Episode 24: Successful Practice Manager = Successful Practice

Many great sports professionals led their teams to championships as players but were unable to coach a team when they didn’t star. Likewise, a practice administrator could be incredibly detail-oriented and organized but ultimately fail without coaching to fill gaps in social skills and managerial style. Cheryl Toth, a consultant for Karen Zupko & Associates and creator of Medical Office Learning Lab, discusses how the admin side of medical practices can follow suit if they lack sufficient coaching for their practice managers.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans and many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together and here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your Paradigm Shift.

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts here today with my co-hosts, Jared Johnson and Scott Zeitzer. On today’s episode, we’re talking to Cheryl Toth. Cheryl is the founder and creator of Medical Office Learning Lab, a marketplace of online courses and training experiences for physicians, manager, and practice teams. She also works as a consultant for KarenZupko & Associates. We had the chance to meet at the Ortho Summit just this past month where Scott and Cheryl were both on a panel to talk about achieving and maintaining success in the practice. Cheryl, thank you so much for coming on the show.

Cheryl: Thanks, Michael. I am very honored to be here.

Scott: Yeah. You know, I think everybody would like to know a little bit, if you don’t mind, tell us a little bit more about Medical Office Learning Lab and your role at KarenZupko & Associates.

Cheryl: Sure. Well, Medical Office Learning Lab is brand new. It’s a marketplace of online courses and trainings for practice teams, for physicians. As it grows, we’ll have courses whether those be online live classes taught for example, on the Zoom platform over eight weeks or OnDemand courses on a course platform, there will be topics that range from soft skills like coaching which we’re talking about today, and management, and business communications, as well as revenue cycle, coding, marketing, operations management. And I fully expect that we’ll have multiple experts, subject matter experts and nationally recognized thought leaders teaching those classes.

Scott: Yeah. Which is really great. Before we got on the podcast, you were talking a little bit about how we’ve got a lot of practices with which we work and somebody gets promoted to be the practice manager, and they were like, “Man I’m excited, but I have no idea what I’m doing here other than making sure the patients are seen on time.” So this kind of stuff is gonna be awesome.

Cheryl: I think so because in my many years of practice in management consulting and working onsite with practices, that’s exactly what would happen. You know, at KarenZupko & Associates, we’d identify the need for a manager who is a real diamond in the rough, or a new…like a supervisor that moved up to administrator or manager, and we’d say, you know, this person needs, they need some writing skill improvement, they need to understand financial management, they need QuickBooks training, whatever. And where do you send them? I mean, other than of course, QuickBooks training, you can get that. But where is there a place for people to cost effectively and comprehensively get training on how to manage an office? So just…there just isn’t that much out there.

Scott: No. There really isn’t, you know, there’s no like, “I’m gonna go to school and become a…I’ll get a practice manager degree.” It just doesn’t exist.

Cheryl: You can go to workshops at conferences and MGMA, and those are fine. But they’re really just, you know, maybe one hour, a couple hours, maybe a day. And then you go back and you receive all this information but you don’t really get the true training, learning, and get to practice, and then go back to your class and say, “Well, jeez. What worked? What didn’t,” you’re dealing with. So hopefully Medical Office Learning Lab is going to fill that gap.

Scott: Yeah. That’s gonna be awesome. How does that fit in with just the whole KZA, Karen Zupko & Associates, that role?

Cheryl: Over the years, I’ve been a consultant and trainer for Karen Zupko, as well as I’ve run healthcare technology companies and I’ve worked with hospital systems. And in all of this, I’ve just seen the lack of the need because of the lack of access to cost effective training and also kind of the lagging of healthcare to move toward things that are using digital learning technologies. So where the tie in I think is with KZA is that we see managers, and staff, and physicians as well, especially those just getting started in business, in their practice needing this kind of training. And when you’re consulting, you’re diagnosing and you’re helping with an implementation plan, and as a consultant you can help implement. But the training piece is just kind of missing.

At KZA, we do offer professional development services. We have a service line that includes coaching, business management coaching. I actually do that piece. We teach DiSC training which, I don’t know if you’re familiar with that, it’s a work style analysis and assessment based on the work of William Marston. It’s used worldwide and we use the perception to work-style assessments. So we do training there to help people build teams, hire better, that sort of thing. And we also have skills sharpening services as well. So I think all this fits together because it’s just one more way to help managers and staff develop their team, develop themselves and their team.

