Your Practice Shouldn't Depend on You: Building Operating Systems That Work—Even When You're Not There
A practice should not depend on the owner or any one employee to remember how the business works. Yet many healthcare practices operate exactly that way. An employee has a question, so she asks the owner. A patient needs to be fit into the schedule, so she asks the owner. The schedule falls apart, an employee calls in sick, a payment issue arises, or two team members disagree about how a task should be performed, and once again, the owner is expected to provide the answers.
Healthcare professionals are particularly vulnerable to this problem. In many cases, the primary provider is also the business owner, which creates an interesting conundrum. The provider must perform sensitive procedures while simultaneously managing multiple fires. As the primary provider, this person cannot directly supervise employees throughout the day. So the big question is: How do you manage and coach a group of employees when you have to be doing the work?
The solution is not to work harder, hire an employee who somehow knows everything, or simply hire an office manager. An office manager cannot effectively manage if employees keep bypassing them and coming directly to the owner for every decision. The solution is to build operating systems that allow the practice to function consistently without depending upon one person to tell everyone what to do.
The Owner-Dependence Trap
One of the easiest traps for a practice owner is becoming the practice's chief problem solver. It can even feel productive. You know the practice. You can make a decision quickly. You solve the problem, everyone gets back to work, and the day moves on. You are the last word. But what happens the next time the same problem occurs? If the answer is, “Ask the owner,” you haven't solved the underlying problem. You have simply solved today's version of it.
The same danger exists when a practice depends too heavily upon an experienced employee. Every practice seems to have one: the person who knows where everything is, remembers how every unusual situation was handled, trains new employees, fixes mistakes, and answers everyone else's questions. Owners often describe that employee as “indispensable.” That should be a warning.
Knowledge that exists only in one person's head belongs to that person, not the organization. When that employee retires, resigns, becomes ill, or simply takes a vacation, the knowledge walks out the door with her. Systemization allows a practice to retain the knowledge of how the business operates rather than losing it when an employee leaves. Operating systems never show up late for work, call in sick, take vacation, or become involved in office politics. They can, however, be ignored and become outdated. A well-managed practice develops capable people, but it does not make the business dependent upon any one of them, including the owner.
What is an Operating System?
An operating system is a documented, repeatable method for accomplishing an important function of the practice. It establishes what should happen, who is responsible, how work moves from one person to another, what outcome is expected, and how the process will be monitored and improved. A checklist may be part of a system. A written procedure may be part of a system. But neither, by itself, creates a functioning operating system. A successful system requires clear responsibility, documentation, training, implementation, accountability, measurement, and continuous improvement.
A straightforward process for systemizing a practice begins with the team documenting how a process is currently performed. Discuss it together, revise it, and agree upon the best process. Assign responsibility for training. Establish an implementation date. Make the system easily accessible. Then use it to train new and current employees and to troubleshoot problems.
The objective is not to create a binder of procedures that sits on a shelf, ignored. The objective is to create a practical, repeatable reference for how YOUR practice operates. Every practice performs duties differently. It doesn't matter how much experience someone has; employees must learn how to perform your systems the way your practice has agreed they should be performed—not simply the way they performed them somewhere else.
Systems Turn Intentions Into Behavior
Most practice owners have good intentions. They want excellent patient care. They want employees to communicate well. They want a positive workplace culture. They want patients treated consistently and team members to accept responsibility. But intentions don't create consistency.
A Mission identifies why the practice exists and what it hopes to accomplish. Team Commitments establish how employees have agreed to behave while accomplishing the Mission. Workplace culture reflects what people actually experience every day. Operating systems turn those intentions into consistent action.
A healthy practice culture is one in which management, operating systems, strategy, Mission, and employees are aligned around an exceptional patient experience and the long-term sustainability of the business. That alignment requires clear expectations. And clear does not mean, “I told them once.” Expectations must be written, discussed, repeated, measured, and consistently reinforced.
Suppose one of your Team Commitments is: “We communicate clearly and respectfully with our patients and one another.” That's a worthwhile commitment, but how does it happen at 10:30 Tuesday morning when the schedule is running behind? Your operating systems provide the answer. Who recognizes that the practice is behind? Who communicates with waiting patients? What does that person say? Who determines whether the schedule needs to be adjusted? How does the clinical team communicate with the front desk?
Without a system, employees improvise. When ten different people improvise, you may get ten different results, many influenced by the emotions and pressures of the moment.
Everything Is Connected
Operating systems do not function in isolation. Consider something as simple as scheduling an appointment for the wrong amount of time. The mistake doesn't remain at the front desk. The provider runs behind. Other patients wait. Clinical employees become frantic. The front desk deals with frustrated patients. Stress spreads throughout the practice. One weak process can affect patient experience, employee performance, productivity, financial performance, and workplace culture.
That is why every practice needs a foundation of interconnected operating systems designed with input from the entire team, using best practices and sound customer-service principles, and then trained as a team. Training only one department or one person accomplishes very little when a system crosses departmental boundaries. Most operating systems affect more than one person, and often more than one part of the practice.
Depending upon the type of healthcare practice, foundational systems may include scheduling, financial management, practice monitoring, compliance, practice development, team development, and communication. Within each category are smaller processes. A scheduling system, for example, may include procedures for scheduling appointments, handling no-shows, managing late patients, filling unexpected openings, running morning huddles, and communicating appointment information. Team-development systems may include hiring, job descriptions, performance evaluations, team meetings, an employee handbook, daily responsibilities, Mission, and Team Commitments.
The objective is not bureaucracy. The objective is predictability, consistency, and knowledge retention. Patients should not receive dramatically different experiences depending on which employee answers the telephone. Employees should not have to guess their responsibilities. Routine operational decisions should not require the owner to stop providing patient care to resolve them. Patient questions should not be answered one way by one employee and another way by someone else.
When Something Goes Wrong, Look at the System
Perhaps one of the most valuable habits a practice owner can develop is resisting the urge to immediately ask, “Who made the mistake?” Ask another question first: “Let's review this system and see where things went wrong.”
When mistakes occur, examine the system first and revise it when necessary to prevent the same mistake from recurring. That does not mean employees are never accountable. There is an important difference between an employee who fails to follow a good system and an employee who has been expected to succeed without one. A leader needs to determine which it is.
If the system is clear and up to date, employees have been trained, responsibility has been assigned, and someone chooses not to follow the process, that is a performance issue. But if responsibility is unclear, the process was never documented, training was inconsistent, different employees were taught different methods, or the system itself has been ignored for years, blaming the employee will not fix the business problem. Fix the system, retrain the entire team, and measure the result.
Build a Practice That Can Work Without You
The goal of systemization is not to remove judgment, creativity, or human connection from healthcare. Nor is it to remove the owner from leadership. Quite the opposite. Good systems allow the owner to lead instead of constantly rescuing. They empower employees to take greater responsibility for day-to-day operations while the owner retains oversight. In a self-managed team, the owner's role shifts toward that of CEO: employees monitor results, identify problems, recommend solutions, assume responsibility, and report outcomes rather than waiting for the owner to provide every answer.
That is not a loss of control. It is wise and realistic management. A provider/owner cannot produce and manage at the same time.
The ultimate test of your operating systems is simple: What happens when you aren't there? If routine decisions stop, employees don't know what to do, patient experiences become inconsistent, or everyone waits for you or one indispensable employee to return, you don't have a people problem. You have a systems problem.
A successful practice should benefit from the talents of its people without depending on the memory of any one of them. Build the systems, train the people, measure the results, improve the processes, and create a practice that can operate even when you are not in the room.
