Senior administrator roles and responsibilities in small medical practices

Organization is a small to medium-sized private doctor's office, with three senior partners and a staff of twelve. All the senior physicians are general and family practitioners. The mission of the organization is to provide the best quality of care to all patients, and its vision is to provide a safe and enjoyable environment with which to receive medical care and attention. Wait times in the office are minimized by a skillful method of scheduling patients, which is overseen by the Senior Administrator. I interviewed the Senior Administrator, who will be called Darleen Samson for the purpose of this report.

Role Within Organization

Darlene Samson is a Registered Nurse who served as hospital administrator for a large local hospital. When the pressures of the job became too much, Samson left even if it meant taking a pay cut. Samson told me that managing the hospital is a stressful position involving politics as well as skill. In a smaller office environment like the one she is in now, Samson finds that everyone works together to achieve mutually beneficial goals.

As the senior administrator, Samson is in charge of patient and staff coordination. She also takes care of orders and supplies for the office and meets with pharmaceutical and equipment company sales representatives. Her contact with patients is minimal, although as a Registered Nurse she is occasionally called upon to aid staff during emergency situations or times when the office is understaffed. Samson maintains databases and records for the office's finances, and reports regularly to the office accountant. In addition to these duties, Samson also coordinates patient outreach, marketing, and human resources.

Samson oversees a staff of nine nurses with varying areas of specialization. In addition to the nursing staff, Samson also works with the physicians assistants and office receptionists. Samson denies that the organization has a hierarchical organizational structure, especially when compared with the hospital. However, she does describe her role within the organization as being subordinate to the physicians. The physicians are the owners and technically her bosses, but they leave almost all of the administrative duties up to Samson. Rarely do any of the physicians interfere with her work because they are busy taking care of patients. Therefore, Samson serves in a valuable role within the organization and the physicians treat her as an equal.

The office receptionist serves in a dual role as Samson's personal assistant. Otherwise, the administrative department of this small organization only consists of Samson's role. She is involved in strategic planning, which involves occasional staff meetings. All employees are encouraged to attend the meetings, because the owners want all staff to be aware of and involved in the health of the office. Part of the organization's vision is to create a positive workplace environment, and one in which all employees feel valuable.

1. Critical Thinking

Samson's position as senior administrator involves a high degree of critical thinking, especially in regards to long-range planning. Her patient outreach project was built on Samson's ability to think critically about what the organization needed to do to reach its goals, and also how to go about implementing new tactics.

2. Reflective Thinking and Self-Evaluation

One of Samson's tasks in her prior role as hospital administrator was to perform regular performance evaluations on nurses. At the time, she felt it would be helpful to require self-evaluations as well. The self-evaluations helped Samson clarify issues, and she found the tactic so helpful that she applied it to her current role with the private office. Now, Samson completes a reflective log at least once a week. The log is recorded on her personal database and is available for the senior physicians to read.

3. Ethics and Sustainable Futures

Samson has struggled with this area as a healthcare administrator. She admits that the hospital was more difficult to manage in terms of ethics and sustainability but even in the small office, changes in operations were needed. For one, Samson minimized paperwork and reduced paper waste creation by over fifty percent. Digitalizing patient files enabled Samson to achieve this goal, with only minimal investment in employee training and technology. Second, Samson met with the doctors about ethics and responsibilities to patients. Confidentiality issues were not a problem, but disclosure issues were an issue with one of the senior doctors. Samson discovered a disturbing number of prescriptions being written for drugs that were not necessary to achieve patient outcomes. She has taken an aggressive approach to minimizing the impact of pharmaceutical sales on doctor prescriptions. Because of the ethical infringements she noticed when first accepting the position as administrator, Samson published a new code of ethics for the organization. In a staff meeting, all employees were encouraged to raise questions and signed the document collectively.

4. Information Literacy

When Samson first became the Senior Administrator for the organization, she found a lack of coordination among nurses and between nurses and physicians. She initiated a series of measures that increased information literacy by standardizing and digitalizing information. The need for increased patient information literacy was even more important. Samson acquired public service announcements and published her own data sheets about diseases. Each patient received a follow-up care guide that they could use at home, as well as a list of Web sites and resources. Patient information literacy was also improved via the implementation of the patient groups initiative, in which patients could meet with other people who had similar conditions or complaints. Outreach services was a top priority for Samson, who integrated information literacy with patient outcomes.

5. Computer Literacy

Samson helped the office upgrade its it system. The improvement of the office's it was projected to cut costs over the long run, even if initial expenditures were greater than two of the senior partners wanted to invest. Already the cost savings goals have been met, two years after the upgrades were implemented. Samson has ensured that all nursing staff and the physicians are connected via PDAs, and all patient data is digitalized. A waiting room terminal also helps to improve patient computer literacy. Samson provides a list of reputable Web sites for medical information to prevent patients from using Wiki or untrustworthy sources.

6. Diversity

As Senior Administrator, Samson understands the need for diversity awareness in creating a positive workplace environment. Samson is herself a minority and half of the nursing staff in the office are non-white. One of the senior doctors is Latino. Samson helped staff trace some of the office miscommunications to a lack of cultural sensitivity. Diversity issues are on the table at one of every two staff meetings, according to Samson. Diversity awareness has improved as a result of directly confronting stereotypes that had previously prevailed in inter-office communications. Samson also believed that diversity awareness was most important in regards to patient relations. Therefore, Samson encouraged staff members to take into account communication differences and other issues related to diversity when addressing patients.

7. Synergy and Human Capital

Generating cooperation and fostering personal strengths is one of Samson's main goals as the Senior Administrator. Achieving the goals of the organization depends on a positive workplace environment, which in turn is fostered by synergy. Samson helped create an environment of empowerment, in which human capital was treated as being equally as valuable as financial capital. Helping all staff members feel indispensable was one of the first steps towards achieving this goal. Then, Samson ensured that staff meetings would be held regularly and attended by all staff. Voicing objections and concerns was encouraged, and Samson even allowed some complaints to be submitted anonymously. An emphasis was place on employee retention as well as patient retention. The human capital is the most valuable aspect of a healthcare organization. During her position at the hospital, Samson understood that high rates of turnover and absenteeism were impacting healthcare objectives. Patients were not receiving the care they deserved because nurses were working in an environment that involved pressure, stress, and poor leadership. Samson helped to correct or prevent such problems in her current organization by appointing a staff leader among the office nurses. The staff leader met with the nurses each morning to discuss that day's roster. Then, to minimize wait times, the nurses embarked on a sophisticated method of scheduling and coordination. Each of the nine nurses could see any of the patients. The nurses were entrusted with information delivery and everyone was on the same page as a result. Keeping all the staff informed was one of the ways that Samson has succeeded in creating a positive workplace environment.