Healthcare Administrators as Coaches

Michael: Absolutely. Cheryl, when we started putting together this idea of having you come on the show, one of the things that we talked about was just what topic specifically we could be talking about and you very quickly talked about your passion around coaching. And we’ve had somebody on the show before that talked very much about healthcare administrators, you know, like in large hospital systems or helping physicians move from that just a physician mindset to becoming more of a leader in the company. But you specifically had more of an angle around office managers, office administrators was kind of the way that we wanted to talk about for you in particular. And so I found that to be very interesting. And so Scott and I were talking a little bit about this whole manager versus coach concept.

Scott: I find it fascinating. I wanted to bring up that whole sports analogy thing where Babe Ruth possibly one of the greatest baseball players of all time, I get it. I always think he was, but he was never considered a great manager. Because I remember one of the jokes and he was serious was that he was managing a team and there was a guy on first base and he went to the player who was about to go at bat and he’d go up to bat. And he basically said, “Look, go hit a home run and let’s win this thing and leave.” And the player looked at him like he was out of his mind. Now, Babe Ruth in his prime could go up and hit a home run. But I don’t think that’s the way that that works and I kinda wanted to get your feedback about that, about how different that is when you’re between being like the person who could do everything, the superstar who just gets it done, versus managing a group of people. A big difference.

Michael: And really coaching them. Yeah.

Scott: Yeah. Coaching them as well.

Cheryl: Yeah. And in a minute, let’s talk about what coaching really is. But before we do that, I think that, Scott, it’s a great analogy for this new… I don’t think it’s really trickled down to healthcare yet, but it is a new trend. And all the data are showing that moving from a manager mentality into a coach mentality is really, the time has come because where we’re at today is that most managers are like Babe Ruth. They are in that manager role because they started with some sort of technical skill, oftentimes in a doctor’s office, they were a front desk supervisor, or they were in the billing team, or that they were high performers, and they had this subject matter expertise. So they get migrated up to manager and they’ve been doers and experts.

And so the manager mentality becomes tell, direct, show, make sure people do stuff on time. But where we’re shifting is to this coach mentality which is completely different. It’s to support, and develop, and engage, and not judge, and even some of the techniques that we use in coaching, asking open-ended questions, giving feedback the right way, the way brain science…we know from brain science works, not just constructive criticism which doesn’t work. So I think it’s kind of, like, what you’re saying is that Babe Ruth would have been better instead of saying, “Hit the home run,” to say, I don’t know, something like, “What’s the goal that you’ve got? Coming up to the plate, what are you thinking about? What’s your objective here?” That’s more of a coaching mentality than just, “Hit that,” you know, “Aim there and just shoot. Aim over there.”

Scott: Hit it hard.

Cheryl: So yeah. Exactly, exactly. So that’s we’re moving is from this expert role and technical skills to be engaged, collaborative, coaching mentality. And that’s really what a coach should be doing with their staff, with their team.

Scott: You know, doctor’s office is like any other small business. You’ve got a group of people, the physician tends to rely on a particular person. More and more, they see that that person is getting the job done, so to speak. And they say, “You know what? We’re gonna move you into this role,” and, you know, then crickets, you know.

Cheryl: Exactly.

Scott: It’s like, ”Now you’re in charge with this.” And it’s like, “Man.” And that’s part of what really excited me about what you can offer via KZA, Karen Zupko & Associates, and via this platform, it’s gonna be filled with this. This concept essentially of just in time training and that you’re not alone. You know, there’s a lot of people out there who are running practices and they have a lot of great information out there and things that they do that work well for them. And helping everybody kinda connect the dots, that’s gotta be very gratifying when those courses end.

