Episode 099: Two Heads Are Better Than One

Speaker 1: You are listening to Your Practice Made Perfect; support, protection, and advice for practicing medical professionals. Brought to you by SVMIC.

J. Baugh: Hello everyone and welcome to today's episode of Your Practice Made Perfect. My name is J. Baugh and we have an interesting podcast for you today, because we're going to actually have two guests, which is a little different from our usual podcast. We have joining us today, Dr. Nicole Shields and Jill Parks. Dr. Shields and Jill, welcome.

Dr. Shields: Thank you.

Jill: Thank you.

J. Baugh: Today we're going to be talking about the successful physician-practice executive relationship. Why don't we start by having each of you give just a short introduction of who you are and what your role is with the group that you currently are with.

Dr. Shields: Well, sure. My name is Nicole Shields. I'm a family medicine physician practicing at what is a multi-specialty clinic with Lincoln Memorial University. I've been with LMU for about six years and have been medical director for five.

J. Baugh: Okay, and Jill, what is your role with LMU?

Jill: I am the practice manager of LMU's Outpatient Medical Clinic, working alongside with Dr. Shields for the past five years. I joined Lincoln Memorial University in January of 2007 with the opening of the Debusk College of Osteopathic Medicine.

J. Baugh: First of all, let me ask you this, how long have you two worked together in your current roles at LMU?

Dr. Shields: Five years.

J. Baugh: And did you hit it off immediately, or did it take a while to find your groove over the five years that you've been practicing together?

Jill: I will say both is a broad answer. Dr. Shields and I did hit it off on a personal level immediately when she and I met. And then when I transitioned into the medical practice, it did take us a little while to get into our groove. But once we learned the operation style, and the communication style of one another, I think we have just hit the ground running ever since.

Dr. Shields: I would agree with Jill. I think that when you meet someone, there's a difference between being able to communicate with them and maybe have a dinner conversation, and working with someone day in and day out. Especially in the business of medicine in today's climate, it's just kind of a moving target. And so you really have to not only get to know that person's leadership style, but also their conflict-resolution style, and how they work under pressure, and have a give and take relationship a little bit. And I think that just takes time to get to know anyone, especially when you're doing it in a professional setting. And Jill and I, her as practice manager and me as a medical director, I'm also a full-time physician; and so I rarely have the opportunity to work literally side-by-side with Jill, and so it just takes time to get to know those things.

J. Baugh: Yeah, I can see that being the case, especially when you have an interaction between medicine and law and business; and there's so many different items that come together to make a successful medical practice work, that I could see that it would take some time in order for all of those pieces to come together.

Now that you've been working together for about five years, how would you describe your communication style? Is it sort of an informal style, maybe on an as-needed basis, or maybe you have a defined meeting structure where you meet periodically, regularly? How often do you connect with each other?

Dr. Shields: We do a little bit of everything, informal, kind of like, "Hey Jill, I need this," or vice versa. But also we have planned time on a weekly basis and a monthly basis to go over strategic planning, budget, finances, that sort of thing. I think that most of our urgent communication is easily done face-to-face, and we put it in writing just so sometimes we can remind each other, "Oh, this is what happened with that." And so we kind of have a paper trail, but it comes pretty naturally I think for the both of us.

Jill: Yes. And when you work alongside somebody, and you're in the same building with them, and you get to know their work style, you can pick up on their body language as well. I know when I make eye contact with her, when she gives me the look, there's something that needs my immediate attention.

J. Baugh: Right, that's good. Dr. Shields, let me ask you this question. What is it that Jill does that you feel is the most supportive to you? What are the things that maybe she does or reports information, maybe that she provides to you, that allows you to be successful, or maybe gives you a sense that things are going well?

Dr. Shields: I think what Jill does really well is she triages what's important, what needs an answer right this minute that she needs to interrupt me for, and what can be dealt with this afternoon or even the next week. And I really appreciate that because in the middle of patient care, it's really hard when you get interruptions, especially when they're unnecessary interruptions. I think that's something that Jill has done very well. Especially, she doesn't have a medical background, so she's not from healthcare. She doesn't have a medical degree or nursing or anything like that, and so I think she does very well at just sensing those little tidbits, like my body language, and facial expressions probably deliver a lot. But I think even just kind of her sensing the situation of when you can interrupt and when you can't is really helpful.

