Why making timely and better decisions is important

For Practice managers and Clinician in the business of operating more sustainable Health
Care Practices

For many years I have been fascinated in the process of making decisions in business. I have learnt that if this skill is developed then enormous time can be saved/gained and productivity made rather than seeing paralysis by “over analysis”. The formal discipline of decision analysis has a rather turgid definition, sourced from a modification of a definition from Investopedia: “Decision analysis refers to a systematic, quantitative and interactive approach to addressing and evaluating important choices confronted by organisations in the private and public sector. Decision analysis is interdisciplinary and draws on theories from the fields of psychology, economics, and management science”.

Well, that is a mouthful so let me distil my thoughts about making decisions into six words that cover what I suspect are the key considerations.

Knowledge:

Over time one gains knowledge about finance, human resources, time management, team building and assessing what is truly important. This knowledge is crucial in the process of making decisions. Work on building your knowledge base.

Team:

Understand the capability of your team. We all have strengths and weakness. Some speak a lot and achieve little and other don’t speak up enough and contribute to the discussion. Assist them by putting them in the position to make decisions and even if they are wrong they will learn to make better decisions next time. The only bad result is for no decision to be reached!

Wisdom:

None starts with wisdom. Wisdom is the synthesis of experience, knowledge, judgement and learning. It is gained over time. Assist you team to explore how they may gain wisdom and that it takes time. Greater wisdom will lead to better decisions.

Confucius once said: “By three methods may be learn wisdom. The first by reflection which noblest, the second by imitation which is easiest and the third by experience which is the bitterest”.

Execution:

Sometimes just doing it is required and sod the consequences. There are always consequences so being aware of both the negative and positive consequences need to be outlined/discussed with those making decisions.

Confidence:

Being confident will help with the delivery of a decision and convey a sense of being in control. There are negatives with over confidence so beware how the message of the decision is delivered

Learning:

Establish the environment of learning with your team. Make sure you direct them to important books, articles etc to learn from and ensure that you regularly follow my aphorism of “teach don’t tell”. Empower them by advising that you want good decisions made and that you will help but at the end of the day they should use their judgement to move forward and act when they feel they have the resources to make the decision.

Remember that unless you assist them to develop this skill you will end with a beautifully coined phrase by one of my leading managers, “needlepoint management”, where all decisions end up coming to you to make… a sure sign of a dysfunctional working situation…

To see how I may be able to assist you with your Health care Practice

How to delegate in a way that doesn’t undermine your team

Leading a team means you will invariably have someone or several people reporting directly to you.

The most important thing is to get the best out of your team members.  This does not imply that you must constantly be directing them or chastising them when a job is not done to your satisfaction.  The mantra of “others never do the job as well as I can, so it is not worth teaching or delegating to them, is part of the reason that team leaders often fail to get the best from their team. This “I will just do it myself” attitude renders them unable to build a strong and productive team. Instead, the leader must forego their ego and accept that the delegation process can be slow, acknowledging that at first they may have to receive work that may be at a lower level than their own.

Delegating tasks is a crucial part of achieving an objective and to developing strong independent workers who make decisions with confidence and authority,  instilling greater competence and growth within them.

This said, it is still important to find the right balance of delegation. The lowest level is to tell somebody to do something and report back immediately. This base level delegation  is common in parenting when teaching one’s child to be more independent. In contrast, the highest level of delegation is to trust your team to make decisions and report routinely about progress and outcomes.

My biggest bug bear with watching leaders delegate is to see them constantly undermining those in their team. This includes asking them several times about progress or even chasing up others to see if the task is done.  Finally, what really irks me is when the leader has their direct report delegate a task/message to a subordinate, and the subordinate, unhappy with the task, bypasses the authority of the direct report and contests the leader. The issue then arises when the leader grants the subordinate's request without reference to their direct report. This is a breakdown in communication that shows little respect towards the direct report by both the subordinate and the leader themselves. This often leads to a lack of trust, unhappiness amongst team members and in a lot of cases, resignation.

The fabric of leadership is a fickle one, and the onus is on all parties to maintain balance.

Be Efficient with things but effective with people!!

I constantly meet Managers and others who have difficulty getting the best out of the people they work with and those who report to them.

I also meet people who are tremendous workers and their productivity with the “things of the job” is outstanding but…….

Effective with people

Over time I have realised that some people are naturally effective in their dealings with people. They seem to be able to get the best out of people, are well liked and manage their team very well. Such people instinctively adopt a position of being effective…

This means that they:

• Take time to explain things to people
• Use the “right time” to interact with people ie when someone is unhassled and not likely to be interrupted or in the middle of something
• Schedule meetings effectively
• Are generally kind and positive in their dealings

Efficient with things

Being Efficient always relates to things:

• Do the accounts before time,
• Reply to email quickly,
• Process mail quickly.

In all these instances the object of the work will not be upset at how it is dealt with, so efficiency rules. Those who are good at this too  often try to be efficient with people and it doesn’t work….just think about the last time you were speaking with somebody and engaging with them, eye contact, good body language and they are talking with you while they take messages or look at the phone.. they are trying to be effective and efficient and it doesn’t work! Even worse they don’t know why it doesn’t work!

