Wednesday, October 25, 2006

Going Solo: why you need an operational manual

Ray Kroc, the founder of McDonalds, was able to create his enormous franchise empire, in large part, by establishing a uniform process of doing business. Every step in the daily operations of McDonalds restaurants were documented and written down in an operational manual. This is true today and has become a standard in the franchise model. There is predictability and uniformity for customers and employees alike and it is the prime reason why a person’s experience in the McDonalds in Cherry Hill NJ is identical to his experience in Peoria IL or in downtown Chicago. Sipping a Tall Mocha Latte in a Starbucks in Long Island feels and tastes the same as in a Starbucks in Seattle or Cleveland or Timbuktu.

Having an operations manual in your medical practice is important as well, but not because you plan to franchise or because you think you have the business savvy of Ray Kroc. No, writing an operations manual is critical to your start-up because it forces you to develop a mental blueprint for how your practice will operate on a daily basis. It is a dry run; a practice run. Practice runs help other professionals as well, including athletes, actors, firefighters, policemen etc. Good golfers conceptualize putts before actually putting. Downhill ski racers take mental practice runs before the race. Tennis players develop game plans prior to the match. In medicine, surgeons perform surgery mentally, in their mind’s-eye, before doing the actual surgery on the patient. This practice makes the surgery go better. Working on an operational manual is like taking a practice run, only on a grander scale. Writing an operations manual will tell you what you know, but more importantly, what you don’t know and make your start up process go more smoothly and less expensively. You’ll make fewer mistakes. Having an operations manual will make your new practice go better.

Your practice manual should cover everything you can possibly think of, like how your receptionist will answer phones and greet patients, how to autoclave instruments and clean a scope, and how to make up a new patient chart. Your operations manual should detail how you back up your digital records, what you do in case a person collapses in your office, of if there is a fire, and how to forward your phones at the end of the day. Literally you must brainstorm your process for dealing everything from the mundane to the fantastical and put it in writing in your manual.

From a more practical standpoint, the operations manual can assist in training new employees and the manual itself can become a de-facto practice manager, only one that doesn’t cost $50, 000 per year. When employees have questions about, for example, how to autoclave instruments, refer them to the manual. When they want to know how to forward the phones at day’s end, refer them to the manual. Employees like it because they know what is expected of them and you’ll like it because it allows you to focus on other issues.

You do not need to write the manual in one day or even have it completed before you start to see patients. But start writing it. I started to write mine 6 weeks before I opened my doors for new patients and the first entry dealt with the only thing I knew at the time about practice management, which was how I wanted my staff to answer the phone. Adjust, edit, and update the manual as needed. It is a living document that helps you critically evaluate your process of practice management. It will make your practice better.

For legal reasons that are unclear to me but clear to my attorney, your manual will need to make certain disclaimers and statements, such as an At-will policy, a harassment policy, an ADA policy etc. You can get the legal wordings for these sections from your attorney or insurance company.