Advice to managers: 'Leave it better than you found it'

Putting it in View By Dianna E. Graves, COMT, BS Ed

From time to time I receive requests from a new manager or supervisor asking for any pearls of wisdom to help them as they begin their new role in the administrative field.

They have the wide-eyed exuberance of youth, a child-like view at the practice they have been in for years and are now seeing for the first time with a “fresh snow” view: untouched, clean, white, gentle drifts of snow.

Those of us who have been there realize they will soon see that what they are really looking at is end of winter: dirty snow and dreary, cloudy skies.

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Their practice did not morph to a clear slate-their view did.

There are two types of managers that occur in a practice:

• The new manager from the outside that has never worked a single day in the practice and is unaware of all the back line stories.

• The office employee that has been promoted into this role. (In some cases, the new manager views this as the kiss-of-death.)

Regardless of which category the manager falls into, the process is pretty much the same: a change was decreed by the powers that be and new management has been ordained.

I have often joked with people when they talk about learning to be a manager that it would be much easier to just read the manual versus the trial and error method that routinely occurs.

The funny thing is that there is no manual to walk you through the step-by-step challenges that are going to be occurring to you at break-neck speed. Your new manual is going to be now defined as your gut.

My experience

For years, I worked hard to hopefully become the manager at the hospital where I worked. I did everything that was asked of me, and more. I worked harder than anyone else (or so I thought) and I was always willing to voice my two cents (sometimes ten cents). Oh, the innocence of youth.

What I failed to do was to listen, watch, and observe.

Because I was often surrounded by chaos, I didn’t have time to experience what the world might look like if I was running the clinic. I had not learned that many times leading meant not offering your opinion, but listening to others and helping incorporate their ideas into a useful model for the future that all sides could and would listen to. I was still in the stage of trying to make it happen myself.

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When I left the hospital and went to the VA to become the manager at the Veteran’s Eye Clinic in Minneapolis, I was more than ready to show everybody that I was “it”, and I was going to run “it” better than anyone else had ever done.

The funny thing was that no one cared.

I was just another manager that was coming on board not knowing anything about their system, thinking I was going to change an archaic world and make sense of the government insanity.

It was apparent on day one, that while I thought I was going to save the world, they did not want or need to be saved. This concept had never occurred to me.

So, I went to work.

I worked as a technician on the floor for over three months: seeing patients, shuttling patients from point A to B, and spending hour after hour listening and watching the system. I did my “supervisor” job after hours.

I wanted them to know that I knew what being a technician was about – and that I was a good one. I wanted them to know they could count on me to bail them out when the clinic got behind. And I needed them to know that I could handle patients and patients’ complaints fairly and swiftly.

Changes began to occur

Changes began to occur. One of the staff nicknamed me “The Director”, and it stuck. More and more issues were being funneled to me, and I was beginning to be the supervisor during the day versus after hours.

I think I learned much more than they did because I began to network with the other managers and listen to them and how they handled their groups. My education took off like a wildfire through dry brush.

Once I had learned the good and bad of the system I was in, I began to make some changes-gently, slowly, and one at a time.

I started with obvious flaws in a clinic system that had to be changed. Flaws people were complaining about, but never changed because “that’s the way it had always been”. It started with the Residents OR book.

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The three, third year residents ran this sad, worn OR scheduling book. It was managed with an uneven hand and had a biased view and a prejudiced look at who deserved the coveted cataract cases, and who got the twentieth blepharoplasty for the hated dermatochalasis!

I gathered them around one afternoon after clinic and stated that I would guarantee that while they were at the VA, I would ensure that they never had an empty spot on their OR day and that they would do more surgery than any other group that had floated the VA in the past.

Initially, the change was painstakingly hard for them. It was like taking the wooky blanket away from the little boy in Mr. Mom.

I hid the book, took it with me when I left the clinic, and finally changed the color of it altogether so they couldn’t find it.

Slowly but surely, it began to work. Cases became equitable, there was less quibbling between the residents, and patients were being better served.

Because we became so efficient, we received more operating room time. This was unheard of at the VA. We started a program where the veterans were not inpatient anymore. They were outpatient yet were allowed to be housed at the VA. This meant no more paperwork and the hated discharge summaries.

The system worked, the residents worked, and the patients were seen.

The change needed to be made, but in a systematic and educated way. The problem was identified and we created a better system that was good for all.

The “Old Dianna” would have jumped in and make changes because I could. But these changes would have been met with resistance from the residents, and therefore caused failure in the system across the board.

Stop, Look, and Listen!

It is important when becoming a new manager, no matter which category you fall into, to allow yourself to be educated into the system you have inherited. Making wholesale changes just to show that you can creates a courting disaster.

It takes you back to learning how to cross the street.

Stop, Look and Listen!

1.              Before making any changes to a system you are new at, STOP. Investigate, watch, and ask questions from a number of areas.  And then put everything together and decide if this is an area that is just dysfunctional and needs tweaking, or is it broken and needs to be overhauled?

2.              LOOK at a number of areas in front of and behind you. If you make a change in a given area, what will the repercussions be, not only to your group but also to other groups: optical, front desk, and the doctors?

We once made a change to the timing of some complete exam slots that would be very beneficial to the technician’s timing. It worked wonderfully for them but sent the contact lens staff, and their schedule, into a tailspin.

Get advice from these other areas and advise them that you are going to make the change and this is what you anticipate happening because of it.

3.              LISTEN to their responses and the advice from the people that it will affect. If everyone is stating that this is a poor change, it might be time to re-assess and determine if there is another way. That much dissention will indicate that there will be resistance not only from your group, but a number of groups. It will be a sure failure to you and your management decision.

4.              Lastly, gather support for the change from a few key players. They will help you through the rough edges as the plan becomes enacted.

Change is not always a bad thing, but it can cause undue chaos that will reflect poorly on you and your managing abilities. After a few glitches-no matter how good the idea for the change is-it will be automatically looked as being a poor decision.

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So, welcome aboard new manager!

I often equate my younger, developing years via the following axiom:

“Be careful what you wish for, for it may soon come true.”

While you dream of success, the unexpected aftermaths may steer you straight for failure!

Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.