conducting performance and salary reviews

• Dismissing employees

• Planning staff meetings

• Maintaining staff harmony

• Establishing work flow guidelines

• Ensuring compliance with all federal and state regulations

• Improving office efficiency

• Supervising the purchase and care of equipment

• Educating patients

• Eliminating time-wasting tasks for the physician

• Marketing the practice

• Performing customer service

Office management can best be accomplished by developing a thorough office policy and procedures manual and then enforcing its contents except in extraordinary circumstances. This is discussed later in the chapter.

The Power of Influence

Managers have a great deal of influence over the people they supervise. A successful manager must be interested in people and enjoy working with them on a daily basis. It is said that if one helps others get what they want in life, the individual usually also gets what he or she wants. An effective manager discovers the motivation behind employees’ drives to be a part of the profession in which they are employed and then helps them achieve their individual goals. In turn, most employees are enthusiastic about working toward the facility’s goals as a productive team member.

Successful managers know that their employees should be encouraged to perform at optimum levels, and they are confident enough in their own skills to give credit to employees who develop ideas and concepts for the team. These managers know how to let their employees help them “look good.” A manager with a group of outstanding employees usually is looked on as an effective leader.

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Critical Thinking Application

When Katherine began as Dr. Collins’ office manager, she found several supportive employees, but a few were concerned about their new boss. How can a new manager help employees be at ease during the first few weeks?

The Manager as a Leader

Leaders nurture other people. They take the time to discover what makes people tick and then give them opportunities that will help them rise to new levels of responsibility. Leaders have a strong belief in people, and they express confidence in their abilities, seeing them as successes rather than failures. Often this belief exists before people prove themselves, and that provides motivation for them to reach their potential.

Perhaps most important, leaders listen to their people. Few things are more frustrating than an employee attempting to talk to a manager who is working on some project or typing on the computer. Listening involves eye contact and questions to ensure that the employee is understood. Being willing to take the time to listen is a step toward success as a manager.

Instead of sitting across from employees at a desk, try sitting beside them in the chairs that are usually placed in front of a desk. When discussing issues with employees, this simple change in position places the office manager on an equal plane with the employee and implies more of a team effort. At times this positioning might be inappropriate, such as during discussions about disciplinary matters. Still, when attempting to get an employee to cooperate or come over to the office manager’s way of thinking, position can play a large role in getting people “on the same page.”

Types of Leaders

The three basic types of leaders are the charismatic leader, the transactional leader, and the transformational leader. Each has positive qualities, and all can be successful in business.

Charismatic leaders have a special way of inspiring an unswerving allegiance and devotion from their followers. They encourage people to overcome great obstacles and buy into their vision for the organization or business. They also tend to trust people in subordinate positions and earn trust in return.

Transactional leaders are structured and organized. They make sure their subordinates understand their duties and roles. These leaders are fair and provide rewards when they have been earned. The transactional leader is hardworking, a planner, and strict about budgets and time frames.

Transformational leaders are innovative and able to bring about change in an organization. These leaders are relationship builders. They stress shared values and strive to create a common ground among team members. Transformational leaders are the most effective when an organization is experiencing change and reorganization.

Styles of Management

Some managers are democratic and willing to listen to employees. These managers are fair-minded and ask the opinions of the staff when making decisions. In contrast, the autocratic manager is more of a dictator, making demands and insisting that tasks be done in a certain way—his or her way. The laissez-faire manager is easygoing and does not make a lot of demands on employees. This is a “go with the flow” manager who lets employees work on their own and does not micromanage.

Theories X, Y, and Z

Douglas McGregor, an American social psychologist, developed Theory X and Theory Y to distinguish two types of management. His book, The Human Side of Enterprise, published in 1960, explains these management types. In 1981, William Ouchi offered his own management theory, calling it Theory Z.

All these theories include several assumptions. Theory X, for example, suggests that humans dislike working and avoid it whenever possible. Because it is unpleasant, management must push, coerce, or threaten workers to do their jobs. Workers, according to Theory X, do not like responsibility and prefer to be directed than to lead. McGregor says that Theory X is applied best to large-scale employers, such as those involved in factories or manufacturing. Theory X is considered “hard” management.

Theory Y is virtually the opposite of Theory X. Theory Y holds that people enjoy work and that it is a normal component of life, as are rest and play. McGregor says that these humans, when motivated, work toward the goals of the organization. People seek and accept responsibility, enjoy job satisfaction, and are imaginative and creative. Theory Y applies to workers such as managers and other professionals. Theory Y is considered “soft” management.

