Headknocking: What's a practice manager to do?

It's great to see many practices are now acknowledging that the old, traditional methods of management are not effective, and they are modernizing their strategies and taking steps to improve staff morale, and consequently productivity.

Most practice owners accept that low morale among their employees means low productivity, which in turn, means low profits. Smart practices strive for a proud and satisfied workforce with improved productivity and profits. Whatever method is being used, it usually still falls on the practice manager's shoulders to implement. They are in a unique position to see what isn't working, what won't work, why problems exist, and what adjustments should be made to help build staff morale.

Sadly for some practice managers, senior management, doctors and governance boards don't listen. Sometimes, when a middle manager tries to express his or her views about a new strategy or goal, some leaders just seem to close their ears.

Practice owners need to keep in mind that staff members are in the trenches, and middle management's role is to instruct and oversee the process. They receive instructions from those veterinarians at the top, who don't always understand what is happening at the ground level. Practice managers who attempt to enlighten the practice leaders often find themselves banging their heads in frustration.

So, does the practice manager assertively argue with senior management and risk his or her position and possibly jeopardize personal career goals within the practice? Nobody wants to rock the boat if it means their job is on the line or they'll be ostracized, even if they know they could save the practice thousands in misspent dollars on initiatives that are poorly designed.

So, what can a manager do? There are courses of action one can take, some of which involve a leap of faith and others are just plain old common sense.

If you are the type of manager who is getting a headache from the way the system operates, you can lay it on the line with your senior management and politely tell them like it is. If you strongly believe doing this would be detrimental to your career within the company, then you need to think carefully about this tactic. Feel your way; build consensus with your colleagues first.

If you are really fed up, whether you decide to be assertive and speak up or not, maybe you should speak to a career coach, consultant or look for a new job. If your family depends solely on your income, maybe you should also start putting some money aside for the possible scenario of losing your job. If you never need to use these funds, the little nest egg you've saved will always come in handy for other things.

Maybe you can organize a private chat with an influential player on the senior-level team or even the practice owner. Maybe you can put it in a report if a verbal presentation is out of the question. If you choose a written report, clearly state the facts, conclusions and at least two separate courses of action.

Whether it will be dismissed or not, you know the boss is finally going to hear/read what you have to say.

Don't just criticize plans or instructions that have been handed down for you to carry out without providing sound reasons and examples of why it won't work. List alternative courses of action that you believe will work and ask for permission to try them. Where possible, show evidence of why your ideas will work to benefit the practice. Show the organization the benefit of implementing "your" strategies rather than the one's they have designed. And don't dismiss the possibility that maybe senior management knows something you don't.

Then there are those managers who are willing to take risks. But it's a fine line between showing initiative and insubordination. To deliberately disregard a directive from your boss and implement your own plan because you believe it will work takes more than just courage. If you are wrong, your job and your reputation are on the line. Of course, if you are wildly successful, even the boss will sing your praises (although there will always be some slight concern about your willingness to toe the line!)

In some practices, the practice manager is not expected to make certain executive decisions and his or her level of authority and responsibility remain ineffective. They are just a link in the chain of command. Some managers are happy to be in a spot to safely pass the buck. Many managers at this level are too scared to make decisions or implement new ideas out of fear. This paralysis can occur in both large and small practices. It occurs more frequently in very large, multi-owner practices, because usually a more authoritarian style of management tends to be used. In this situation, practice managers are expected to do as they are told and not question their superiors. However, larger practices who train their managers in a more participative style of management and who practice open communication are happy to find this system works.

Senior-level management and practice owners need to take notice of the management team operating on the front-line. Listen to them and their suggestions; include them at your planning discussions and strategic assessment sessions. It may save your practice thousands of wasted hours and dollars, and if nothing else, will improve your middle management's morale and their own level of productivity!