Controlling a Controlling Business Manager

Question to Ask the Workplace Doctors by an MD who owns a large practice but has a business manager who maintains control by keeping information to herself: She doesn’t always show up, and when she is gone, we are in a financial pickle. Please help me.

I am a doctor and own a large practice. The business manager is very controlling and won’t show anyone else how to do her job. She got a new billing system and has all the codes and won’t permit anyone else to use it. She doesn’t always show up, and when she is gone, we are in a financial pickle. Please help me.

Signed, Need A Prescription For Our Business Manager

Dear Need A Prescription For Our Business Manager:

Apparently, your business manager has learned how to be indispensable. And you are allowing her to be so. I don’t know if she needs a dose of honey or vinegar, or if you should give up your large practice. Of course that’s easy talk to come from a distance. Seriously though, have you confronted her with the problem? If not, isn’t it past time to engage her in the need for cross training and in discussion of the success/failure of your practice?

Let’s suppose your practice was akin to a professional ball team, and the coach had made herself indispensable by scheduling when and where and means of travel and had that logged that in a secret code, and then was so sick she couldn’t talk. That too would be a financial pickle. Could it have been prevented? Yes, if the owner/manager had engaged the coach and assistant coach and business manager in talk about what was necessary for a winning season. Obviously professional teams don’t get into the playoffs and benefit from income that comes from that unless all who work for the owner see themselves as stakeholders in that sports enterprise.

In short, you need more than a two-minute time out with your office manager. You need a skull session that engages her in spelling out the policy and rules that make your practice survive and thrive. That doesn’t mean you come on as a demanding boss, but that you make clear how you want your practice to function and that you want her to be a team player, which adds value to the practice. Ideally to do that she and you and important staff member should collaboratively hammer out clear job descriptions and the do and don’t rules about how you communicate.

One of those rules should be cross training and another should be two-person check on money coming in and going out. Also you might evolve a system for providing bonuses for improved performance based on lean management efforts. I’m copying my answer to your query to my friend who heads up an Operations Excellence Center for a very large children’s hospital. His Center trains and engages the many departments within the hospital in ways to improve their efforts to deliver quality health care efficiently and effective. Should he have advice to add to mine, I’ll forward it to you.

Organization is an ongoing process and that is what you are doing when you confront what doesn’t work, such as a business manager keeping billing codes to herself. I know your chief concern is patients, but a big practice requires developing policy and rules for those who make it hum. And working to this end will take more than one skull session. Much more could be said, but the essence of what it will take is embedded in my signature sentence: Working together with hands, head, and heart takes and makes big WEGOS. Please update me on what you do and how it works after a few weeks.

Second Opinion: As I mentioned, I was copying your question and my advice to a friend who heads up a Center for Operations Excellence of a large Children’s Hospital. He sends these remarks: Dear Doctor, I agree with my friend’s response. This is a normal trait of what we identify as a “command and control” manager. They believe that they must hold all power to be successful. In today’s healthcare environment, many organizations are transforming the managers into leaders. Ken Blanchard describes this transition as someone going from managing or hold complex business process back to someone that conforms to change. They allow their teams to grow and take part in the business activities.

As the owner of this large practice I would challenge yourself to take part in the business manager’s transition. Use the two-minute time out to develop a strategy for her success as a leader and not a manager. Develop a 30, 60, 90 road map where they define and write the business process, have them train the process to others within the practice and have them be engaged in your organization’s success. Just because they give up some of the day-to-day control doesn’t mean they are not needed. You need them to be a system builder and developer. Good luck with their transition. –Doug Dulin, Akron Children’s Hospital

William Gorden