Cheryl: What I like about the online live taught class is because I’ve taught these and I’ve actually been a student in these classes, and I’ve taught this classes. Not in healthcare, in another forum, where you’ve got like, eight weeks. Everybody shows up for two hours on a Zoom platform where everybody… It’s video conference. The cohort is small like, 12 people maybe, maximum 15. Everybody gets to share their experiential exercises. There is some teaching and then in between the weeks, people have peer accountability calls. So what’s happening here is just what you’re saying, it’s not just, “Okay. I’m learning this stuff and here’s how I delegate, here is how I prioritize and set goals.” It’s checking in with each other and supporting each other. And again to tie it back to what we’re talking about, that’s how managers should be thinking about how they optimize or unlock the potential if you will of their staff is support and being there for each other, and keeping them accountable.

I mean, coaching is about performance. That’s why you coach. I mean, you are… There’s a variety of different types of things managers can do. But in the end, it is to improve their performance. But it’s also to improve people’s personal growth. That’s what I find in coaching. It’s interesting how many personal things come up in my coaching sessions with managers then when we resolve them, it helps their professional life.

Who Can Become a Coach?

Michael: There’s a lot of personal…those aspects and attributes that I think when trying to move to this coaching mentality instead of just the pure manager role. Some of the best practice administrators that we get to talk to are like, just so organized, and they’re so detail, and they’re so ready. But I don’t necessarily think of them as the overly sociable people, you know. I don’t think they’re gonna be the one at the cocktail party arranging everybody and making sure that the conversations are going on all the time. So does that, like, sort of social factor play into becoming an effective coach or really can anybody that’s effectively performing as a manager move to a coach?

Cheryl: That’s a good question. Can everyone effectively move to a coach? I’m an eternal optimist, so I like to think that everybody can. You might have some folks do it better than others because it may be more comfortable for others. It’s interesting because when you say social, you know, that really is gets to the heart of building relationships. And one thing that I think over the years, we’ve looked back on management trends in the past decades, you’re not supposed to get personal with people or, you know, women especially. I can say this, you know. We’re not supposed to cry at work, you’re not supposed to show your humanness. That’s all changed. The millennial generation has changed a lot of that.

They want regular feedback, short feedback, almost daily, you know. Data shows they want it at least weekly. So does Gen X, that’s my generation. And feedback and also taking an interest in your employees, I mean, that’s part of being a good manager and a good coach. You can’t just sit there and analyze, and like you said, be detail-oriented and stuff, and be organized. It is part of your role because if you understand people’s personal situation and take a bit of an interest in them, when they’re not performing well, you’ll notice and you…

I had a great physician leader I worked with over…have worked with over the years and I remember sometimes we’d have a call planned. And for the first… He’d ask me how things are going and maybe I had a bad morning. And so for seven minutes, I just go on venting, right? And then I’d say, “Oh, I’m sorry. I’m wasting your time. We only have an hour.” And he’d say, “No, no, no. This is why we have to start this way because now that you’ve got it on your system and, you know, you feel better, now we can get on to work.” So it’s kinda like that, you know. He was a great coach without even trying to be a coach. That’s what good leadership is.

Michael: Do you think that people have a tough time? Just thinking about people that I know who’s like, star performers, they’re very efficient, they’re just used to going in and getting it done, trying to move that mentality where they have to take more time to coach instead of just get it done. How hard of a shift is that for people?

Cheryl: I think it is gonna be a challenge for people because it’s again, not gonna come as naturally to them as others. It’s not that they can’t do it, but they just probably need to have a plan and some support in making that transition. They can certainly do it, but it might be harder because you are so focused on just getting your work done. Probably it’s gonna be harder for you to delegate and let go of things, which is really important for any practice leader to continue to grow themselves. And honestly it’s a gift, delegation is a gift to the staff, you know. You’re teaching them a new skill or something, but you can’t just say, “Here, do this,” and let them sink or swim. You have to keep following up, you have to have regular check-ins, you have to make sure you’ve given it to the right person and guide them. So yeah, I think some people might have a little more of a challenge but they can do it if… If it’s something they truly want to achieve and gain…garner those coaching skills, they absolutely can do it.

