Building an Organizational Chart for Your Practice
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Transcript
Jennifer Spector, DPM: Hello again, everybody, and welcome back to Podiatry Today podcasts where we bring you the latest in foot and ankle medicine and surgery from leaders in the field.
I'm Dr. Jennifer Spector, the assistant editorial director for Podiatry Today and we are excited to welcome back our guests on some innovative practice management concepts we have today with us, Dr. Nicole Freels and Cody Meier. We've got to know them last time talking a little bit about team reward systems and today we're excited to have them back to talk about organizational chart creation and how that can help move your practice forward. As a reminder, Dr. Freels is the founder and CEO of Lexington Podiatry and Modern Podiatrist. She's dedicated to patient education and innovative treatments, often lending her expertise to focusing on guiding new practitioners through podiatry practice management and the details thereof. Cody Meier is the director of operations at that practice and has an extensive history in healthcare administration, beginning back in his time in the United States Air Force as a hospital administrator and since then he successfully led and optimized healthcare services across numerous global military treatment facilities. We're so glad to have you back. Thank you so much for joining us.
Nicole G. Freels , DPM, FACFAOM, cPed: Thank you for having us. We're super excited.
Dr. Spector: Yeah, let's dive right into this. I have to admit from my past experience as an associate in a practice, this is a really novel concept to me and I'm really excited to learn more about it. So to start out, could you share why having a well-defined organizational chart is so important to the success and efficiency of a practice?
Dr. Freels: I'm going to start this one because I was here before we had an org chart and I never thought you could corporatize a private practice that is smaller like us. You know, we have 3 providers. And I thought that was more for, you know, 15 plus providers and how applicable is that to our practice? I will tell you, having this chart has been completely eye opening and looking at your employees where they are positioned in the office. And it's created so much less chaos. Everybody knows the direction who they're reporting to—you know, don't jump over this particular person to get to the next level. And I think that we're closer to our employees and ever because of this organizational chart. So I'll let Cody talk about it a little bit just because he's the one that implemented it.
Cody Meier, MHA: Yeah, I mean, I totally agree. The whole point in creating an org chart is to corporatize your practice. And I know many of you small practitioners probably just got chills and are already throwing me out the window right now because you don't want to corporatize your practice and be private practice. Walk that fine line and recognize that corporate structure exists for the reason. Accountability and objectivity are my 2 favorite ones. I said that countless just the other day.
But more importantly than creating that streamlined process of accountability, and who reports to where and where do I go for XYZ, is to maintain your brand and your personality from a private practice perspective. So you have to walk that fine line and make sure that you're not getting too red tape. But that doesn't defeat the purpose of an org chart structure.
Too often—I’ll answer that overarching question right out of the gate—the reason why you need an org chart structure is to spread out your task and the accountability. We all hire these office managers to come in and take over roles and in the runner or practice for us. And then after a couple of months, we're looking at them saying, well, they dropped the ball on the XYZ. "Why didn't they get this done? I could do this better without my office manager." And fire him, let him go, or whatever. And now the practice owner is back to running or going to the clinic on the run without the office manager help. Because they didn't have a good structure in that. You cannot be accountable to hold the cards to be the billing director, to be the patient experience lead, to be the clinical care lead, to be the clinical operations lead. It is the juggler of chainsaws. And while you are invested in your practice because you're a doctor, you're more willing to jump in and do that extra work. This is a $50,000 to $60,000 employee that is not so much on the chain to do those things. The way the structure allows them to hold other folks accountable for their own departments and it will lead to operational efficiencies across the entire plan.
Dr. Freels: I really liked the visual whenever it was laid out. I mean, I really, you know, hated the first visual of our org chart because we laid out what we had at the moment. And that was one office manager over 37 people. How ridiculous is that? When we saw that up on our whiteboard, we about fell over. And then we just started kind of, okay, who's a good leader here? You know, who do we want to interview? When we opened up all of these positions, creating this org chart for in-office people to interview, and we told them, hey, we're going to post this on Indeed as well. And we really made them interview for their own position just to make sure that they were in the right seat on the bus and they didn't need to move during this kind of restructuring. So to me, the visual was the most eye-opening. And I thought, you know, gosh, I've been an absolute idiot for years. How on earth would I expect one person to manage this many people? So I think everyone drawing out what you currently have, just as an exercise, would be eye-opening and then start there and just work backwards.
Dr. Spector: So especially for folks who may not be completely aware of how these work, what are some essential elements that you have to include when creating an org chart for a practice? And are there specific roles or departments that you find are often overlooked here?