I think the other thing is Jill has been doing this long enough, and for the short amount of time that she's been doing it, she's done very well. But, I think what she does exceptionally well is, handles things that she feels like she is capable and able to handle without explicit instruction or direction. And then she has that fine line of, "Hmm, probably need to present this to the advisory committee or maybe we should talk about this together as an administrative team." And so I think it's nice to know as a supervisor or an administrator that you've got people on your team that recognize that this is my lead, this is my rope, and I'm able to go this far with it, and this is when I know I need to have help.

The other thing I'll say is that when you're working in a small clinic with multiple different personnel, it's really helpful to me because I have to work one-on-one with most of our healthcare team. It's really nice when the HR aspect of personnel is handled by someone other than me. And Jill is exceptionally good at kind of taking those day-to-day maybe disagreements or workflow issues or, "Hey, you were late to work." She handles all of that for me. So I'm less of a disciplinarian in any fashion on our healthcare team, and it really helps me be able to focus and work with - let's say the nursing staff for example - it helps me focus on patient care and less on the maybe personal bumps so-to-speak.

J. Baugh: Yeah, it does sound like that if you're a physician in a practice, that it would be very helpful to have someone in your office who can take care of those types of issues. Especially when you have someone like Jill, who's able to balance between asking you too many questions and not asking you enough questions. To have sort of that middle ground that works well for the team, and I think that's a great skill set to have.

Jill, what is it that Dr. Shields does that is most supportive to your work?

Jill: Well, Dr. Shields is an awesome resource for a medical office. She is excellent at streamlining our processes. If there's a new procedure that we can work into the practice, a new piece of equipment that we're bringing in, a new service we're going to provide, we can look at all of the payer reimbursement codes, how do we bill, how do we document, what do we need? Dr. Shields can actually put this into our EHR, because she's hands-on. We're a small practice. She knows how to operate it as a business to make the money on the financial aspect.

But also on the clinical side, how can I streamline this for the front desk? How can I streamline this for my nursing staff? What's the least amount of steps to get to the same goal? She is wonderful at streamlining those workflows and she's an excellent support or reinforcement for me. If there's something that's going on, she's 100% supportive. I do my data, get my background information, present it to her and the advisory committee. Here's what we have, here's what we'd like to do. We discuss it around the table and bring all points of the conversation and make the best decision for the practice.

J. Baugh: Well, I think it's good to hear of everyone working together as a team. I think that's really important in a medical practice when you have so many different people who come in from very different angles. Some of you have medical backgrounds, some maybe who have business backgrounds, and to be able to work together as a team and to have the employer/employee relationship working is great to be able to support each other.

Let me ask you this question about both of you working together. I'm wondering if you ever find yourselves playing good cop, bad cop, with the two of you in the way that you work together. Does that ever happen?

Dr. Shields: I don't know. What do you think, Jill?

Jill: I would say more as a reinforcer than a good cop, bad cop, because most instances we have communicated in one way or another before a decision is made. But, there have been times, that say an employee would present an issue to me or to Dr. Shields, and we give them our opinion. And then the employee may go to the other, then get an opposing opinion; and that has happened and that's going to happen in any business. I think any healthcare business or any business really. And we do kind of play off one another when we need to, but our ultimate goal is to take the best care of our patients that we can and be supportive of our staff.

J. Baugh: Yeah. I think as long as everyone on the team has the same ultimate goal and they remember that whatever it is that they're doing, they're trying to provide the best quality of care to their patient, then that's key in the team. Being able to work together is to always understand what your ultimate goal is.

Dr. Shields: I would add that, yeah, I don't think it's good cop, bad cop and I think Jill summarize it very well with reinforcement, but we are I think a very transparent administrative team-

Jill: I agree.

Dr. Shields: ... and so there's very little room for, "Well, she said this... " and misinterpretation of that, because when I have something that I know it was kind of more in Jill's realm, I'll be like, "Hey, Jill, this is kind of what happened. This is what was said," and I redirected them back to you. I'm very familiar with the chain of command and who needs to kind of be involved in certain situations.

I don't know that we have the need for good cop, bad cop. I would say it's more a delineation of roles. And so I usually take on more of the physician dealing with physician role or provider's role or the university administrative role, and Jill will take over our billing management and our staff roles. And so I feel like we kind of delegate it up pretty decent.

Jill: I agree.

J. Baugh: What is it about your relationship that makes it work as well as it does?

Dr. Shields: Interesting that this question to come up because, recently, you know you have kind of ups and downs in life, right, both professionally and personally. And I think when either one of us senses that the other one isn't quite 100%, we know what the other one needs most of the time; if it's distance, if it's support, and sometimes we were not sure. Jill came to me the other day she goes, "Hey, are we okay? Are we good?" And I really appreciate her kind of straightforwardness, and not everybody has that confidence or courage to say, "Hey, is everything alright? And if it's not, let's deal with it. Let's take this head-on."

