Enhancing Practice Performance

How administrator styles impact the practice

Part two of this two-part column explores how to address “intimidating” and “bored, low-energy” managers.

In part two of this column, we continue to contrast common management styles observed in our work throughout the country and how these styles can be modified for practice improvement. Part one looked at the “hair-on-fire” administrator ( ).

Although we focus on administrators, many of the same lessons here can be applied by managing partners and middle managers.


This second administrator type presents as a strong, in control manager but is also intimidating. Another term for this is a “guardian style” of management, which sounds appropriate and protective of the staff and practice but veers into excess — think “pit bull.” The practice appears to be well-organized and the clinic runs smoothly. And that may be true. But, the eventual results of a practice leader that is more of a bully than a motivator can be a high staff turnover rate, problem-solving creativity killer and customer service gaps.

Employees (and doctors) made to feel inferior or fearful respond by becoming withdrawn, unmotivated and discouraged in their work effort. They stop sharing improvement ideas and inevitably pass along their unhappy demeanor to patients — if not overtly, then subtly.

Here are some recommendations on how to address administrator intimidation:

  • Communicate. Share the perception of intimidation with the administrator. Propose specific examples of behavior that could have been improved by using a kinder, more supportive approach. Expect defensiveness, and call it out when you see it, using this as another point of coaching discussion.
  • Eliminate the need for micromanaging within the practice. Micromanaging creates an environment of distrust and frustration. Those who are micromanaged can feel defeated. If the administrator feels pressure to control every step taken in the practice, the board or managing partner can help to alleviate that need.
  • Provide skills education and coaching to the entire management team. This can take some of the pressure off the administrator to be so overbearing. Most people want to perform well in their positions, especially managers striving in their career. If the management team has skill gaps, provide the resources they need. They want to improve but may not know where to start.


A third, potentially problematic administrative type is less recognized. He mostly acts as a steward, managing the status quo. The practice may actually run very well but lack innovation. This can occur in non-competitive rural markets where the practice does not have a “pacer” to keep up with. Or, perhaps the owners do not provide a vision for the future, so one year follows the next without much change. There are fewer challenges than there used to be, and some days are downright boring.

Why is this a problem? What could be wrong with an organized clinic and few crises? Isn’t it OK to simply manage a steady state, more foundation-like organization?

It may well be if your management team is continuing to improve and have remained energized. But, if it has become a ho-hum place to work, your best managers will desire more challenges and ultimately leave the practice, lured away by the desire to do more and be more.

Here’s how to address administrator and management team boredom:

  • Demand constant improvement. While “demand” is a strong word, it can have a good, constructive application, too. Build this into the fabric of your practice; surgeons are always looking to improve their skills, and managers should, too.
  • Hold quarterly meetings. Design these meetings to identify new current challenges to address as a practice. As a management team, brainstorm the issues and potential solutions. Implement the steps needed to solve the problems, and review progress quarterly. Remember, you can challenge yourselves to go from good to great. Focusing on strengths, not just weaknesses, is typical for successful practices.
  • Discover areas to improve. Use tools such as patient satisfaction surveys, employee satisfaction surveys and management scorecards (find these in our newest book, “UP: Taking Ophthalmic Administrators and Their Management Teams to the Next Level of Skill, Performance and Career Satisfaction,” available at ).
  • Attend annual ophthalmology practice management meetings. Examples include ASCRS/ASOA and AAO/AAOE. Find new ideas. Read avidly. Visit sister practices. Develop a cohort of peer-managers around the country who can help you challenge yourself with new ideas. Share this enthusiasm for growth with the whole practice.


Without challenges and professional growth opportunities, the best and brightest management team members will search elsewhere for employment. The most successful practices attract strong managers, providers and patients by achieving the highest standards of enterprise management. OM