Who's in control?

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Who's in control?

A self-serving team member may be pulling the strings at your practice, cutting fragile lines of communication, and controlling the team with fear. Why are you letting it happen?
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May 01, 2008


Illustration by Val Bochkov
Someone is in charge at your practice. If you're the owner, it should be you. But you might be surprised to learn that the de facto leader of many practices isn't the person whose name is on the deed—it's a team member given too much power by a boss who doesn't want to manage or is afraid to. This team member manipulates everyone to his or her benefit and to the detriment of your practice's finances, your team's morale, and your medical care. I see it all the time, and it always stuns me.


Mark Opperman, CVPM
I encountered an employee like this on a recent consulting visit. Kim (name changed to protect the guilty) had been with the practice since she was a teenager, starting off as a kennel assistant and working her way up to practice manager even though she didn't have any formal management training.

Kim had unbelievable control in this practice—you were either with her or you were drummed out of your job. If you didn't agree with Kim or her way of doing things, she and her fearful followers would make your life miserable until you quit. She'd give you the worst schedule. She'd ignore you. Kim lived by her own rules. She came in when she wanted, left when she wanted, and coerced others into doing her work for her.

You may wonder where the practice owner was during all of this. Well, he was afraid of Kim too. He believed (because Kim led him to believe) that if she was happy, then he was happy, and the entire practice was happy. Also, this doctor didn't like conflict, and when Kim got mad, he paid for it. She'd storm around the practice and make life hard for everyone. So a high school graduate with a bad temper and poor leadership skills was running a multimillion-dollar practice. How did it happen? The owner let it happen.

Be an owner and a leader

Kim's reign of terror began when the owner informally turned over control of the practice to her. The problem? Instead of delegating, he abdicated. When you hire or appoint a practice manager, you still need to oversee that person and make sure he or she is doing the job and doing it right.

If the owner of Kim's practice had ever conducted an exit interview with a departing employee, he would have had an idea of what was going on. But this owner was a "nice guy" and wanted to be everyone's friend. He chose not to get involved, and in doing so, he hurt his practice and the rest of the team. Projects he thought were getting done weren't; Kim sabotaged any idea she didn't like and ordered other employees to do the same.


Rules for owners
The practice took in millions, but it wasn't growing—its revenue was actually declining. The owner wasn't aware of this problem, and Kim didn't pay attention because she said she wasn't interested in finances—she had a bookkeeper, who was under her thumb, for that. She was concerned "only about the well-being of patients," an argument she used any time she was against a new policy or procedure, even one that came from the owner.


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