Ouchi’s Theory Z is a combination of American and Japanese management theories. Theory Z considers characteristics such as long-term employment, collective decision making, individual responsibility, and a holistic view of the employee and his or her family.

Maslow’s Hierarchy of Needs

Maslow’s hierarchy of needs, first discussed in the chapter on communications, also can be applied to management. The triangle of needs begins with physiologic needs (air, food, water, sleep) and safety needs. Moving upward, social needs and then esteem needs are addressed. The last need is self-actualization.

In the workplace, physiologic needs are met with lunch breaks, rest times, and days off. The worker’s salary helps the person meet other physiologic needs, such as shelter. Safety needs are addressed in this theory as having a safe place to work and a sense of security through savings, health insurance, and retirement programs. Social needs are met through interaction with co-workers, working as a team, and enjoying the work family at events away from the office. Needs related to esteem include feeling appreciated, valued, and being recognized for good work. Continuing to set higher goals and working to reach them are steps toward self-actualization.

Frederick Herzberg believed that job enrichment had to exist for a worker to be motivated. He theorized that several factors affect job satisfaction, some negative and some positive. The six factors that can lead to job dissatisfaction include:

• Company policy

• Supervision

• Relationship with supervisors

• Work conditions

• Salary

• Relationship with co-workers

The six factors that lead to job satisfaction include:

In his book, The Motivation to Work, Herzberg states three points:

1. Jobs must be satisfying and must motivate employees to grow and reach their full capabilities.

2. Employees who show greater ability should be given more responsibility.

3. If the job does not allow the employee to use his or her full ability, a different employee who can grow and find motivation in the work should be placed in that position.

These are only a few of the many theories about employment and management. The theory of management by objectives suggests that goal setting serves as a basis for greater job efficiency and better employee motivation and commitment and that it leads to planning for results instead of just planning to work. Some managers believe in the theory of management by walking around, which suggests that the more visible and engaged the manager is with his or her employees, the more productive they will be. Supervisors develop and modify their management style as they gain more experience. The medical assistant who understands the type of manager he or she has may find it easier to understand the manager’s actions and preferences. This realization can lead to better job performance and promotions for the medical assistant.

Leading During Transitions and Change

Change is a part of the life of every person and every business. Most people initially are hesitant to face change, and many people try to avoid it completely. However, a business cannot experience growth without change. The manager who can lead subordinates through periods of change is a valuable asset to the organization. Employees need guidance on maintaining focus on the tasks at hand. The manager should remain visible to employees during times of change and communicate frequently through status reports and updates on policies and procedures.

The book Who Moved My Cheese? by Spencer Johnson, MD, is an innovative story that all managers should read. Any manager or employee experiencing a time of change should study this simple, short book. The opening quotes renowned author A.J. Cronin:

“Life is no straight and easy corridor along which we travel free and unhampered, but a maze of passages, through which we must seek our way, lost and confused, now and again checked in a blind alley. But always, if we have faith, a door will open for us, not perhaps one that we ourselves would ever have thought of, but one that will ultimately prove good for us.”

Who Moved My Cheese? stresses several points about change that the good manager should remember:

• Change happens.

• Anticipate change.

• Monitor change.

• Adapt to change quickly.

• Move with the change.

• Enjoy change.

• Be ready to change again quickly and enjoy it again.

The simplicity of this advice does not diminish its truth. Change happens in everyone’s job and personal life. Those who learn to adapt quickly and move forward do not become casualties of change.

The Role of Power

Power is the ability to influence employees so that they carry out their directives. Leaders use many types of power.

• Coercive power is manipulative, and the leader often makes threats or uses fear to accomplish goals. The fear of losing a job is a manipulation of power.

• Granting rewards is a more positive use of power. When the leader is able to give employees some type of reward for a job well done, most employees strive to reach their goals.

• Expert power is a factor when the leader is knowledgeable about a subject. Employees respect leaders who know their job and how things should be done. Most people look up to a person who has a high degree of knowledge about a given subject. Employees frequently are frustrated when they must work for someone who knows nothing about procedures or the service offered.

• Legitimate power is that of position or status. It does not really matter who the president of the United States is; the office itself carries the weight of power. Therefore, the individual who serves as president holds legitimate power.

• Referent power is granted from subordinates to those who lead by example. It is a power based on the admiration of the leader. Mentors, parents, and teachers often are the objects of referent power.

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Critical Thinking Application

Katherine is a respected office manager in the office where she works, but several other managers in the office building are not as well liked. What makes a strong, effective office manager?

Everyone has worked for at least one supervisor whom they did not like. What traits make a poor office manager?