Meier: Yeah, absolutely. So a book called Traction—it's very popular, but if you haven't read it, we should. It kind of lays out the basics of a corporate structure, the difference between your marketing department, your operations department, your financial department, identifying a facilitator and a visionary/CEO, really laying out that upper line strategy. As Dr. Freels mentioned, I would highly recommend to take those positions down those departments and put a name to them. Who is holding on each of those departments? Do you have a director of operations? Can they be your operations head? You have a CFO in your financial and administrative section, marketing—not everybody has the bandwidth to be have a marketing director offers instructor and a financial director so you might have to wear many hats.
Example for us, Dr. Freels is our visionary CEO and our marketing director. That is definitely possible just because you have the different buckets doesn't mean you need a different seat. And then from underneath of those, those departments, that's really where you get into the creative side and identify what makes your practice different. This is an example, we have our clinical care department, clinical care, being medical assistance. We have our patient experience, which is obviously check and check out and calling queue admin hub. We have a billing department. We have a clinical operations department, which is everything from the, we call her the Jill of all trades. She does everything in the office from fixing the x-ray to laying down the floors to robotic processing. And then everything in between really compartmentalizing where do the bodies fall.
Dr. Freels: And I think really keeping track and everybody has a job description. So if we have someone that we keep adding to their JD and we see them kind of floundering, if you will, it's just too overwhelming, then we know that we need to expand that particular department because those tasks are getting too heavy for one person to handle. So I think having that well laid out, it creates complete transparency for accountability. They know exactly what they're responsible for. So if it's not happening, then there's no one else to blame. And it's all—once you read Traction, you'll see how nicely it's laid out. We also use Trello in tandem with our meetings and with our, I guess, roles within the practice. Great tool to communicate. Really kind of helps everything be more efficient.
That's really the goal of this is efficiency. Everybody knows what they're doing. If you read our Google reviews, one of the things that we get constantly: “Everyone here knows their job.” And so that if patients can see that and feel compelled to comment on it, then the employees more satisfied, nobody wants to come in and not know what to do. You know, you feel like a jackass. So You really need guidance, and they can't read our mind. You can't expect them to do that. They don't make what we make. So they're just not as patient, especially with these patients pulling their hair out and the full moons that come up every single month, that type of patient. So I think this is a super helpful for everyone to be on the same page.
Dr. Spector: Absolutely, and you mentioned about delineating roles and responsibilities across this organizational chart. How could a well-structured chart like this help reduce ambiguity and then also, could it help improve communication amongst the team members?
Dr. Freels: Well, I will tell you, I have the best position on the org chart. So as Cody mentioned, do the marketing and the visionary, I get to dream. So one of the best things that ever happened to me is he told me one day, because I had been walking down the hall and I hate when people are at my workstation and they just like to kind of congregate there and there was like 7 people within this small area and I literally just like flicked my fingers kind of like I didn't say anything but I'm like get out of my way—you know, like, you got to move because I need to get here and you guys are just talking about your weekend. So that kind of stuff drives me nuts. So anyway, that got reported to Cody. I didn't even say one word. And so that's not the culture. That's not what we're promoting. I'm thinking like, oh my God, how much are we paying these people to sit here and talk about their weekend? He said, “Nicole, you have one job to come in and smile. It is not your job to reprimand and handle this. You have to rely on your mid-level, who is essentially our clinic manager, if you will, clinic care lead.”
So I go to her, I'm like, wow, so-and-so's sitting over there just shooting the shit, not doing anything. I don't have to do anything. I'm the office cheerleader. We were talking yesterday and there was some HR issue and I told him, I was like, “It's not my job. My job is to sit here and smile. So it sounds like a you problem, not a me problem.”
And, you know, having that levity has made my job way more pleasant, way more, they respect me more. I don't have that, you know, if they're unhappy with me, then they're not going to be as good to my patients and all this, but I'm not the bad guy. I'm just here to take care of people. Val's the bad guy. And so having that separation has completely changed how our back office and how everybody on that lower tier is involved and friendly with the doctors. I mean, they really roll out the red carpet for us and they genuinely care because I think you're not the ones directly reprimanding them.
So anyway, that's my two cents. I love my role now. I highly recommend if you can get a mid-level and you dissipate your, I guess, desires are reprimanding through them. It's a win.
