MMHA 6000 Week 1 Administrator Role Post Example

Week 1 Discussion: The Administrator's Role

Practice Administrator for Eight Clinics and Forty-One Clinicians Who Do Not Report to Me: Naming the Seat, Its Decisions and the Line Between Administrative and Clinical Authority

The seat I am describing is practice administrator for Calder Ridge Medical Group, the employed physician group of Calder Ridge Community Hospital, a 118-bed independent nonprofit. Both organizations are invented for this post, though the seat is modeled on roles I have seen. The administrator reports to the hospital's vice president of ambulatory services and runs operations for six primary care clinics and two specialty clinics, with 41 physicians and advanced practice clinicians and about 130 staff. I spent four years as a clinic office manager, so this is the job one level up from mine.

The decisions that land on this desk fall into five kinds. Staffing and scheduling: approving overtime, covering a medical assistant vacancy, deciding whether a clinic opens on Saturdays. Budget variance: explaining to the vice president why supply costs at one clinic ran 14 percent over plan last quarter, and what will change. Vendor and payer questions: renewing the phone system contract, working with the revenue cycle team when a commercial payer starts denying a common visit code. Patient complaints that front-line managers cannot settle, such as a billing dispute or a complaint about wait times. Compliance deadlines: annual staff training, clinic license renewals, and the documentation the hospital needs for its accreditation survey.

The boundary with clinical authority runs through the middle of the job. I can decide how many exam rooms a clinic has, but the medical director and each physician decide how long a new patient visit takes, which sets how many patients a day a clinic can see. I can see that a clinic's no-show rate is 18 percent, but whether to overbook is a decision the physicians must agree to, since they bear the crowded afternoon. I shape these decisions with data and proposals, but I do not own them. Healthcare management is distinctive for exactly this reason: much of the organization's core work is done by professionals whose authority comes from their training rather than from the hierarchy, and who answer to professional standards as much as to managers (Buchbinder et al., 2021). Mintzberg (1979) described organizations built this way as professional bureaucracies, in which the people doing the core work control much of how it is done.

Changing physician schedules is where I expect the most difficulty. Suppose the data show that blocking two same-day slots each morning would cut the clinics' backlog for urgent visits by half. I would need six medical directors and most of 41 clinicians to agree, without being able to order any of them to do it. I expect that persuasion, with data presented early and clinicians designing the change, will be most of the job.

How does the seat you described handle decisions that depend on people who do not report to you?

Reply to Marisol

Marisol, your seat as a nursing unit manager reports through the chief nursing officer, so your staff do report to you, which is the opposite of my seat. I noticed, though, that you listed bed assignments as a decision you share with the hospitalists and case managers. That sounds like the same boundary I described, just in a different place. Researchers who studied hospitals described them as several separate worlds, of clinicians, managers and trustees, that have to be coordinated rather than commanded (Glouberman & Mintzberg, 2001). Which of those worlds do you find hardest to reach from your unit?

Reply to Devin

Devin, your seat as director of a hospital's revenue cycle has authority over a large staff and very little contact with clinicians, or so it first seems. You mentioned that denials for missing documentation are your biggest problem. Since documentation is done by physicians, is that actually a decision you shape without owning, like my scheduling example? I would be interested to know whether you have found a way to get physicians involved in fixing it.

References

Buchbinder, S. B., Shanks, N. H., & Kite, B. J. (2021). Introduction to health care management (4th ed.). Jones & Bartlett Learning.

Glouberman, S., & Mintzberg, H. (2001). Managing the care of health and the cure of disease, Part I: Differentiation. Health Care Management Review, 26(1), 56-69. https://doi.org/10.1097/00004010-200101000-00006

Mintzberg, H. (1979). The structuring of organizations: A synthesis of the research. Prentice-Hall.