A few years ago I was called in to work with an OB having trouble with her landlord. A ruptured pipe in the suite above had caused extensive damage to her offices (they were flooded most of an entire weekend), and the damage—which included the typical wall/flooring soaking—had caused cabinets to begin to delaminate and done extensive damage to her wiring and IT systems. It was an insurance mess, complicated by her busy practice, and one other thing that I hadn’t known about in our early meetings.
Her often extremely hostile attitude.
She was great with me, cordial, funny, smart. I had known her a bit socially, and we always had good conversation. I had been told she “could be difficult”, but marked that up to a very typical complaint I often head about doctors.
Was I surprised.
Dr. Jane (pseudonym) ran her office with little “emotional consistency.” Hot, cold, angry, happy, nice, mean, reasonable, unreasonable: She could cover all that ground, often in the same day. The staff was paralyzed.
The simple issue of coordinating a complex insurance situation, involving her carrier, the hospital, and the tenant above morphed into a first, tense meeting. At the very start she lashed out at everyone and demanded not only “immediate” repairs, but restitution for downtime including payment for her staff who were unable to see patients, on top of her business interruption insurance. After the first 20 minutes I asked her to join me outside her office where I told her we needed to stop this meeting; to my surprise she said OK, we walked back into her office, where I asked for a postponement and she, much to everyone’s surprise, very cordially thanked the others for coming.
As I walked down the hall in her office I stopped to look at a wall of photos of her holding newborns in the delivery room. There was an almost angelic glow that surrounded her in those pictures, and when you could see her full face the smile thereon radiated joy. Clearly this was what she relished about her practice—the interaction with patients. Everything else was just a chore for her.
So over the next few weeks, as the repairs to her space began and patient flow got back to normal (she and I agreed this was something I best dealt with and I just provided verbal reports to her on most of the work being done) I was able to work with staff to try to build both bridges and barriers that would minimize the “emotional inconsistencies” and improve reporting and other processes to provide her with better ways to see what was going on in her practice, both financially and from an operations viewpoint. I beefed up the direct communication processes with her clinical staff so she got reports in advance on patient issues (especially post-partum). We looked at restructuring her patient flow with “OB days” and “Gyn days”, which smoothed out the schedule, increased her productivity, and almost eliminated patient wait times. This also opened up more time to chart, within the day, so she got home earlier.
The big challenge was the back office. The administrator, who wore a “deer in the headlights” expression on her face most of the time, was the place to start. We developed reports that provided a better snapshot of the practice billing and operations costs, revenues, and drew out a chart that detailed who did what, answered to whom, and protected the staff from her outbreaks. We also began to escrow cash (she always complained of being broke). It took a few months, and consistent pep talks with the staff to buy in, but they did.
And, of course, she began to change too. Her peace of mind was more evident. She smiled more. Slowly the relationship with her staff, and especially her administrator, became more based on the idea that everyone in the practice tried to support her real love—patient care—while minimizing stress that might be caused by operational issues.
Best, she started to develop empathy as she better understood how things worked, and the dedication of her staff.
Yes, there were still days when she went off, when her “emotional inconsistency” reared its head. But they were fewer and farther between, and the staff changed from being paralyzed to helping keep things on course.
The flood from above would require extensive repairs, and the after all the damage was dealt with she had what looked like a brand new office, which the patients loved. Simultaneously the repairs we made to her daily operations and overall practice management were smoothed out, improved, and resulted in a happier, more productive staff. To this day I’m still surprised at the way a bit of water damage could cause such a profound change in the way her medical practice worked.--TOM ELLIS III
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