Effective practice leadership involves balancing authority, power and responsibility

Ten communication principles can create a more powerful and effective professional team.

John B. Pinto

Craig N. Piso

“The price of greatness is responsibility.”
— Winston Churchill

“You can delegate authority but not responsibility.”
— Stephen W. Comiskey

“With great power there must come great responsibility.”
— official Spider-Man credo

Most of these columns through the years have been prompted by workplace challenges that every client surgeon faces to some degree. This column is no exception.

This month, we explore the challenges of finding the right balance between tough and fair — between the authority, power and bluster needed to get the job done and the responsibility and sensitivity it takes to use that power wisely.

At the roots of every practice challenge, a unified board needs to establish every policy and goal for the company. Each of these policies and goals should advance the interests of the company and not the unilateral interests of individual doctors. Once the board’s desired outcomes are clear, and clearly well-intended, the administrator carries the ball going forward. But managers in today’s enlightened world are not just mute executors. They have a duty to challenge their boards to better decision making.

If a practice manager disagrees with the board, he or she has several choices. First, the manager can raise concerns backed up by facts and attempt to secure a revision of policy. This is a vital, valuable duty of any administrator and should be welcomed by every board.

If a revision is not secured, the competent administrator will next typically accept the policy nonetheless and support it publicly and vigorously. If a policy is deemed by the administrator to be illegal or materially against company interests and it cannot be changed, the administrator has a duty to leave the organization.

A board’s goals are always going to fall into two crisp domains: objective goals (eg, collections, patient volumes, profit margins, market influence, staffing levels, service mix), and subjective goals (eg, working environment, morale, style of operation, tone of the office).

The administrator’s ability to understand and achieve the desired practice outcomes is always tougher for the subjective goals. Everyone can agree on what a “40% profit margin” looks like and can measure it. It is harder to communicate what is meant by staff harmony, high morale or empowerment. This softer, subtle, subjective domain of management is what trips up most administrators and managing partners to one degree or another. The key is understanding the balance between power and responsibility.

In any healthy individual or system, power and responsibility are proportionate attributes, counterbalancing each other. As we empower any staff member, we create the reasonable expectation of holding that person accountable in like measure. A lot of this rests on effective communication. It behooves both lay managers and medical leaders in group practices — especially in larger groups, where communication can get quite tangled — to understand the principles of effective communication and information sharing.

Here are 10 principles of communication with doctors and staff (and every audience segment of your practice, including patients, vendors and payers) to help you create a more powerful and effective professional team.

1. Communicate in a direct, timely manner

Commit to face-to-face discussion of difficult issues rather than “splitting” or “triangulating” (ie, complaining to others while avoiding confrontation and/or conflict). Address issues in a timely manner, rather than allowing them to fester. The courageous commitment to having what some have called “fierce conversations,” with everything put on the table in person, ironically, creates an increased sense of safety and security because the process leaves no stone unturned and most often results in logical resolution of issues and greater stability. Scary, but effective.

2. Present a united, positive front

Always represent the best interests of the practice and its governance, even when problems are apparent and still unresolved. Just as parents do well to support each other, especially when a complaining child attempts to stir strife at the top of the family pecking order by turning one parent against the other, do not allow anyone to play “divide and conquer” with you and your partners. Understand and respect the power of words to help or hinder any initiative that you oversee. Never publicly diminish the authority of your managing partner, administrator or supervisors, which will only expose an Achilles’ heel at which others will predictably shoot more arrows, undermining individual performance and ultimately harming the company.

3. Keep the jury out

Give the benefit of the doubt regarding any negative report you hear about a person, including peers, administrators, patients or other providers. Reserve judgment until all of the required facts are understood, thereby restraining the urge to reach closure prematurely, especially under the strain of intense feelings such as anger, frustration and worry. As you develop this aspect of emotional intelligence, you show others how to let cooler heads prevail. There is power in rational thinking and behavior, often requiring silence and dispassionate reflection.

4. Uphold the chain of command

The organizational chart defines roles and reporting relationships with an explicit chain of command through which power and control are to be mobilized. Strict adherence to this chain of command is essential for the support and continued empowerment of every position in the hierarchy. Therefore, ensure in every communication that no manager or supervisor is overlooked or bypassed, because doing so renders that person less effective, especially in the eyes of whoever succeeds in nullifying that authority. For example, if someone complains to you without first having broached their complaint with an immediate supervisor, redirect them to the supervisor with the clear expectation that he or she will handle the situation competently. Should that not be the case, schedule a meeting of all relevant parties and discuss the matter transparently toward resolution, always supporting the supervisor in question, especially in front of the staff.