Scott: I’ve owned a small business for 20-some odd years now. I started when I was 5, everybody. And yeah, I remember over the years when we promoted somebody, the real win wasn’t simply telling the new person that was just promoted that, “Hey, you can’t do it all. Stop doing it. Delegate it.” It was also for me to take a step back and realize everything’s gonna take a little bit longer now, you know, for the initial say x number of months. Because instead of me just going to whoever that person I just promoted and say, “We just do this,” it’s like, I know that person wants to just quote, “Do it.” But now they’re gonna take some time to train, to follow up, to make sure it’s getting done. The new person that’s doing the new work, they’re excited. They’re getting new skills. And so is the manager in the middle. And I think it’s important for maybe the physicians listening to this, to the new hire that, “Hey, give that new supervisor, give that new coach a little bit of time as well. They’re gonna need that extra time.”

Cheryl: Absolutely. And that’s when we get… You know, when the schedule is brimming and there’s empty seats that we need to hire for and, you know, the physicians are saying, “Why is the AR so high?” you forget that you have to bake in time to your schedule, in your schedule to do that otherwise you’ll never succeed and you’ll become, like, what I would hear over and over when I, you know, from consulting with KZA and we’d go in, and we find out there’s this manager that’s got some great talents, but here she just really can’t get to a leadership role because they’re, you know, they’re still hanging on to doing the accounts payable and some of the other things that are too tactical. Well, you know, in order for them to move away from that, they tried it and they’ll say, “Well, I’ve tried delegating once. It didn’t work. It was just faster if I could do it myself.” You have to bake in the time for the transition. It always takes longer for people to learn new stuff. You have to check in with them daily, weekly, then monthly, whatever till you truly have them fully delegated, but it’s critically important to the success of that.

The Benefit to Patients

Jared: I totally hear you on that, Cheryl, and I think we can think of a lot of different instances where that absolutely occurs if we’re not careful and if we’re not paying attention to that.

I know, just overall, coaching, I think we’d all agree, coaching provides some pretty clear benefits to physicians and managers. And I think we wanna draw a line from there to staff and patients. I think we’d all agree that’s important as well.

What benefit could we expect to see for staff and ultimately patients if more practice managers could shift to a coaching mindset?

Cheryl: That’s a good question. So I guess… Let’s recap first on some of the benefits for the manager. What I find in my work coaching with folks is increased confidence, improved skills and performance, better goal setting, and more personal growth. And self-awareness, I would say that. That is huge. The self-awareness component that comes when a manager has sort of made that coach mindset and is receiving some coaching. Why I wanna start with that recap is that that then trickles through to people. So what we see in a coaching mindset with what happens with staff is that they feel more supported, less judged.

I can think of two managers that I’ve worked with in the past six months that I taught them basic coaching essentials. And when they started using them with their staff, it was just like magic for them. So what they found was they were more engaged, they were less, you know, they showed up on time more often, more frequently, they started to become more, take more initiative, you know, asking for things instead of waiting to be told. Because what these managers were doing as coaches was they were asking open-ended questions, getting people to really think about where this staff person wanted to go with their goals and that gave the staff person more confidence to take initiative, and make changes, and offer new advice.

So that’s what I think about the staff. And patients, of course, if you’ve got a manager who is in a good place and self-aware, and being positive, and the staff are too, and they’re very engaged, now the patients are gonna be treated better. I mean, we’ve all had the experience both as patients and I think all of us working in healthcare to see the front desk person and the billing people that are just like, they just look down and they don’t look…make eye contact or they’re not nice on the phone. Well, when people are happy at their job and they feel engaged, and fulfilled, and heard, and thanked, and appreciated, patient care is better.

Scott: Yeah. It just is. I couldn’t agree more. I remember I was seeing a physician for some check-up and I knew the physician pretty well. And the person essentially checking me in couldn’t have seemed more down, you know. And I was like, “Whoa.” And went in and I’m just talking to the doc. And I basically said, “So were you yelling at the person at the front desk or something, or what? And it’s very funny, the doc basically was like, “I don’t know what to do with her,” you know, “Every time I tell her what to do.” And I’m like, “Right.”

Cheryl: Right there.

Scott: And I just threw them out. And I said, “You know, it might be better to ask her what she wants to get done and kinda work with her. And, you know, start…” I was never trained like you were. So some of this was just kind of the innate quality I guess that I had and I got lucky. But for all the practices out there that are trying to figure out like, how do we all get better, you know, it is there and there are a lot of…there’s a lot of coaching that you can get from professionals out there that will help you get better. And that front desk person, boy, they could ruin it for everybody, you know.

