AE March/April 2018 Vol 27 No 2 - 15

* Alienation, fear, or perceived
hostility, coming from providers or senior management, is
a common factor. Whether or
not such feelings are reasonable
or rational, they are real to the
involved individuals and can be
fanned by a ringleader. Cliques
arise in an effort to counterbalance perceived vulnerabilities
or isolation.
* Inappropriate doctor encouragement: "You guys are special; I
don't expect you to follow all the
same rules as the business staff."
Second, a ringleader has to
surface to incite and hold the clique
together. This is almost always
done through negative messaging,
e.g., "These new templates are
killing us. We senior techs need
to stick together and stand up to
management."
Third, for a clique to prosper
there has to be a lack of vigilance
and action on the part of managers
and doctors. This is sometimes
accompanied by a fear of doing
anything about an emerging clique
because individual tech clique
members are hard to replace...and
they might even leave as a group.

2.

PREVENTING AND REVERSING
CLIQUES AND SILOS
We use numerous prescriptions in
our consulting work to help practices avoid or reverse inappropriate
staff clusters. Here are some that
may work in your setting.
1. Look for early signs of clique
formation: unwarranted group
pushback on policies, protocols, or template changes...a
department head who moves
beyond being a reasonable
advocate for their staff (good)
to sounding like an emerging
union organizer (not so good).

6.

3.

4.

5.

7.

Assert or reassert leadership
from the top, along with a
clear message about the primacy of the practice mission,
ahead of the narrow interests
of any one department or staff
subset. Create a practice values
statement that emphasizes
patient-first collaboration and
that everyone is part of the
larger organization.
Don't allow your practice
to be held hostage, even by
mission-critical staff. You
can recover faster from the
dismissal of a toxic, talented
ringleader than you can from
their cumulative damage over
time if allowed to stay.
Avoid assigning a provider
in a multi-physician practice
their own, standing team of
technicians or receptionists.
Rotate staff, not only to break
down cliques but to boost
cross-training and build resilience to staff loss.
Intervene quickly with an
emerging ringleader. Dismissing the persistent ringleader will
dissolve or weaken the clique.
Tamp down efforts for a substitute ringleader to emerge.
Bond every new staffer to an
experienced colleague in the
same department for their first
year...and make that colleague
co-responsible for the newbie's
success.
When faced with practice-wide challenges like
low patient satisfaction
or clinic flow problems,
muster inter-departmental
work groups to propose
solutions. Not only will
you cross-ventilate closed
departments and foster new
working relationships, but

diversified, interdisciplinary
teams generally come up with
better solutions.
NOT JUST TECHS
Cliques can arise to a lesser degree
in any department, even a department of one.
Optical staff are so dependent
on providers and staff to feed
them customers that they tend to
maintain open and cordial interdepartmental relations. Billing staff,
and to a lesser extent, reception
and phone staff, are susceptible to
becoming inward-looking, but to a
much lesser degree than in the technical department.
One-person departments-
like surgical counselors in small
practices and solo marketing staff,
as well as associate optometrists-
should not be overlooked for their
potential to stand apart from
the rest of the practice. Clear
reporting lines, regular involvement with group meetings, and
accountability for group as well as
individual goals are essential. AE

"

Just like a
fire needs
heat, fuel,
and oxygen
to erupt,
three
concurrent
conditions
are needed
for a clique
to arise,
prosper, and
spread.

John B. Pinto (619223-2233; pintoinc@
aol.com) is president of
J. Pinto & Associates
Inc., an ophthalmic
practice management consulting firm
established in 1979, with offices in
San Diego, Calif. His book Simple:
The Inner Game of Ophthalmic
Practice Success, is available from
the ASOA Bookstore.

www.asoa.org // AE

15


http://www.asoa.org

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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