Roots Before Fruits

(This is a cover letter for a report I wrote for a client after a consulting engagement.)


By Ronald A. Blue, Consultant

During my recent consulting engagement, my interviews with the administrator and clinical manager revealed a strong perception that there was a lack of focus in the practice, that doctors were “spread too thin”, and thus, didn’t have time to meet (i.e., not enough communication).

Specifically, I heard statements like “I don’t understand what they want”, and ‘We seem to have separate agendas”, and “He has his hands in too many things”, and “It takes forever to get a decision made”… I sensed a feeling of frustration and paralysis…that they were helpless to change anything or to stop the wheels from spinning in place.

In my experience, I believe this situation represents the rule and not the exception. What can be done to help resolve the pressing concerns and improve effectiveness going forward?

Well, the old cliché “It starts at the top” rings true.


Regardless of titles or desire not to have them, I feel the physician-owner must adopt the mindset of a chief executive officer. As “CEO”, he is the leader of the organization. He must communicate to everyone his professional goals and his vision for the type of practice he thinks he needs to have and what it takes to be successful. The “CEO” must keep the organization focused by constantly reinforcing his vision through ongoing communication.

More specifically, the “CEO” determines the right thing to do and thus defines what is appropriate. This includes providing direction in the areas of policy, budget, capital expenditure, planning, staffing requirements, and strategic development, As “CEO”, his emphasis should be on results and not methods.  He is the key decision maker regarding “macro” issues confronting the practice.

In effect, the management function must be delegated to the administrator by the “CEO”. Many physicians believe delegating is a bad thing…that it means loss of control.

Actually, the opposite is true.

Delegation expands control and liberates the physician from time-consuming, low priority activity that robs him of valuable time that could be spent on high leverage activity that only the physician can do, for example: learning new surgical techniques, seeing more patients, and more important, spending more quality time at home with loved ones.

Change and improvement begin with the leader.


The administrator must function as the manager. The administrator must be fully empowered with the effective authority to perform in congruence with the responsibility placed upon her to produce results.  The administrator’s responsibility is to develop the “micro” portion of the CEO’s “macro” design, develop the methodology to get results (doing things right), hold people accountable, measure results, and solicit appropriate feedback from those involved.

The administrator must be able to make decisions impacting daily operations and the CEO must refrain from intervening.

The administrator, too, must learn to delegate any task that someone else can perform equally as well or better, and concentrate on activity only the administrator can perform (e.g., managing and expanding the data processing function).

Also, it is incumbent upon the administrator to keep the CEO fully informed of key issues and concerns.  Thus, regularly held meetings are crucial and should be considered a priority.


Leadership and management must be in balance. The physician/CEO and administrator must, through mutual trust and understanding, come together as one… forming a synergistic bond.

I suggest this leadership/management paradigm I am describing, is the only viable way overall organizational effectiveness can be achieved. You cannot expect to bear “fruit” without first establishing the “root” and synergistic leadership/management is the “root”.

The prospect of successfully implementing the recommendations made in this report and realizing  the resulting “fruits”… is directly related to the depth of the root…and the depth is determined by the credibility of the commitment.

Credibility diminishes in direct proportion to the number of received mixed signals interpreted along the way, therefore, the physician/CEO must continually “walk his talk”.

Unless the physician/CEO is willing to wholeheartedly embrace this concept, unless he is genuinely committed to the process, unless he understands that delegation expands control rather than decreases it, and unless he is willing to empower the administrator to “carry the ball” after he has handed it off, the chance of achieving long-term, lasting change is not favorable.