Building an Effective Practice Team: The Administrator’s Role

We as administrators must become change agents. If you are not moving forward, you are moving behind.

Alicia Vasquez, CRA, FRBMA
CEO, The Hill Medical Corp.
July 29, 2020

For decades, Alicia Vasquez, CRA, FRBMA, has served as the administrative leader of The Hill Medical Corp., Pasadena, Calif., a founding member of Strategic Radiology. Her half of a Team Building session at the ACR–RBMA Practice Leaders Forum was a virtual master class for radiology practice leaders who serve in the administrator role, beginning with a clear-eyed assessment of the current health-care practice environment and ending with a mandate to become the change agent your practice needs.

As CEO of both a The Hill Medical Corp., 20-radiologist private practice in the San Gabriel Valley, and California Medical Billing Services, a full-service MSO with more than 350 employees, Ms. Vasquez focused on the administrator’s role in building an effective team to support radiology practice mission. “Our practices have become businesses, and every year I have many goals, but the first goal is how do I maintain long-term sustainable income?” she said.

The decision of The Hill Medical Corp., and the only viable one in Ms. Vasquez’s opinion, is to embrace quality as a business model. “All of our practices are in the quality business,” she asserted, and the role of the administrator is to instigate the necessary changes to achieve that end. Private practices now face a perfect storm of declining reimbursement, consolidating competition that results in less revenue predictability, increasing utilization, increasing regulatory scrutiny, and narrow networks, she said. They can no longer think of themselves as small or family-run businesses; the old ways of doing business don’t work anymore.

“I’ve squeezed both sides of the nickel, I’ve cut operating costs, I’ve tried to decrease our fixed costs,” she said. “Now it is about time—time is money—and how can we make folks more efficient without compromising quality? We as administrators must become change agents. If you are not moving forward, you are moving behind.”

Ensuring Long-term Sustainable Income

In addition to decreasing costs by increasing efficiencies, the path to long-term sustainable income necessarily includes:

  • A focus on quality and safety
  • The ability to be nimble
  • Getting paid for everything you do
  • Implementing data-driven decision on “lead” not “lag” data
  • Ensuring a good patient and referring physician experience (ease of access, technology, service, patient financial experience)

Our markets, our customers, our competition, our organizations are changing, and leaders need to change too, Vasquez said. “We leaders need to change how we do what we do, and most importantly we need to change the teams that we lead,” she asserted. This is at the heart of Vasquez’s argument for leaders to become change agents: People are inherently uncomfortable with change.

To implement quality as a business model, a practice first must define its quality core. Hill identified eight quality components and eight guiding principles to support the quality core, including acknowledging that Hill is a patient-centered company and adherence to hard work and the Golden Rule. 

Ms. Vasquez uses the Balanced Scorecard approach to link performance metrics and drive performance of the Hill Quality business model by:

  • Communicating what the organization is trying to achieve (change, modify)
  • Aligning day-to-day work with strategy
  • Prioritizing projects, products, and service—Hill Medical revisits priorities monthly
  • Measuring and monitoring progress toward strategic targets, such as clinical quality, service and customer satisfaction, financial performance, market position and growth, operational efficiency, and workforce excellence.

Enabling Workforce Excellence

She distinguished between quality—the endpoint—and excellence, which she defined as “the capacity to continually improve.” Specifically, within the practice environment, excellence requires “the ability to satisfy complex, conflicting, diverse, and changing needs and expectations of all stakeholders.”

It is the job of leaders to enable this workforce excellence, Ms. Vasquez said. Leaders must devise the strategies, systems, and methods for achieving excellence and building knowledge and capabilities. That includes creating a patient-centered organization with clear and visible values. Evaluating performance must include the use of data to determine trends, projections, cause and effect.

“We need to set the goal out there,” Ms. Vasquez said. “All of these leadership models are built to achieve results, and we as leaders have to focus on the execution. We as leaders have less privileges not more, and if you are a leader you must exceed standards, because everyone is looking to you as an example.” 

She offered a dozen examples of Quality and Process Improvement projects, including physician peer review process, physician 360 reviews, cycle time reduction in MRI, CT, and PET, and scheduling and call handling.

“It’s really hard to look at yourself in the mirror and to admit that you are not the best out there,” said Ms. Vasquez, “but it will drive you to be better.”

To be a change agent, administrators must be intellectually curious, passionate about their business, enthusiastic, inspirational, and visible, and build teams that are goal oriented. “We need to set a sense of urgency and not take anything for granted,” she said. “Communication is key, we have to avoid complacency. Essentially, we are building our future.”

Choose your battles wisely, she advised. “Physician scheduling?” she proposed. “I am never getting involved in that.”

In conclusion, Ms. Vasquez shared some advice with like-minded leaders who wish to be change agents in their practice:

  • Leave your ego at the door. “To begin, we have to breathe through our nose—you can’t speak when you breathe through your nose,” she said.
  • Link operational divisions together.
  • Create a sense of future direction and opportunity.
  • Balance the interests of many stakeholders.
  • Promote common values, high expectations, and a focus on excellence. “We have to have purpose.”
  • Promote a fair and just culture.

“If my team can’t tell me what they think is going on, then that is a problem, and the problem is me,” she concluded.

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