In the world of work, we need to be both efficient and effective. So to be both just make sure you do your best to not be efficient with people as this is a pathway to ineffective management of people and interpersonal interactions with anybody.  

How Do You Work With Your Team To Assist Then To Improve Their Performance?

We often hear about people having a performance appraisal……In my experience this invokes fear, discomfort or even the notion of “we suggest that you add value somewhere else because you are not adding value here…”

Performance appraisal should be about improving performance and be for the benefit of the individual. It should never be about putting someone down or rubbing their nose in areas where they may have done better. In my experience these necessary procedures should be called “how to be better at what you do”. Consequently a number of strategies should be employed when assisting your people to grow and improve the work they are doing. It might help to consider that you are always working to assist improvement and thatyou just do this often and informally (with feedback), then more frequently and a little more formally (assessment)  and then with a more structured formal event (review).Thesethree methods that can be used to assist your people in their performance, so let’s tease out some more detail.

FEEDBACK

Feedback should be provided regularly and informally. By often we mean several times per week or in the early stages a couple of times per day. Try and ensure it is provided in the first person with many “I” messages. An example of this may be “when I was stuck for the best response to make to a difficult patient I used to restate what I perceived them as saying……..”.

 It is never good when you hear “you should have done…….”. Providing an observation is a good way to minimize the reaction and will often produce a quick dialogue, ideally this observation should be factual and objective, not judgemental. Once again an example “I have noticed that when you take a client from the waiting room that eye contact is not being made and a smile will help to create instant rapport”. Try and invite a response as this may remove any unwanted over reaction and build positive communication. Always start with a positive comment. We say that even if the only thing you can come up with is “I like your shirt/dress today..” then that is a good start.

ASSESSMENT

Making an assessment of progress is a more formal activity and should be done with some but short notice. This sort of activity may be used weekly or every couple of days at commencement and will involve sitting down out of ear shot of others and when both parties have the time to be productive. Time allowed for such activity should be around 15 minutes. Similar types of approach to feedback as mentioned above but the following factors make this interaction more structured:

Provide objective and non-judgemental feedback and invite a response
Impart details regarding why an action is appropriate/inappropriate e.g “maybe it is a good idea to go out of the room while the clients gets dressed”

Offer suggestions or provide directions or alternative actions if required
Provide resources to assist behaviour e.g an article about a topic like e.g“empathetic listening”. The reading of the resource prepares the person for the meeting
Provide personal demonstration of desired action
Role play. We cannot urge you enough to use this activity as a learning tool. In this way you can help your personnel to see a situation from another point of view.

QUARTERLY AND ANNUAL REVIEW

This type of activity is something that is formal, structured, has preparation required by both parties and done at distinct and scheduled times in advance. We suggest annually when a detailed plan is prepared and hopefully able to be measured against some KPI that were set at the time the person was engaged to work. Hopefully such KPI’s will be a mixture of qualitative and quantitative

People can be very poor at setting objectives and need much assistance. SettingS.M.A.R.T objectives when someone starts work that they create and own will assist with the review when it happens. 

• Specific
• Measurable
• Achievable
• Realistic
• Timely

See what difference you can make in your team by following some of the simple advise outline above and good luck!

In Business Coaching, Business Education, Michael Kenihan, Business Tags improve, performance, team, goals

Building Business Capacity in your Health Care Practices

Most of us have visited health care practices. We visit expecting a service and generally judge the practice on how friendly the staff are, how the facility is presented and on the "feel" we get while waiting for our visit. Generally speaking we have little ability to judge how good the advise or treatment we receive is and whether one clinician is more technically effective than another. We just know what we "feel" about what we have experienced and if we "feel" listened to and engaged with we are mostly happy. I have highlighted the word feel because when receiving a service that is how we judge that service not on the technical competence that may be delivered.

How then does this relate to business capacity in health care practices?

It matters because what a business needs is the engagement of their clients whom they hope will become advocates for that business. Such engagement may need to be something that we train our people to deliver, both from staff and the clinicians. Technical ability is assumed by clients so by paying attention to the feel good factor we will build business capacity.

How to assist your people for better results by mentoring and teaching them what matters!

The Mentor

Over the years I have mentored many practitioners. I am aware that to develop your people takes time and patience as well as a consistent approach where respect, mutual expectation and understanding are built. The primary role of the mentor is to assist others to improve performance and grow professional! The role is about providing feedback and developing a relationship upon which trust will grow. With trust, your ability to be an effective mentor will be enhanced. Do not have the expectation that because you have authority people will listen or engage with you as this is a mistake. A mentor mentee relationship is one of mutual respect.

Spending time on this role is the key to the development of a successful, sustainable and profitable practice as it is by the work and engagement of those who work with you that your practice will grow and thrive.

