AE March/April 2018 Vol 27 No 2 - 14

RUNNING THE PRACTICE // FAST
XXXXXXX
PRACTICE

BREAKING DOWN PRACTICE CLIQUES
John B. Pinto

"We are neurologically hardwired to seek out people like ourselves.
We start forming cliques as soon as we're old enough to know what
acceptance feels like. We bond together based on anything that we can-
music preference, race, gender, the block that we grew up on."
-iO Tillett Wright

P

ractice cliques can be more
painful and damaging than
the high school kind. The
harm is manifold. People in
cliques hoard information
that should be flowing to
others inside or outside
a department. For "outsiders,"
including new staff, exclusion slows
training and increases early-employment resignations. Clique leaders
can become so strong they are emboldened to challenge the authority
of administrators and owners.
Let's examine cliques in the
context of the largest department
in most practices-the technical
services staff-including work-up
techs, scribes, special testing staff,
and those helping with in-office
injections and minor procedures.
A LOST RESOURCE
Technical services staff are typically
supervised by a single mid-level

14

AE // Mar/Apr 18

manager, who reports to the practice administrator. In the average
general practice, the tech department represents about 40% of the
lay staffing headcount, at least 50%
of lay staffing costs...and consumes
up to 15 cents out of every dollar
collected by the practice.
This is an expensive resource to
allow to falter due to preventable or
reversible cliques.
TYPES
At least three kinds of cliques can
arise in your practice's technical
department.
* Splintering: This is when a subset of the department (often the
most senior cohort) breaks off
and forms its own faction, leaving "unworthy" or less popular
techs out of their club. Because
of their seniority and productivity, they can hold a practice
administrator hostage.

* Techs-vs-everyone else: Techs
are naturally positioned to form
problematic cliques, pitting their
department against all others.
They know they are the hardest
to recruit and replace and may be
treated leniently. They work most
closely with providers, and over
time may come to feel entitled or
at least shielded.
* Subspecialty-based: This is when
a subspecialist (e.g., retina) is
assigned his or her own standing
crew of techs, and is exacerbated
when the subspecialty team occupies its own freestanding suite.
GENESIS
Just like a fire needs heat, fuel, and
oxygen to erupt, three concurrent
conditions are needed for a clique
to arise, prosper, and spread.
First, for a clique to surface, there
needs to be a sense of separation of
the tech department from the rest
of the practice. This can arise from
several causes:
* Weak leadership at the top,
causing departmental staff
to feel more bonded to their
immediate team than to the
practice as a whole.



