Introduction
Rochelle Anderson, business manager at the Idaho Women’s Clinic was excited and
anxious about her assignment. The Idaho Women’s Clinic physicians’ 2006 strategic retreat had
just ended and the work accomplished had been more productive than she had hoped. First, all
five physician partners were there and they were able to work as a team and write the mission
statement. Second, they had agreed that a central patient database and a central billing office
needed to be set-up. Then, announcing their confidence in Rochelle, they delegated the
implementation of the database and central billing office to her. Dr. Carter stated, “We want to
practice medicine, not run an office. Rochelle, we depend on you for that.” Dr. Cochran,
President of the Clinic Board and one of the charter physicians of the partnership, agreed.
“Rochelle, you have my total support in this endeavor to centralize business operations. You
figure out how best to choose what database system should be chosen and how the billing office
should be set up.”
As she thought more about the assignment, Rochelle worried that perhaps the physicians’
confidence in her might be overstated. Many of the clinic physicians had staff that had been with
them for most of their years in practice, including the years prior to the partnership formation.
Staff for the three original partnership physicians averaged over 15 years of service, and one had
worked for the same physician for 30 years. How was she to convince these staff “old-timers”
that it was time to change?
The Clinic
The Idaho Women’s Clinic was founded in 1997 as a three-physician partnership. Over
the last ten years, the Clinic had earned the reputation of providing “best practice medicine” to
its patients. The physicians were leading innovators in southeastern Idaho in women’s health
care, and patients reported that they received excellent OB/GYN care. Consequently, patient
demand had encouraged the original three physicians to grow their practice. Also, because the
Clinic operated in Idaho, which ranked 49th among states in physicians per capita, more
physician services were needed for the rural community-at-large. Since the Clinic’s
establishment in 1997, two more physicians had joined the practice along with one physician
assistant, three nurse practitioners, and two nurse midwives. The end result was an incorporated
group practice that had grown quickly. The Clinic was currently searching for two more
physicians to join the practice and they were discussing expanding the nurse midwife program.
This expansion, however, had created an organizational structure in which each physician
had his/her own staff, billing center, and patient medical charting system (see Figure 1). Each
physician also had his/her own waiting room with its own separate entry, different receptionist,
and different nursing staff. The aggressive growth rate had resulted in a Clinic that was actually
five separate independently operating practices. The reporting structure of office personnel
reflected this independent arrangement. While Rochelle reported to the President of the Idaho
Women’s Clinic (Dr. Cochran), none of the office managers reported to her. Each one reported
to her respective physician with the nurses and office personnel reporting to the office managers.
The structure had evolved informally and the organizational chart reflected this informal
arrangement. For example, Dr. Sutherland’s nurse had requested and received permission to
report directly to her physician and, unlike the other office arrangements, bypass the office
manager.
Nonetheless, the overall growth and evolving organizational structure of the Clinic did
not affect the day-to-day operations of the office staff. Since the Clinic was essentially a
structure of silos, staff members between separate doctor’s offices did not regularly interact with
one another about work. Rather, staff interaction was limited to lunching together and discussing
their social plans for the weekend. Clinic operations, filing systems, and billing issues were not
discussed precisely because each physician’s office had an office manager that followed her own
office protocol. The only change noticed by the staff was the growth of staff in other offices.
There simply were more people to get to know and see.
Rochelle Anderson
Rochelle had been hired six years ago as an administrative assistant for the Clinic. At
that time, she had earned an Associate Degree in Medical Assisting from the State University,
and she knew that she was prepared to answer the phone, schedule appointments, and help with
billing. She quickly learned that her responsibilities in the Clinic exceeded her training. She was
also expected to manage the call schedule, put together the agenda for the physician meetings,
take the minutes for the meetings, and offer sound advice regarding office business practices.
Rochelle responded well to work demands and she learned that she liked her job. She found the
work to be interesting and challenging and the staff members to be friendly and encouraging.
She and the staff agreed that her top priority was to help manage the staff increase at the Clinic
and ensure that scheduling, billing, and day to day operations were not negatively affected by
future growth.
Rochelle was well liked by the Clinic staff and the physicians. She excelled in her work,
was personable and friendly, and she was known as the “home grown star” around the Clinic.
Dr. Cochran was happy to note, “We are proud of Rochelle. She came to us a few years ago,
eager to prove herself. And yes, she has surpassed our expectations. In fact, we agreed two years
ago to help her grow in this position. The Clinic pays for her tuition to earn a Bachelors degree
in Healthcare Administration from the State University. And she is doing great. Rochelle is a
straight “A” student.” Dr. Cochran paused and smiled, “But,” he added, “We didn’t expect
anything less of our star.”
Dr. Carter added, “She is the one who got us to have the first strategic planning retreat.
And, that was a success. The doctors got out of the Clinic and spent the entire day at a The Hot
Springs Resort. We really experienced a retreat, and it was the first time I saw us as a team of
physicians, a group. I used to think of us as physicians who merely shared office space.”
Dr. Cochran spoke, “Rochelle got us to draft a mission statement—she wanted us to
define who were are and what we want to be remembered for regarding our work. I liked
thinking about us as a group. And that helped me to understand that, as a group, we need
Rochelle to take the lead in initiating measures to help create office practice efficiencies that
makes sense.”
• We have Integrity
• We maintain Professional Excellence
• We encourage Collegial Support
• We provide a Safe Environment