5. Let your word be your bond

Always mean what you say and say what you mean. Without exception, demonstrate an unwavering commitment to cultural integrity through your honesty, transparency and authenticity. People will then listen to what you say with trust and confidence. Your impeccable honesty engenders trust, and trust produces followership and loyalty, which are basic sources of power for any practice leader. Maintain confidences, keep your promises, take responsibility when appropriate and apologize when you are mistaken. Follow these prescriptions faithfully and people will more faithfully heed your words.

6. Walk the power, responsibility talk

Speak frequently about this dynamic when explaining the rationale for your decisions and actions. For example, “Because of the consistent manner in which Jane has made effective choices (or exercised her power) to succeed at projects, I recommend her for this promotion with expanded duties (or responsibilities).” Conversely, the same principle applies when communicating about negative performance or behavior: “Jane, you are being terminated (or being held accountable) as the result of your choice to belittle your supervisor to a vendor after being warned repeatedly and in writing that the next infraction of this sort would result in your loss of employment here.”

7. Use the power of focus

Recognize that our focus upon people and things tends to expand, either positively or negatively, influencing how we interact with them. For example, a steady focus upon another person’s faults only serves to expand our sense of those faults, creating tension and a vicious circle. We become more effective when we maintain a focus on those things that contribute most to our goals, rather than letting ourselves become distracted by lesser or counterproductive things. In your communications, therefore, create and maintain a positive outlook and focus. Help your people shift their focus in ways that support their successful actions and create a more positive work environment. For example, when staff members are complaining about their struggles and problems, real or imagined, help them by shifting their attention toward what is working, their available resources, potential solutions, and their choices and options, rather than perpetuating the negative focus in which they have become stuck.

8. Convey positive expectations

There is a powerful relationship between hope and energy. Energy (motivation) comes from the core dreams that we hold deep within ourselves. The more important and realistic the dream, the more energy that is produced, thus enabling us to pursue our goals with sustained drive and commitment. The familiar concept of a “self-fulfilling prophecy” is the process of living up, or down, to expectations expressed by others. Effective managers make conscious efforts to instill hope in their people — hope about their goals, their potential, and their long-term success and fulfillment. If you genuinely believe in and express the unique strengths and untapped potential of your people, then they naturally feel the contagiousness of your positive view of them. For example, when someone says, “I just can’t figure this one out,” a helpful reply is, “You will; you just haven’t figured it out yet.”

9. Model and require courageous action

Too often people at work put off doing the very things that are most important for their success and happiness, simply because they are afraid of failure, discomfort or change. Strong, resilient leaders show the habit of acting in real time to solve problems and to complete key tasks, rather than procrastinating or wishing away their problems and projects. It is this quality of reframing adversity as opportunity and maintaining faith that you will prevail in the end that separates exceptional from average leaders. Similarly, excellent managers require their staff to find the courage to follow their example in order to meet the challenges that they face. Insist that courage is not the absence of fear when challenged; that would be a superhuman expectation. Instead, courage is taking decisive action in the presence of fear, giving all of us mere mortals a green light to act, even when our knees are buckling, in order to get things accomplished.

10. Influence change

Expressing empathy and understanding with staff is the most important communication skill you can demonstrate as a manager in order to influence the changes you desire. This begins with the willingness to listen to what others have to say and giving genuine respect to their ideas and opinions, even when they are quite different from your own. It means meeting people where they are (ie, pacing to their tempo) before attempting to move them where you want them to go (ie, leading them). This has a profound impact upon others because it gives them a sense of being valued and understood, two of the most important factors that determine how people feel when working under your direction. You have to connect well with others, through effective listening and respectful communication, to influence their thinking. By having first validated other people’s right to their opinions and feelings, even if you strongly disagree with them, you have reduced the tension that otherwise stands in the way of changing their point of view. By patiently and respectfully understanding the person, you help him or her to be less defensive. This builds a bridge of communication over which that person is more likely to walk and then join you where you stand.

• John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. Mr. Pinto is the country’s most published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement; Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice; The Efficient Ophthalmologist: How to See More Patients, Provide Better Care and Prosper in an Era of Falling Fees; The Women of Ophthalmology; and his new book, Legal Issues in Ophthalmology: A Review for Surgeons and Administrators. He can be reached at 619-223-2233; e-mail: pintoinc@aol.com; website: www.pintoinc.com.
• Craig N. Piso, PhD, is president of Piso and Associates, LLC, an organizational development and psychological services consulting firm based in Northeastern Pennsylvania. A consultant/psychologist with 30 years of corporate executive and clinical practice experience, Craig is the author of a new book, Dream of Life … Live Your Dream – A Manual of Skills for Living for Today’s Young Adults. He can be reached at 570-239-3114; e-mail: cpiso@pisoandassociates.com; website: www.pisoandassociates.com.