I think that there's lots of things to go into making our relationship work. But for us, I think it's communication, I think it's mutual respect. And I think that we're both very passionate about our goals here for LMU Medical Clinic and what they are, and supporting each other as well as others in the practice getting there. And so I think just that overall almost, I wouldn't say unconditional, but very loyal support no matter where you are personally or professionally.

Jill: Right, and I agree with that too. And just to add, I think if you can define the mission of what it is you're set out to accomplish, you can't reach your mission unless you know what it is. We decided early on what the mission was of the clinic and how we were going to get there, and we set our goals and our values. And we may get off-track sometimes, but we always circle back around and get right back on track and keep going.

J. Baugh: Yeah, it sounds like both of you have qualities and vision and those types of things that make teams work together really well. I appreciate what you've been saying today that gives some good advice to our listeners about what they can do to try to make their practices work well.

How do you resolve differences of opinions? The two of you probably don't agree 100% on everything. There will be times in which the two of you may have differences with each other. How do you resolve differences of opinions that you might have with each other?

Jill: Well, we have had differences of opinions and we normally just gather the data. I mean most of the opinions that we have are based on something, so in the business of healthcare, you just collect the data of what it is that you're trying to resolve and you present the data. And if we take care of our patients and we make a little money in the end, then we've resolved our differences.

Dr. Shields: That's funny. Jill and I've been working together for so long, that's pretty much what I would have said. I will add a couple of things. I think when you've got a good team, an administrative team especially, yes, there's a difference of opinions and you collect data and you come up with a game plan together. But, once we have decided on that game plan, we usually have a fallback. Okay, so if this doesn't work and this doesn't meet our outcome, we don't meet our goals doing it this way, then by X date we'll try... fill in the blank. And so I think it's less of a disagreement necessarily and more of an after-action review, kind of looking at everything over and over and over again. Is this working well? Is it not working well? Do we need to go back to the drawing board? You know that idea that you had, it probably worked better than what we just tried, that sort of thing.

J. Baugh: As we get ready to wrap up this podcast and end our conversation here today, let me ask each of you this last question. What is the one thing that you each wish someone had told you before you took your current position? If you could have been given some type of advice before you took the position that you currently have, what is that piece of advice that you wish you had been given?

Jill: And I guess the first thing that comes to mind for me is personality types. Because I think once you learn the various personality types that you're going to be spending 50 and 60 hours a week with, you can learn how to be successful. Most of the providers in the clinic and our staff want communication in different ways. They want different data presented to them. They have a different goal in mind.

If it's to see 27 patients in a half-day or 50 patients in a half-day, how do they want the data presented? Do they want color charts? Do they want black and white data with just numbers? Do they want it in Excel format? Do they want it in a PDF? Do they want to look at how many Workers' Comp patients they see, and how do you approach them? Do you go to them while they're on the floor seeing patients or do you schedule a one-on-one meeting on the after-hours?

It's just preferences and I think if I didn't have to spend the time learning those, which can take years, I would've been successful earlier on. Just like Dr. Shields said, you just stay on top of your work and you learn the personality styles, what your goal is, what the mission is of the clinic and how to be successful. You just stay focused.

J. Baugh: Dr. Shields, how about you? What is the one thing that you wish someone had told you before you took the position that you currently have?

Jill: Oh, there are so many things. I think the one thing that I wished somebody had just taken me by the shoulders and looked me in the eye and said, "Medicine is really hard." And not because you can't necessarily take care of the patient with the knowledge that you've worked years to obtain, but there's so much more than your stethoscope and your relationship with a patient. That if you allow it, will get in between you and the patient and affect our patient care.

And this is everything from electronic health records, to insurance companies, to staff to scheduling. I mean, there's a thousand things that can come between you and the patient. We work, I work, daily to overcome those and to kind of keep my efforts towards good patient care. And if you do the right thing for the patient, everything else will kind of fall into place. But medicine is hard for lots of reasons. I think I knew that, but I wasn't aware of all the different ways that this altruistic view of "helping people" could have been worn down, I guess.

J. Baugh: Right. Well as we end this podcast, I'd like to thank both of you for the time that you spend providing quality care to your patients in the community that you serve. And I would like to thank both of you for taking the time to record this podcast with us and give our listeners some great information, so to Dr. Shields and Jill, thanks again.

Dr. Shields: You are welcome.

Jill: Thank you.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect, with your host J. Baugh. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast.

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