Abuse of Power and Authority

Unfortunately, many managers may abuse the power they have. A manager who puts up barriers and erects emotional walls with employees has difficulty forming a cohesive team. Some managers use other people as tools to get what they want, and other managers stick to their own level or stature, relating only to the inner circle of decision makers in the facility.

When an organization has no checks and balances, power is easily abused. Working with a manager who cannot look inside himself or herself and see mistakes is difficult. Some managers stress rules and conformity, leaving no gray areas where subordinates are concerned. Some show a false humility and pretend to care, but most employees can see right through this half-effort at a relationship. Others only hire “yes” people, who agree with everything the manager says. All these are abuses of power and indications of a poor manager.

The Power of Motivation

A number of factors can motivate a person to reach a goal, including:

Any of these motivators can prompt an employee to action. There are two general types of motivation. Intrinsic motivation is internal, or originates within a person. Intrinsic motivation is long term and can be focused toward a lifelong goal. Extrinsic motivation is external and more material in nature. Generally, extrinsic motivation is more short lived and less satisfying than intrinsic motivation.

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Critical Thinking Application

Katherine knows that employees have different reasons and motivations for working. Some must work to help support their families, and others work simply because of a love for their field. How can Katherine discover her employees’ motivations for working?

How does this knowledge benefit the office manager?

Can this knowledge help Katherine achieve her goals?

The New Office Manager

The medical assistant will encounter various reactions when entering a facility as the new office manager. Often, he or she will face negative reactions from employees. They may have felt an intense loyalty to the previous manager and may resent that the person was terminated, or they may have settled into a routine with an office manager they had had for many years. As mentioned earlier, most individuals resist change, and getting accustomed to a new supervisor can be extremely stressful. A new office manager wants to create a positive work environment; therefore, he or she must find ways to win the support of current employees.

The first thing a new office manager can do to begin garnering support is nothing. Never storm into an office and begin making radical changes in the first few days. Always observe for at least a few weeks and make notes about problem areas. Then, meet with the physician and share the information observed and present a plan for changes. Ask for the physician’s input, because he or she may know the history of difficult situations and can provide guidance in moving forward with plans for change.

After discussing these plans with the physician, use strategy when attempting to move employees toward achieving office goals. Schedule individual meetings with employees and allow them to tell you three things they like about their jobs, three things they dislike, and three things they need to do their jobs more effectively. Surprisingly, the employee may need only a truly insignificant item, such as his or her own box of file folders or a stapler that works with larger stacks of paper.

Once all the meetings have been held, review the information the employees provided and create a plan of action. The information provides a preliminary road map for management, because the employees’ responses give the new manager an excellent idea about what is important to them and where the problem areas are in the office. Also, choose one item from each employee’s list of what they need to do their job more effectively and obtain it within 1 week of the interviews. Employees will be impressed that the new manager is interested in their opinions and wants to meet their needs for the good of the office.

Hold a staff meeting a week later, and wherever possible, move toward eliminating the issues the employees do not like about their jobs. Ask for input, and perhaps even more important, ask for their assistance in improving the work environment. If the new manager follows this process, the employees will realize that he or she can get things done, is interested in their input, and often acts based on their input. Do not change a slew of policies or procedures too quickly; remember that change is difficult for most people. However, indicate to the employees that their issues are important and will be addressed. Distribute memos frequently that communicate with employees in a way that makes them feel like part of a team. Be willing to ask for input and try suggestions for dealing with problems in the flow of the workday.

Realize that some employees still will resist, which may make the new office manager feel frustrated. At some point staffing changes may be necessary, and this might include terminating employees who do not get onboard with the office moving in a positive direction. Although any terminations are stressful for the entire office, realize that this is a common situation when new managers begin their positions. This process is the first step in building a functional team.

Creating a Team Atmosphere

Teamwork is critical in the medical profession. In the physician’s office, the manager must promote an atmosphere in which the employees are willing to work together toward common goals. Morale in the office may be low because of recent changes in policies or procedures, changes in staff or management, recent terminations of employees, lack of business, or any number of other reasons. The wise manager takes steps to improve employee morale constantly, including scheduling frequent meetings and keeping the employees abreast of changes and developments that affect them (Figure 25-1). Employees like to be kept “in the loop.” Some managers try to shield employees from negative information, but this practice can cause rumors to circulate and worsen morale.

FIGURE 25-1 Communication is vital when building a team. Employees appreciate good communication with management. Sharing good and bad news openly with employees leads to fewer rumors and eases workers’ concerns.

