A Refresher on Delegating: Look Inside Your Healthcare Practice

Contrary to the beliefs of too many physicians and administrators, you can’t do everything yourself! Traditionally, doctors have been trained and socialized to be confident, highly independent thinkers—and for good reason. Physicians who second-guess themselves or hesitate (especially in an emergency) can put patients at risk.

Administrators have different reasons for their typical reluctance to seek help. It’s not uncommon for physician-owners to communicate (directly or indirectly) that practice managers never quite earn their “hefty” salaries. Never mind the fact that those salaries often aren’t very “hefty” at all! Insecure managers absolutely detest admitting that they can’t do everything themselves. It’s understandable, but hardly what’s best for the practice.

Managers at smaller practices—those with one or two physicians—often have to cover a broader range of duties than those in larger group practices. In fact, everyone working in small offices has to wear multiple hats, even the doctors. As an organization grows and becomes more complex, job descriptions narrow, and everyone has to “specialize” on specific priorities. Managers navigating those transitions don’t seem to mind adjusting staffers’ responsibilities, but letting go of some of their former duties often proves daunting.

It Starts at the Top

The most productive physicians in the best-run practices almost always do a superior job of delegating duties to staff members who support them. We’ve often quoted one of the nation’s foremost experts in physician efficiency, Richard C. Haines Jr., an Atlanta-based architect specializing in physician-office design: Everything a physician does falls into one of three categories:

• That which only he or she can do;

• That which someone else could, and perhaps should, do; or

• That which nobody in the practice should do.

Go ahead and try his system—you’ll soon see the truth in it. A good deal of the doctor’s work relies on his or her specific training, experience, and credentials. These have to be the top priority when deciding how to allocate the doctor’s time.

At the opposite end of the spectrum, you’ll find doctors performing tasks and activities that don’t add value to the physician’s practice. It often takes the help of a consultant with an objective viewpoint to ferret out all of these time thieves. Many of them have arisen because of unwieldy business systems and awkwardly designed work spaces.

Somewhere in the middle, then, are those activities that don’t require a physician’s hands-on attention. Here’s where the delegation challenge lies. The physician may ask, “Why should I pay someone else to do something I can do myself? I’m handling things just fine.”

And you may indeed be handling things “just fine,” but at what cost? Physicians—especially independent practice partners—forget just how expensive their time is. A doctor earning just $200,000 per year earns about four times the hourly rate of an average nurse. That means you overpay by 400% when you perform a task that your nurse could do. Doing clerical work is even more wasteful. And if you look at even more highly compensated surgeons and specialists, the waste is breathtaking.

The waste is substantial because the physician’s gross hourly value is even greater. A doctor’s time and expertise (the work only he or she can do) accounts for the lion’s share of your practice’s work product—the stuff that people pay you for. You can look at a physician as an owner, as an employee, and as a revenue-generating machine—all at the same time. (Many management mistakes happen when doctors and their administrators fail to take all three aspects into account.)

The Least Qualified

The art of delegating requires owners and managers to think differently: It may seem counterintuitive, but the overarching principle is assign every task to the person least/minimally qualified to perform it.

Be careful not to misread or misinterpret this mantra. Of course, you must make sure that the designated worker is indeed qualified to perform the assignment. You just have to avoid regular assignments to the overqualified. It’s a matter of human resource management.

Spend a little time analyzing how your physicians and staffers spend their time. Start lists of delegable tasks and time-wasters. You might be surprised at the results. These task lists become your “to-do” lists for reorganizing how jobs are assigned.

Effective delegation goes beyond reworking your job descriptions, however. In fact, when we talk about delegating, we usually refer to that part of the job description that says, “ . . . and duties as designated by your supervisor.” The job description may say that a person is responsible to run errands, but another level of delegation happens when the supervisor actually sends the employee on a specific errand.

Principles for Effective Delegation

The general management community has produced a pretty fair amount of advice and instructions for assigning tasks more effectively. We’ve distilled the following principles from three resources that we’ve cited in the references:

• Get your own act together first. Clarify in your own mind the results you’re looking for. Too many employees fail to deliver because the supervisor wasn’t sure what he or she wanted in the first place.(1)

• Select the right person for the job. Match the person to the task. Consider his or her skills and work style. If, for example, you need the employee to work independently without “bothering you,” assign the job to an independent-minded staff member.(2)

• Thoroughly communicate the task. Give explicit instructions regarding the work product or outcome you expect. Documentation helps reduce misunderstandings and forgotten instructions better than verbal directions.(2)

• Help the staffer understand the why of the assignment. Give the staffer an idea of how the task fits in with larger strategies. Try to elicit the worker’s buy-in—a commitment to your goals. Sincerely ask him or her for the help you need to accomplish the work.(3)

• Grant the appropriate authority. If you hover over the worker and micromanage each step, you’ve only compounded your work. Clarify the amount of creativity you want from your staffer.(1,2)

• Provide support, guidance, and feedback. Make sure the worker has everything he or she needs to get the job done.(1-3)

• Create accountability. Specify due dates and performance measures for the project, and follow up appropriately.(1-3)

• Acknowledge and reward good work. Managers often miss great opportunities to increase employee loyalty when they fail to show appreciation to staffers who perform well. Public acknowledgement and sincere words of appreciation leave a deep impression and encourage future good performances, too.(1,3)

At first, you may feel a bit like 17th-century philosopher and mathematician Blaise Pascal who famously apologized for his long letter because he didn’t have the time to write a short one. It seems like it would be easier and quicker to just do it yourself—and it may be true on occasion. But as you develop employees whom you can entrust with your delegable tasks, you will certainly end up with more time to do the things that you are best qualified to do.

If you’re a manager working for doctors who question whether they’re getting their money’s worth out of you, learning how to delegate effectively will multiply your productivity. If you’re a doctor struggling to remain profitable in today’s practice environment, effective delegation will increase your productivity and revenue, and will help protect (or even grow) your income.

References

1. Nelson B, Economy P. Managing for Dummies—Third Edition. Hoboken, NJ: John Wiley & Sons/For Dummies; 2010: ch 11.

2. Pearson JE. 6 Tips for Delegating Effectively. www.businessknowhow.com/growth/delegating.htm .

3. Morgan RL. 12 Tips for Delegating Effectively. www.ivillage.co.uk/12-tips-delegating-effectively/83031.