Meier: Yeah, and that's even aside from mid-level managers, it's identifying a departmental lead. Somebody that holds the accountability for that department. So Dr. Freels, for example, if there's 7 medical assistants that are staying around the hall, she's part of that medical team at that point. Dr. Freels is not a manager on that or she's a doctor. She is the one that's going in and talking to those patients that get them happy, healthy, and they're back on the beat. The team lead, the clinical care team lead is the one that should be looking at that. (Inaudible) is saying what's going on and reprimanding or correcting as appropriate. That's her role. That's what she's being paid for. That is her job duties. It is not Dr. Freels’s job duty that from the moment in time, you can see that patient, again, happy and healthy, that is it. So that's really where the reducing the ambiguity of who does what, why is out the door for more. I know if this individual falls within that medical team, within that clinical care team, and they were standing around not doing what they're supposed to be doing, if we're going to follow the path right up the chain and find the individual that I'm going to go ask what the deal is, and she will investigate. Step forward that.
Dr. Spector: Well, practices undergo natural evolutions and change and it sounds like that's no exception for your practices you implemented an organizational chart. How can leaders ensure then that that chart remains relevant over time? Like what are the signs that it might be time to revisit it or update it?
Dr. Freels: I think it starts at ELT. I think where they are every week talking about HR issues and they have a very close eye on everyone that's underneath them. I think that they can anticipate, so-and-so is not happy. Maybe we can just sit down and talk with them and it's not like we need to get rid of you, but maybe we're just gonna put you in a different position or you were promoted and you changed your mind, so let's drop you back down to where you were. It's all, it's so detailed, there's no question on either end. This is what I interviewed and I accepted at this rate. I'm not doing this or I am doing and I want to continue to excel. I think it really helps them just grow, grow and be, you know, honestly employees that we never even thought we had.
Meier: Be really careful about the word evolution or phrase evolution of an org chart, org charts should be created at your strategic, at your, whenever you create your strategic direction. First time you sit down and make an org chart, you should be asking yourself, what do I want my practice to look like in the next five years? If it's staying in the course and doing what you're doing, easy. Departmentalize, departmentalize, find individuals that fall within each bucket, and then identify your leaders and create your work chart off of that.
As an example, I would probably just have one team lead that's over your clinical care, one team lead that's over your patient experience, and then if you have other departments outside of that, then you of course create those departments, but nothing too crazy. A lot of practices will get themselves into trouble in evolving their org chart off of the employees’ desires or their demands. If you've got a really strong employee that's come through and just wants to continue to climb that ladder and progress, but you don't have a position, don't create the position. Unless you are on a strategic direction to meet said position, do not create the position. Stick to your guns, you made that org chart for a reason and don't let your employees bully you. That happened way too often and that's why org charts get burned out of the ground and you lose your accountability and oversight and the ambiguity returns. Absolutely org charts can evolve, but only with your strategic direction. You want to open up a new office in the next 5 years? Sure, in three years, you might need to progress somebody from your clinical care lead into your practice manager or into an operational lead that can help oversee both areas, both clinics, but not until you have that kind of goal.
Dr. Freels: Yeah, I will tell you this, I went through this painfully and did get bullied because, you know, we didn't have an organizational chart and Cody's right. You know, if the position is not there, it is not your job, no matter how much you like this person to put square peg—round hole because that job is now open. Well, maybe that's not the right person for the job. And just because personally you like them, don't risk it and like, don't create new positions just to keep them. Those people have you wrapped around their finger. And one, at some point, they could just come to you and say, hey, I need whatever raise or I'm leaving. Those are those type of people. So if they are willing to stick with you and stick within the role that they signed up for in hopes of a new maybe upper echelon position is available, then that speaks volumes of their character. If they don't, they leave—you know, probably best. But do not create positions and do not let anybody put you in the corner and say, if you don't do this, then I'm leaving or I'm not going to show up on Monday, whatever the whatever this they want to say, just let them go. Let them go out the door. Way easier.
Dr. Spector: Those are some really great points on where this organizational chart could pose problems or challenges, but are there ways in which that you feel that the staff morale and say collaboration have improved as a result of organizational charts? Could it contribute in some way to cohesiveness of the team or motivation of the team?
Meier: Absolutely. So we have alone a side permit adding to the accountability side of people knowing what they are supposed to be doing. There's no question anymore about what does my afternoon look like and who do I go to for questions? Aside from that, we've kind of pointed to this new term that I refer to as positive turnover. Upon hire, I have a very upfront and candid conversation with each employee and put them under one of two buckets—whether they are a lifer or they're what I refer to as a springboard employee.