Cheryl: Absolutely. I just wanna add something because you raised a good point, Scott, and I’m thinking about at KZA when we go and do a consulting project, every staff person gets a confidential survey. And one of the things that’s always amazing to me is how consistent the practices that things aren’t going well. What comes back is that staff don’t feel appreciated or acknowledged for their work. And so when we go in and we talk with them one-on-one, one of the biggest changes, simplest and free you can do, that doctors can do, is just say “thank you.” And so what happened so often with that front desk that you’re talking about and the billing office, they never see the doctors. There could be six doctors.

They come in the back door which is where the clinical hallway is, which is where the doctors offices are. I mean, you can picture this, right? We all know this. They never go upfront. So I think just saying, “Hey, thanks. We really appreciate it.” Especially, make it specific. When you give feedback, like a coach, and to say thank you, you don’t wanna just make it vague because it can seem disingenuous. If it was a super busy clinic day and it was behind for two hours, everyone was stressed, at the end of the day it’s nice to go up there and just say, “You know what? Today was really hard and people were not very pleasant, and you guys did a great job keeping your cool. Thank you.” You know, so that’s a great way to help people feel just a little bit better about themselves and their role in the practice.

Michael: Cheryl, I’m thinking about comparing, you know, this set up here and comparing it to other industries, you know, with… There’s been so many stories in the past years about airlines running into trouble because their employees weren’t empowered to actually think, to actually make decisions on the frontline, and so held company policy. And no matter what, no matter how bad the situation goes they just held the company policy. And so you end up with these people that are just so frustrated and disgruntled with the airline.

And I compare that to with all the care that my daughter has to get, we talk to our nurse in particular quite a bit and ask for a lot of questions that don’t go according to just regular policy. “Yes, I know that this is the regular guideline on this, but what about this? Help me understand this. Help me figure out a way to deal with the scenario.” And she actually helps us to where she’s empowered enough, like, whatever office scenario they have set up there, she’s empowered enough to help us wrestle through these kinds of things. Have you seen practices make a big shift in this kind of thing and sort of moving from just holding the line, holding the policy, to actually being more critical thinkers on the frontline as well?

Cheryl: As you’re talking, a person came to my mind. A practice, actually here out west, that exact thing happened. There was the manager who was awful. I mean, everything that you read about bad management, this particular person was. And the physician was so unhappy with the manager and just couldn’t figure it. She felt so badly, you know, because she hired her and she felt like she needed to keep her, she kept giving her chances, but she was controlling, she didn’t share information. I could go on, but I won’t. So anyway, we finally were able to…as I like to say, as Karen Zupko likes to say, liberate and free this person, right? We let her go on and fly, be free, you’re leaving.

And we brought in a woman who was very skilled, more mature, and she… It took a year to get the staff to really understand that they truly now had the power and the authority to think on their feet and to do things right for the patient. So yes, it’s night and day now. I go into the practice and it’s amazing what has been done. And the staff feel empowered to just, yeah, like you said, give a discount. This happens to be an aesthetic practice, so they’re able to do that a little more liberally. But, yeah, make decisions, come up with new ideas. It’s very refreshing and everybody is so much happier. It’s like, remember Linus from the “Peanuts”?

Scott: Yeah.

Cheryl: He had that cloud, you know, the cloud is no more there. So it’s perfect. It’s wonderful.

Scott: That’s awesome.

Michael: It’s interesting seeing the stats right now just about the American workforce in general, just how unengaged, disengaged the American workforce is in so many capacities. And so to have some sort of way of really engaging people, it’s not just about things like raises and just making things better at work around, like, perks and stuff. But really just acknowledging people, giving them the room to be able to make decisions. So that holds true for medical practices too and so it’s just very exciting to hear that. Cheryl, thank you again so much for coming on. We really appreciate hearing so much of how practice managers can continue to evolve into new roles and really take more leadership in practice. We’re very excited about it.

Cheryl: Well, thanks for having me. This is a really great conversation. Thanks a lot.

Announcer: Thanks again for tuning into the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.