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How aligned are your partners and staff?
Practice alignment is key to achieving goals, facing problems and continuously improving.
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“Align: verb; to arrange things so that they form a line or are in a proper position; to change (something) so that it agrees with or matches something else.”
– Merriam-Webster Dictionary
Some aspects of proper practice management and governance are obvious. We need proper facilities. We need trained staff. We need a source of patients. And we have to make a fair profit every year. These are all tangible requirements for success.
Other aspects of great practice management are less tangible but at least equally important. Perhaps more so.
One of these is the concept of “alignment.” My goal this month is to get you so fired up about the importance of alignment — between individual partners, between owners and support staff, and even with patients and vendors — that you will put up a big sign in the break room that simply says, “ALIGNMENT.” And that you will pass out the simple self-assessment tool below and discuss the results with your team to help launch an ongoing internal discussion on the subject.
Group alignment
Perhaps the most extreme examples of human alignment in work groups are professional sports teams and military units. They literally “line up.” But they are aligned in more than just a physical sense: They have achieved a common level of fitness and commitment to a difficult task. They have been steeped in a common culture with commonly held values. They train and drill, following precise, written guidelines. They have clearly delineated ranks, responsibilities and reporting lines. They have a clear definition of winning, such as points on the board or territory won and held.
How does the degree of alignment in your practice compare with the level of alignment in the San Francisco Giants, who won this year’s World Series? How does your practice compare to the spirit and alignment of the U.S. Army 82nd Airborne Division, which not only fights our wars but also jumped in after the Haiti earthquake a couple of years back to provide humanitarian relief?
Alignment check-up
Take this simple nine-point “alignment check-up,” assigning the following points to each attribute:
+2 We have this attribute in place and do this consistently
+1 We are a bit less consistent than would be ideal in this area
–1 We may have good intentions but no execution in this area
–2 We actually seem to struggle in the opposite direction as this attribute
It is impossible to align a team around an abstract goal. Imagine what a dull game football would be without the agreed object of scoring more points than the opposing team. In your practice, you have an agreed written plan describing where your practice is heading in the future. You keep numeric “score” by measuring visits, cases, profits and other success metrics where everyone on the team can see them and agree on what constitutes a “win.”
Goals can be spongy, squishy things, difficult to nail down and easy to lose sight of. Accordingly, great alignment comes from constant reiteration of the practice’s vision, values, mission and objectives. Just as the world’s most enduring religions have created repetitious verses and chants to align their adherents, the most enduring practices think big and curate a portfolio describing what they believe in and wish to accomplish in the world.
Most businesses are run as a democracy, with those in a leadership or ownership position periodically holding discussions and arranging formal votes. While some votes may be unanimous, it is not unusual to have two or even three sides and to have a split vote. In strong, aligned practices, after the votes are tallied, everyone gets behind the agreed action, even if they voted against it.
Aligned teams face up to and agree on the most pressing problems and opportunities. You could hand out blank sheets of paper to each member of such a practice team and instruct them to write down the top three challenges of the new year. The results would largely overlap and agree.
Practice teams — strong ones — have something akin to the body’s immune system when they come across people who are not going to fit in. If this is present in your practice, you might say, “We have such a tight team that anyone who is not good at the give and take of ‘group think’ would simply not fit in.”
“Continuous improvement” can be one of the most powerful company values driving alignment. Even if big-picture, long-term goals are a bit fuzzy for everyone in the current ophthalmic world, getting everyone to agree on what “better” would look like in the here and now, and then making slow gains to such ends, can encourage a group and get members in sync.
Do you truly have a well-aligned practice, or do you really have a practice composed of cowards who are unwilling to communicate so completely as to unmask the happy talk and pseudo-alignment, revealing (and then dealing with) the underlying discord? The most aligned practices value full disclosure, non-defensiveness and transparent communication. An outsider watching such a board or department meeting, complete with the occasional swearing and tears, might think such radical honesty is a sign of discord, but it can actually be a sign of powerful alignment.
It is a lot easier to be aligned with people who you like rather than with people who you do not really click with. It can simply be a matter of great chemistry, or common interests or backgrounds. All business aside, you will get and stay more aligned if the members of your team are interpersonally compatible.
Of course, speaking at the level of the individual, it is hard to get behind your practice’s vision if it does not align with your own professional goals and life ambitions. It works beautifully when a provider who enjoys mission trips happens to work in a practice that values giving back to the world and affords its doctors ample time off.