One needs to have some credibility to be a competent and effective mentor. In a service business, be it in health or another industry, having some “runs on the board” is essential. In other words having been a practitioner yourself who has had to grow a practice, has had to develop a referral base and who has taken the opportunities for professional development will be the “runs on the board” I speak of. To make engagement effective it helps to have “real life stories and experiences to draw from. These will assist you to add value and gain the engagement you will need. As we have stated respect comes from the development of trust.

This will come from:

• Meeting commitments
• Clarifying expectations
• Open and honest communication.

This communication from you will be both caring and supportive and at times more courageous where you deliver clear and honest messages about perfromance.

Teaching

The need for training does not imply that those you engage have not had some formal teaching or technical training. Depending on the experience they have had and the time since they graduated from their academic education they may bring many skills and abilities to the business. There are however many aspects that will be underdeveloped particularly in the commercial and business domain. Most colleges and universities do not prepare people in an understanding of appropriate commercial behaviours one needs to be successful in any private practice. Having technical knowledge does not always mean that practitioners understand clinical reasoning and how to manage their patients and practice. There is a difference between treating patients and managing them.

Teaching Resources

We can recommend that you develop some sort of directory that stores the teaching resources that you will develop yourself, acquire from other places and maybe even engage a consultant to develop for you. One method of managing such resources is to develop and intranet that sits as a private part of your web site. An intranet is secure for your people to access via a password and when administered well will assist you to keep your documents up to date. An intranet is a living thing and needs to be updated and developed regularly so it is current for the day. Your aim is to develop greater independence in your practice culture.
It is important to create a clear table of contents so the relevant documents can be accessed quickly and easily. This can also be facilitated by having a search function as part of the system. Categorising the documents is also necessary. Think of the broad areas that will need to be taught such as:

Clinical and Commercial documents and then sub categories thus:
- Relationship Marketing
- Patient management
- Forms and policies i.e leave forms, sexual harassment policy
- OH and S manual
- Procedures i.e stock system, billing procedures, item analysis etc
- Practice building and growth
- Leadership and management

The task may seem onerous to develop a good teaching system but take your time and try and add documents sequentially and you will get there!

Key Points To Remember

• Set the agenda for discussions
• Make the time to meet regularly
• Create and understand mutual expectations and ensure they are met
• Make sure the objectives they set are theirs and not just what you want
• Help them develop a formal plan including their clinical and commercial objectives
• Illustrate with lots of stories from your experience to make the time you spend more interesting and engaging
• Develop some teaching resources that will assist them with learning about the importance of commercial success

Business skills help to build a sustainable private practice

The following is from NAB's Business Research and Insights

Poor business skills can limit even the best healthcare practitioner’s ability to earn a good income and build a sustainable career.

“I know of incredibly skilled and experienced people who have left their profession because they couldn’t support themselves and their families,” says Michael Kenihan, General Manager of LifeCare Health, Australia’s largest network of allied health and sports medicine practices.

Frustrated by this waste of talent, he was inspired to share the skills he had acquired during his own varied and successful career. He established LifeCare Business Mentoring to help up and coming clinicians then, when results confirmed the practical value of this kind of support, he co-founded Knowledge and Learning Solutions International (KALSI) to make education and mentoring available online.

FOUR BASIC PRINCIPLES

LifeCare Business Mentoring is based on the principles of clinical excellence, commercial success, cultural leadership and customer service.

“We constantly remind people that private practice isn’t just a clinical pursuit, it’s a business pursuit,” he says.

The program covers all aspects of business from developing a strategic plan and financial management to leadership skills. It also teaches commercial behaviours.

“These days being technically capable isn’t enough – people expect as high a level of customer service from a practitioner as they do from someone in retail,” says Kenihan. “If you don’t make the effort to build a rapport with your patients they’re unlikely to come back, or to help you build your business with word-of-mouth recommendations.”

AN AFFINITY WITH SPORT

A former South Australian high jump champion, Kenihan trained as a physiotherapist after a severe ankle injury prevented him from competing. As a clinician, he treated over 30,000 patients, including the Richmond Football Club AFL team, before turning his attention to creating, developing and operating private healthcare practices. He is also a past president of Sports Medicine Australia

“I’ve found that the same principles apply in business as sport,” he says. “For example, your technical skill is the foundation of your success but you also need to focus, work hard and function well as part of a team. And, whether you’re a cricketer or an osteopath, you need passion and commitment to what you do.”

He also believes that every venture starts with a clear goal.

“As a high jumper, I used to sit on the track visualising how I was going to get over the bar,” he says. “Now I encourage practitioners to visualise exactly what they want to achieve in their career.”

FIVE TIPS FOR BUILDING A SUSTAINABLE PRACTICE

1. Don’t expect too much too soon. “The first couple of years are about learning, not earning,” says Kenihan.
2. Be prepared to work outside regular business hours so that you’re available to your patients when it’s most convenient for them.
3. Observe more experienced practitioners at work whenever you have the opportunity.
4. Be prepared to spend time building and maintaining good relationships and strategic alliances with people who can refer patients to you.
5. Make the effort to build rapport with your patients. Even little things, such as addressing them by name, smiling at them when they first come in and taking them back to the reception desk to arrange future appointments, will help them to feel confident, comfortable and well cared for.