Table of Contents for the Digital Edition of AE March/April 2018 Vol 27 No 2

How We Can Successfully Lead
Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
Business Operations: Some Things to Know About Professional Liability Insurance
Customer Care: Making a Diffi cult Journey A Little Easier
Fast Practice: Breaking Down Practice Cliques
Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
InfoTech: Cloud Computing— Storms or Blue Skies?
Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
Technicians: Creating a “Feeder Program” to Staff Your Clinic
Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
Taking Your Practice to the Top
Use Podcasts to Increase Practice Visibility—and Thrive
Trailblazing— How to Implement Career Pathing in Your Practice
Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
Asked and Answered
ASOA News
Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
Advertisers’ Index
Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover1
AE March/April 2018 Vol 27 No 2 - Cover2
AE March/April 2018 Vol 27 No 2 - 1
AE March/April 2018 Vol 27 No 2 - 2
AE March/April 2018 Vol 27 No 2 - 3
AE March/April 2018 Vol 27 No 2 - 4
AE March/April 2018 Vol 27 No 2 - How We Can Successfully Lead
AE March/April 2018 Vol 27 No 2 - Advanced Administration: Administrator Success Factors—Needing a Tune-Up Is Expected
AE March/April 2018 Vol 27 No 2 - 7
AE March/April 2018 Vol 27 No 2 - Advice for New Administrators: Introducing the Administrator Beginners Circle—The Go-To Resource for New Administrators
AE March/April 2018 Vol 27 No 2 - 9
AE March/April 2018 Vol 27 No 2 - Business Operations: Some Things to Know About Professional Liability Insurance
AE March/April 2018 Vol 27 No 2 - 11
AE March/April 2018 Vol 27 No 2 - Customer Care: Making a Diffi cult Journey A Little Easier
AE March/April 2018 Vol 27 No 2 - 13
AE March/April 2018 Vol 27 No 2 - Fast Practice: Breaking Down Practice Cliques
AE March/April 2018 Vol 27 No 2 - 15
AE March/April 2018 Vol 27 No 2 - Human Resources: Recruiting Strategies for Ophthalmology—Where to Search for New Physicians
AE March/April 2018 Vol 27 No 2 - 17
AE March/April 2018 Vol 27 No 2 - InfoTech: Cloud Computing— Storms or Blue Skies?
AE March/April 2018 Vol 27 No 2 - 19
AE March/April 2018 Vol 27 No 2 - Reimbursement: Embracing Change to Thrive in an Evolving Reimbursement World
AE March/April 2018 Vol 27 No 2 - 21
AE March/April 2018 Vol 27 No 2 - Technicians: Creating a “Feeder Program” to Staff Your Clinic
AE March/April 2018 Vol 27 No 2 - 23
AE March/April 2018 Vol 27 No 2 - Washington Watch: MIPS in 2018—Key Changes for Ophthalmic Practices
AE March/April 2018 Vol 27 No 2 - 25
AE March/April 2018 Vol 27 No 2 - Taking Your Practice to the Top
AE March/April 2018 Vol 27 No 2 - 27
AE March/April 2018 Vol 27 No 2 - 28
AE March/April 2018 Vol 27 No 2 - 29
AE March/April 2018 Vol 27 No 2 - 30
AE March/April 2018 Vol 27 No 2 - 31
AE March/April 2018 Vol 27 No 2 - 32
AE March/April 2018 Vol 27 No 2 - 33
AE March/April 2018 Vol 27 No 2 - Use Podcasts to Increase Practice Visibility—and Thrive
AE March/April 2018 Vol 27 No 2 - 35
AE March/April 2018 Vol 27 No 2 - 36
AE March/April 2018 Vol 27 No 2 - 37
AE March/April 2018 Vol 27 No 2 - Trailblazing— How to Implement Career Pathing in Your Practice
AE March/April 2018 Vol 27 No 2 - 39
AE March/April 2018 Vol 27 No 2 - 40
AE March/April 2018 Vol 27 No 2 - 41
AE March/April 2018 Vol 27 No 2 - Ocular Surface Disease: Reimbursement Considerations for the Evaluation and Management of Dry Eye
AE March/April 2018 Vol 27 No 2 - 43
AE March/April 2018 Vol 27 No 2 - Retina: Should Retinal Specialists Be Integrated Into a Multispecialty Practice?
AE March/April 2018 Vol 27 No 2 - 45
AE March/April 2018 Vol 27 No 2 - Asked and Answered
AE March/April 2018 Vol 27 No 2 - 47
AE March/April 2018 Vol 27 No 2 - ASOA News
AE March/April 2018 Vol 27 No 2 - 49
AE March/April 2018 Vol 27 No 2 - Bookshelf: Off Balance On Purpose: Embrace Uncertainty and Create a Life You Love
AE March/April 2018 Vol 27 No 2 - 51
AE March/April 2018 Vol 27 No 2 - COE Corner: Preparing for the COE Exam – Keep Your Eye on the Prize
AE March/April 2018 Vol 27 No 2 - 53
AE March/April 2018 Vol 27 No 2 - Focus on a Practice: Ohio Valley Eye Physicians & Surgeons, PLLC, on Operating a Practice in Two States
AE March/April 2018 Vol 27 No 2 - 55
AE March/April 2018 Vol 27 No 2 - Gamechanger: Karen Bachman, COE, COMT, OCS, ROUB
AE March/April 2018 Vol 27 No 2 - 57
AE March/April 2018 Vol 27 No 2 - Advertisers’ Index
AE March/April 2018 Vol 27 No 2 - 59
AE March/April 2018 Vol 27 No 2 - Peer to Peer: What’s Your Favorite Technique for Holding a Productive Staff Meeting?
AE March/April 2018 Vol 27 No 2 - Cover3
AE March/April 2018 Vol 27 No 2 - Cover4
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