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Monday, June 7, 2010

Six ways to communicate better with your administrator

The TransforMed medical home National Demonstration Project (NDP) had a breadth of practice types. Our practice is a "satellite" family medicine clinic with three family physicians. We are part of a regional 250-provider multispecialty clinic. This gave us some advantages (such as already having an electronic medical record) and some disadvantages (like having to go through a lot of bureaucracy to get new projects approved). Communicating effectively with other members of the health system, particularly administrators, became crucial during the NDP. We found some simple steps to help us:

1. Do as much as you can locally without involving the system. By this, I do not mean be deceptive. We simply found that if we could do easy things -- like scheduling team meetings, running an ad in the local paper or surveying patients -- without involving our marketing department or directors, things would get done much faster. This often meant that more physician time was spent on the task, but in the end, the overall efficiency warranted the time spent.

2. Be direct when asking for approvals. Like physicians, administrators are busy people. It is often helpful to have a quick "elevator speech" ready to deliver when you find yourself crossing paths with your administrator. The elevator speech is essentially a 2-minute pitch that summarizes your service or project request, why it is important to the administrator and what action the administrator needs to take. The speech should be very specific, and you should always follow up on the action to ensure it gets done.

3. Listen and establish common ground. Listening requires you to clear your mind and really hear what the other person is saying. Too many times, we are busy formulating a response to the speaker and don't truly listen. It is by listening that physicians can understand better the administrator's operating premise, which is usually quite different from the physicians' perspective. Physicians tend to operate by doing what is best for patients, where administrators are charged with doing what is best for the business. These two basic operating premises are often at odds, but we can learn from one another and find common ground if we truly listen and seek to understand one another's perspectives.

For instance, in studying our immunization rates for patients with diabetes, we were stunned to discover that more than 50 percent of eligible diabetics had not received recommended immunizations. Other NDP practices were using a registry software product that mined the electronic medical record for such data and printed a point-of-service list of services due. We thought using this software would easily solve our immunization problem. We approached our IT administrative team with the request. Five meetings later, we came to understand that the administrative team was blocking our request due to concerns over software incompatibility and cost. From our perspective, the most important consideration was patient care. We did not want one of our patients with diabetes to contract pneumonia and land in the hospital. However, from the administrative side, the most important consideration was that our little project did not crash the system. Once we came to this understanding of each other's perspectives, the IT team was able to show us how to use our existing EMR to perform the registry function we needed.

4. Reserve adequate time for communicating. Good communication takes focused time. Physicians are notorious for running on a continuous, unfocused, multi-tasking hamster wheel. However, we need to slow down from time to time and spend time together listening and problem-solving, at least for large issues. Though most physicians I know dread being summoned to an administrative meeting, these meetings should give both administrators and physicians time to focus on the matter at hand. An even better scenario to allow increased focus would be to ban cell phones and pagers from these meetings. (I'm dreaming.)

5. Run meetings effectively. Respect all meeting attendees' time by sending out an agenda and supporting materials for consideration prior to the meeting. Start the meeting on time, and follow the agenda. Make sure to delegate tasks or action items that come out of the meeting, and follow up on those items with progress reviews at pre-determined intervals. Also, take good notes. You don't want discussion items or actions from one meeting to be forgotten by the next. A lack of follow-through will send a message that members' time and efforts are not respected and appreciated.

6. Take immediate responsibility. Problems should be identified, explored and resolved immediately. Ignoring problems and letting them fester leads to passive-aggressive and counter-productive behaviors. Physicians and administrators both need to own up to problems or failed initiatives and work together using good communication techniques to change course or correct problems.

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About the Author

Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.

Note: This blog is no longer updated; this is archived content.

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Real-Life Practice Transformation is a Family Practice Management (FPM) blog. However, the views expressed here are those of the individual authors. They do not necessarily reflect the opinion of FPM or the AAFP. The FPM blogs are not intended to provide medical, financial or legal advice. For more information see Terms of Use.