Managers can improve morale by scheduling activities that involve the families of employees and by making an obvious effort to include them in various events. One of the most effective ways to improve employee morale is to communicate. Regular staff meetings, e-mails, and memos are critical for good communication and smooth operation of the medical facility.

Five Essential Elements of Teamwork

1. Mutual accountability: Each person on the team holds the others accountable for the success of the organization.

2. Common purpose and performance goals: Short-term and intermediate goals must relate to the long-term goals of the group.

3. Small size: Most successful teams have a small number of members; fewer than 10 is optimum.

4. Common approach: All team members must learn to work together toward the goal.

5. Complementary skills: A variety of talents, skills, and abilities is needed for a successful team.

From Katzenbach JR, Smith DK: Wisdom of teams: creating the high-performance organization, Boston, 1992, Harvard Business School Publishing.

Use of Incentives and Employee Recognition

The staff of the physician’s office should feel satisfaction with the working conditions and atmosphere in the facility. The office manager plays a part in ensuring that this happens.

Incentives give employees reason to perform over and above the level expected of them. If the staff meets or exceeds a goal that has been set, the physician may elect to provide tickets to a sports or entertainment event for the entire staff. A paid day off is always a great incentive for accomplishing a goal. Some physicians have an incentive program that is related to collections for a given period. These ideas provide a goal for the employees to work toward and an opportunity to expand their efforts as a team.

Recognition is a strong method of improving employee morale and encouraging outstanding performance. Certificates for peak performance are a great way to motivate employees. For instance, the office manager may decide to award a certificate each month to the employee who provides the best customer service. Patients could even be involved by allowing them to nominate employees for this honor. When an award is at stake, most employees enjoy participating and striving to accomplish the goals that have been set.

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Critical Thinking Application

One of Katherine’s employees, Jewel, is very sensitive about performing perfectly on the job. She is an excellent employee, but she has a few weaknesses. However, she has received a lot of recognition for the good things she has done at work. Katherine still feels that she needs to discuss with Jewel the areas where her performance is weak, but she knows it will upset her. How might Katherine deal with this sticky situation? How can Katherine reassure Jewel that she is pleased with her overall performance?

Problem Employees

Occasionally, problem employees disrupt the efficiency of the physician’s office. Counseling these employees to find the source of their difficulties is the first step toward resolution. Many employees can be redirected to become productive staff members with a little patience and understanding on the manager’s part. However, some employees have negative attitudes that seem impenetrable.

The manager must never hesitate to counsel the employee who is not performing at the expected level, and this includes employees with attitude problems. Establish a set regimen of counseling. Many offices allow one verbal warning before written reprimands go into the employee’s file. If the manager does not make a habit of writing formal reprimands, there may be insufficient documentation of problems with the employee once the manager is ready to terminate him or her. Even small offenses, such as being tardy, should at least be noted in the employee’s file. The manager should never be in a position in which the termination of an employee cannot be justified by written documents.

Problem Patients

Patients can be quite challenging to the physician’s staff and office manager. Most patients are genuinely concerned about their health and are cooperative with the physician’s instructions. However, a few patients require extra understanding, which may lead to intervention by the office manager. Types of problem patients may include those who are:

The office manager may act as a liaison between the patient and the physicians when issues arise that are somewhat complicated. Some patients may feel ignored or mistreated. Others may have a general lack of trust that makes complying with the physician’s orders difficult for them. Cultural differences, social issues, and financial problems all can affect patient compliance and attitude. The rare patient may have a personality disorder or psychological problems that are frustrating as they receive medical treatment.

The time may come that the physician decides to discontinue care for a difficult patient. If that happens, the physician must notify the patient in writing and send the letter by certified mail, return receipt requested. Because some patients refuse to sign for mail, a copy of the same letter can be sent by regular mail. The physician must tell the patient that care is to be discontinued, inform the patient what day will be the final one the physician will provide care, and urge the patient to seek medical care from a new physician. The letter does not have to detail the reasons for the physician’s decision, but those reasons should be explained in the patient’s medical record. Always follow office policy in terminating patient care.

Preventing Burnout

Burnout is defined as exhaustion of physical or emotional strength or motivation, usually as a result of prolonged stress or frustration. Medical professionals are particularly susceptible to burnout because of the intensity of their jobs. Even small decisions could affect a patient’s life. Therefore the office manager should take measures to help employees avoid burnout.

Some of the causes of burnout include a stressful, disorganized home or work environment; poor human relations skills; a feeling of being out of control of one’s life; excessive expectations from supervisors or family members; long work hours or time away from family and friends; and not being able to relax either at home or in the work environment.