The lifers, of course, those folks that want to jump in and they tell me that they just want to get the foot in the door and they love Lexington, but I actually want to stay here forever and become a team lead one day. Or they just really want to be the best medical assistant that Lexington has ever seen. That's fantastic. Springboard employees are those that may be in school. They may be want to be a practice manager one day. And maybe you want to go be a doctor, so they're studying for their MCATs. Maybe they want to be a pilot, as an example of something that we've had in the past, and it's totally acceptable, totally fine.
So we have those upfront conversations to put them on a track of how long do I have you until you are going to be seeking out your next springboard. When are you going to be leaving me to go chase your bigger, larger dreams? So, knowing where they fall within that org chart and that they can kind of stay stagnant within that area for those springboard employees is enlightening to them. I'm not pushing myself to get them to that next level of training to turn them into a scribe or the cross ran into another department and because I know I've only got them for another year and a half to two years. And I'm ready for them to do that out. We're going to bring the best and highest level impact they can for me for a short amount of time that I got them. And then I'm going to help them progress out into chasing their larger dreams.
Dr. Freels: Yeah, why not encourage, you know, growth like this. And like you said, if they want to be a pilot or whatnot, at least they have a goal. If they don't have a goal, then we don't hire them. Because, you know, what are you doing? So I think just instituting and adopting this philosophy—because they're going to be going anyway. I mean, it is just today's, you know, employee market. They are here for a couple years. So why not embrace it? Why not work together? And instead of being kind of pissed or whatnot when the employee is only going to be there and you're hoping, well, having that conversation ahead of time, you guys are both on the same page. So Cody will write a reference letter to whatever school to get him into so they know that they can go to him and he is going to—he's almost like their mentor. Even though they're our employee, they're looking at him to help them grow into whatever future they want, no matter what, but they have to want a future. And like he says, maybe one will stick for life and become a lifer unexpectedly. That's obviously ideal, but it's just not realistic anymore.
So I think adopting this positive turnover mentality, it will make everyone so much happier. Because again, it's everyone's on the same page, everyone's working towards the same goal. We want you to be a doctor. Like we have our MA from last year is in podiatry school. So these are the people that we're hiring and we're working with. And I think the transparency is key. Just communication from day one. And I love the idea of asking those same questions, especially with those surveys because employees get nervous. And you know, when they come in that office, they think that they're under the gun and you know, they're going to—who knows, they're going to get reprimanded or something. But asking those same questions, they don't dread that survey conversation with him quarterly, or however frequently he's able to do it. I do think just because, you know, that I guess level typically isn't confident. And so they are not comfortable being in the presence of a doctor or somebody that's accomplished, you know, like Cody, so I think having that consistency with the questions they know the what to expect. And there's no, no stress, no pressure. Hey, let's work together. Again, the same thing that we keep repeating. Let's work together.
Meier: Well, you know, for the lifers to answer some of the questions about adding to the morale, our lifers are set on pathways to become a coordinator to a specialist, to a senior specialist grade one, to a senior specialist grade two, to a training lead, to a team lead, to cross progression and to different departments. So they have these super clear progressions, even within each department of X timeframe or lead to them testing into X position or promotion. And that is super clear. I mean, we've had certificates that we've printed off, the award party and stuff for them when they progress into the next area.
So to add to Dr. Freels’s point, as they start to move into these different progressions within their department and their positions, everybody's on board and it's super happy for them, as I would say, it's a raise and everything, but it's just that growth in the clinic and within the organization. Everybody wants growth. Even if you're not jumping from a team leader, then a two-year span, going from this low-level coordinator, basic employee, into a specialist is such a progression for them. They feel accomplished and everybody can get behind that.
Dr. Freels: Yeah, they really do support each other. And which in the past before we had the org chart and all of this laid out, they would be jealous. Anybody was moving up or whoever was closest to the doctor, they'd just get jealous. But it's kind of crazy having this and having it available to everyone. Everyone has an equal opportunity to grow as an individual. Then they're always happy with each other. So that has been, I was shocked, the support and morale that was so positive around this upward growth progressions within the departments. Nice surprise.
Dr. Spector: That's fantastic. This has been extremely illuminating about something that seems like such a rote, potentially even dry undertaking, but really truly this represents the lifeblood of a practice. So it's so exciting to learn more about this and how it can be implemented to have just such great ripple effects across the board.
We're so excited that you both joined us again today and we look forward to future conversations as well. We hope the audience will continue to tune into this and previous episodes of Podiatry Today podcasts with Dr. Freels and Cody. So be sure to stay tuned for those and don't forget that you can continue to listen to this and more episodes on podiatrytoday.com, on SoundCloud, Apple Podcasts, Spotify, and your other favorite podcast platforms.
