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WORKING WITH PHYSICIANS

For personal success, get beyond the words and metacommunicate

Meta means beyond. And though it has varying definitions, in simplest form, metacommunication means going beyond regular communication to get the full point across. It means making sure everything – spoken or unspoken – gets communicated to and from both sides.

Most employment situations are rife with unspoken expectations and assumptions, says Barbara Kay, LPC, RCC, a business psychologist and productivity coach in Wheaton, IL.

Employees don’t know or don’t understand what their leaders expect, don’t meet those unspoken expectations, and see their careers lag as a result.

That’s where metacommunication comes in. It lets the manager find out what the doctors truly want and, in turn, show them the value they’re getting from their manager.

15 minutes? maybe 30? please?

Most managers get only an annual review, Kay says, and often that review is formal and structured and rigid to the point that both sides “miss the unspoken things.”

That’s scarcely enough time to know the doctors’ full expectations and stay in line with meeting them for the next 12 months.

It’s the manager who has to start the metacommunicating, and it’s done by asking the managing physician for time to talk about the expectations for the job.

Ask for 15 minutes at a minimum, though 30 is better “and an hour is optimum,” Kay says.

If the answer is no, try again a few weeks later. And keep trying. This is essential.

Medical office managers are responsible for a tremendous number of things, she explains, and while they may start out on the right path, they can easily take a wrong direction. Also, “people’s priorities shift based on circumstances,” Kay points out, and the shifts the doctors make aren’t always spoken.

The initial direction may have been to cut expenses and keep “a lean and mean staff,” she notes, when unbeknownst to the manager, several doctors have heard that patient service is suffering and want to hire more staff. And nobody has thought to tell the manager.

A good introduction to the conversation: “I want to make sure I’m on the same page with you and the other doctors in respect to the expectations you have of me.”

Uncovering the unspoken

Go into the meeting in order to get an answer to the question “What are the priorities you want me to pursue?” In other words,  Kay says, “find out what will get an A on the report card,” or what’s high on the doctors’ priority list.

From there, ask “How am I doing in executing your top priorities?”

This is not begging for a rating. Instead, it opens up an opportunity for the doctor to talk about what’s being done well and what things are important to the medical staff that the manager is not doing well or possibly not doing at all. Or, “I see you’re putting a lot of effort over here, and actually I need you to put more effort over there.”

Also, if another priority has come up, it’s a reminder for the doctor to reveal it.

That’s metacommunication. It brings out all the facts.

What if the doctor doesn’t give enough information on what the preferences are?

Nail it down by asking “Is there anything you’d like me to do more of? Less of?”

Or, “If we get to the end of the year and you’re absolutely thrilled with my performance, what will I have accomplished?”

Takes notes and then verify it all

Kay points to two more factors that will affect the productivity of the discussion.

One is to take notes during the conversation, but don’t get buried in the note taking. Keep the eye contact going. This is a time to make a professional and personal connection. Staring down at the notepad is hardly conducive to metacommunicating.

The other is to follow up afterwards to verify the accuracy of what the manager has heard.

Send an email summarizing what’s been said and what’s to be done. For example: “If I understood you correctly, your highest priorities are A, B, and C. You want me to put more emphasis on D. And success for me would be to accomplish E, F, and G.”

Dear Diary . . .

Now set up a diary to track the progress.

In it list the goals the managing physician wants to see accomplished during the next six months to a year.

Under each, list the activities that will be required.

And to identify them, ask “What do I need to do to achieve this?” That’s the action plan.

A lot of managers list the goals but don’t break them down into activities, Kay says. “They know what they want to accomplish by the end of the year but not what they need to do every day and week and month to get there.”

She recommends following an approach that’s been around since 1981 and is still in force. It’s called SMART, and it means that each activity has to be

Specific – spells out what will be done

Measurable – can be measured for success

Achievable – realistic enough to be completed

Relevant – has a direct impact on the goal itself

Time-bound – has a deadline for completion

For example, if the goal is to improve staff retention, one step might be to schedule individual meetings with staff during the next three months to discuss their professional development and satisfaction.

That’s specific, because it’s spelled out. It’s measurable, because the meetings can be calendared and marked off. It’s achievable, because the meetings will be scheduled and won’t conflict with other duties. It’s relevant, because staff’s comments can improve morale. And it’s timed, because it has an end point.

Anything I don’t know about?

Throughout the year – preferably quarterly and even monthly if a lot of changes are happening – check back with the managing physician.

And be positive. The meetings are an opportunity to stay in line with what the office wants.

Go over the diary entries and show what’s been done. Ask if anything has changed or if new events have occurred: “Is there anything different I should be aware of? Is there anything going on that calls for a change here?”

If the office has added an ancillary service, for example, there may need to be more staffing or a change in marketing. This is the time to recalibrate and fine tune the plan.

Be direct with “How am I doing? Am I on track with what you want?” But be aware that the meeting is not a review. It’s a check-in time to see what needs to be continued and what needs to be changed.

Any manager “is much more successful” when there’s frequent communication with the boss, Kay says. The work stays on track, and the boss knows it.

Metacommunication = metagood

At year’s end, take the completed diary to the managing physician. The presentation format depends on the relationship and also on the office itself.

If the atmosphere is formal, present the information in writing. If not, an informal conversation might be appropriate.

Show the original goals, the action taken to achieve each one, the changes made throughout the year, and the end results.

With metacommunication, the manager has known all along what the doctors have wanted to achieve and has taken the right steps to achieve it.

Now, according to Kay, the doctors “have a clear record of what their manager has accomplished.”


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