How to give feedback to your problematic practice manager

Most plastic surgeons in large practices have a practice manager who provides leadership for the practice. When a performance issue surfaces, it is usually very difficult for physicians to address the issue effectively.

A common problem is giving performance feedback to a practice manager who is valued in many ways, but who is causing serious trouble in other ways. Typically, the practice manager in question is valued for his or her technical or operational skill, and might have even been brought into your practice for the express purpose of introducing new ways of doing things.

The tools we will present are based on these assumptions:

• the practice manager in question has demonstrated significant contributions, so that keeping the manager is worth some investment of effort and resources;

• the problems are of sufficient magnitude that you are willing to part company with the manager or coordinator unless those problems are resolved; and

• you have given the manager clear and honest feedback on several occasions about what he or she needs to improve, but you have not seen sufficient improvement to be satisfied that the manager is a good fit for your practice’s needs.

Step 1: Preparation

We recommend that you schedule a 1–2-hour meeting with the practice manager, and give a week’s notice. It may be a challenge to find the time for this meeting because of busy schedules, and you may need to commit to a meeting after office hours.

When you first speak with the practice manager to arrange this meeting, do not go into great detail, but say that you want to discuss his or her performance and career goals. The idea is to get the practice manager to start thinking beyond immediate practice issues to larger career issues.

As for your own individual preparation, you need to give considerable thought to this first meeting. The first step is for you to be very clear on your vision of how you want the practice to operate. You need to be ready to articulate that vision clearly.

Giving feedback and counseling to a distressed employee is never an easy process, and it should not be done “on the fly,” so write down the major points you want your practice manager to hear. For example, what does he or she do that looks like good leadership? That is, how does the practice manager’s behavior develop shared direction, challenge processes in a productive manner, develop the performance of others, and create a culture and climate that support the practice’s purpose? Describe specific behaviors.

Use your preparation time to think about these questions as well: What does the practice manager do that does not look like good leadership? That is, what does he or she do to create confusion, miscommunication, needless frustration, misalignment, or mistrust? What are the effects of each kind of behavior on the practice?

For example, if the practice manager is spending too much time performing the duties of other office staff, so that the work that only he or she can do is not getting done, what is the effect on the practice’s overall health and viability? What is not getting done that should be getting done? What is the implicit message that this behavior sends to others in your practice?

If this process seems overwhelming, or if your surgery schedule prevents you from focusing on practice-management problems, you may want to obtain support from a professional practice-management consultant. Have the consultant participate in the initial meeting and throughout the entire process.

Step 2: The Initial Meeting

Review the purpose of the meeting and clarify any misconceptions with your practice manager. Be sure to ask the practice manager to state his or her goals for the meeting. Express your genuine desire to help the practice manager maximize his or her contributions and success in your practice, and share your vision of how you would like to see the practice operating in the future.

Next, ask the practice manager about his or her long-term career goals. The more clearly you understand the practice manager’s goals for the future, the better you can link his or her performance with those goals.

Then, provide objective, specific feedback about the observable behaviors you identified during your preparation. Begin with the things the practice manager does that look like good leadership, and point out how those behaviors lead step-by-step to your vision for the practice and the practice manager’s career goals.

Then, review clearly your perception of the things the practice manager does that do not look like good leadership behavior. Clearly state how those behaviors do not support your vision of how you want your practice to operate.

Next, state the ways in which your support for the practice manager will be crucial for helping him or her to reach his or her personal career goals in your practice. Describe recommendations or suggest projects for which your support is important.

Ask the practice manager to respond to your comments, and check to ensure that you have communicated them clearly. Discuss with the him or her the changes that you believe need to occur to have your support, and ensure that he or she understands what must be changed.

It is desirable, but not necessary, for the practice manager to agree with your position. It is only necessary that he or she clearly understands your position and commits to making changes.

The practice manager now has a choice. He or she can always “be right” by discounting your feedback and continuing on the present course, or can choose to “be successful” by changing to a new set of leadership actions. There is no in-between option. After the practice manager clearly understands your concerns, ask him or her to have another meeting with you (or your consultant) in about a week to discuss how he or she plans to address them. Encourage him or her to bring questions to this meeting such as: To whom will projects be delegated? Which processes will be used to develop others’ performance? How will cross-functional problems be solved?

Step 3: The Follow-Through

During the second meeting, review the practice manager’s plan and negotiate as necessary. It is here that you must follow through on your genuine offer to support him or her by offering formal coaching and consultation with a practice-management firm, off-site visits to other plastic surgery practices, in-depth leadership-development programs, management-skills-development experiences, or other ways to provide support for the new behavior.

Using the plan, give regular feedback about the practice manager’s progress. If his or her behavior does not improve sufficiently, follow through in keeping with the policies of your practice—which may include letting him or her move on to another career opportunity.

Gary R. Casselman, PhD, and Timothy C. Daughtry, PhD, are CEO and president, respectively, of CCG Inc, an innovative professional firm in the field of leadership and organization development located in Greensboro, NC. Both Casselman and Daughtry have more than 25 years of experience in developing high-performance organizations. They can be reached at (336) 294-8793, [email protected], or via their Web site,