Chapter 21: The Medical Assistant as Clinic Manager

What is the procedure for developing and maintaining a procedure manual?

1) Gather all of your necessary equipment and supplies. Make sure that they are in good working order before beginning the procedure. For this particular procedure, you will need to have a computer (electronic storage allows changes and revisions to be made easily); a binder, such as a three-ring binder; paper; and a standard procedure manual format 2) Pay attention to detail by writing step-by-step procedures and rationales for each clinical, technical, and administrative function. Each procedure is written by experienced employees close to the function and then reviewed by a supervisor and clinic manager. Rationales help employees understand why something is done. This establishes consistent guidelines to be followed. 3) Include regular maintenance instructions and flow sheets for cleaning, servicing, and calibrating of all clinic equipment, both in the clinical and in the administrative areas. Equipment needs to be cleaned and maintained on a regular basis to ensure it is working properly and that it lasts as long as needed. Some manufacturer guarantees and service contracts require regular cleaning and maintenance, especially on new and leased equipment. Instructions are necessary so that the task can be performed properly. The flow sheets provide documentation of dates the equipment was cleaned, serviced, and/or calibrated and the person who performed the task. 4) Include local and out-of-the-area resources for clinical and administrative staff, providers, and patients. Provide a listing in each area with contact information and services provided. The procedures and instructions listed in the procedure manual should provide supporting documentation needed for accomplishing each task. For example, if the clinic requires that local public transportation resources be given to each patient who needs transportation, the procedure manual has a listing of transportation available in the area with telephone numbers and schedules. This document can either be printed from the computer or photocopied from the manual and provided to the patient. 5) Recognize the importance of local, state, and federal legislation and regulations that are related to processes performed in both clinical and administrative areas. Having a listing of the rules and regulations assists in performing those regulated duties correctly and legally. 6) Include the clinic procedures and flow sheets for taking inventory in each of the areas and instructions on ordering procedures. When a clinic has processes clearly written for managing inventory and ordering equipment and supplies, the clinic is less likely to run out of needed items and may even be able to take advantage of discounts offered by manufacturers 7) Collect the procedures into the clinic procedure manual. This provides a reference guide with step-by-step instructions and examples where appropriate 8) Store one complete manual in a common library area. Provide a completed copy to the provider-employer and the clinic manager. Distribute appropriate sections to the various departments. This provides a reference guide with step-by-step instructions and examples where appropriate 9) Review the procedure manual annually and add any new procedures, delete or modify as necessary, and indicate the revision date (i.e. Rev. 10/12/20XX). This maintains current clinic protocols.

What is the procedure of performing an inventory of equipment and supplies?

1) Gather all of your necessary equipment and supplies. Make sure that they are in good working order before beginning the procedure. For this particular procedure, you will need to have a computer; printout of the most recent inventory spreadsheet, listing items by storage location, name and identification code, number of items, minimum quality requiring reorder, date and quantity of last reorder, expiration date of items, if any; a clipboard, pad of reorder forms, and a pen or pencil 2) Paying attention to detail, compare number of items on hand corresponding to each name or code identification number with the printout, and write in the new inventory number on the printout. This determines what is on hand and what needs to be ordered. 3) If the number of any item is less than the minimum quantity, fill out a reorder form listing completely the name, identification number, and quantity required. 4) Repeat the previous step for each storage location on the inventory printout sheet. 5) After completing the inventory, enter the new inventory information, including date of inventory, quantity, and date of reorder request, into the computer database. This determines what needs to be ordered. 6) Forward the reorder forms to the person responsible for purchasing. This forwards information to the person responsible for reordering supplies and equipment NOTE: If the clinic uses handheld computers on a wireless network, all information can be entered directly into the computer record while doing the inventory, making unnecessary the reentry and preparation of reorder forms. If the handheld computer is not networked, it will be necessary to download or sync the data after completing the inventory

What is the procedure for performing routine maintenance and calibration of clinical equipment?

1) Gather all of your necessary equipment and supplies. Make sure that they are in good working order before beginning the procedure. For this particular procedure, you will need to have an equipment list with maintenance or calibration requirements; a clipboard, pen with black ink, maintenance log and service calendar forms, and deficiency tags; access to operation and service manuals of equipment to be serviced; and access to any necessary maintenance tools and supplies 2) Locate the number assigned by the clinic manager to identify the equipment being serviced, and verify serial number, manufacturer/maker, technical support phone number, warranty information, and last date of service. This provides the medical assistant with all information needed for maintenance and servicing of equipment. 3) Paying attention to detail, visually inspect each piece of equipment associated with the clinical area. Practicing risk management principles, check for any frayed electrical cords, loose connections, or safety issues such as tripping hazards associated with electrical cords. Clean each item according to manufacturer specifications, and replace light bulbs and batteries, if necessary. Equipment works more efficiently when clean and all parts are working properly. 4) Check to ensure the equipment meets operational/calibration standards as defined in the operation and service manual. Recalibrate the equipment following the instructions in the manual if required. Calibration standards must be maintained for correct results. 5) Follow necessary safety precautions and tag any equipment not meeting operational standards and report deficiency. Equipment must either be replaced or repaired to ensure proper results. 6) Fill out and sign the maintenance record sheet if the equipment meets operations standards. This documents that routine maintenance was performed. 7) Paying attention to detail, complete documentation form by verifying information for each piece of equipment serviced and/or calibrated. Complete the appropriate information for service using the service calendar log form. This documents what has been done and the date completed. NOTE: The equipment list, maintenance records, and deficiency reports may be included in the practice management system of many practices

What is the procedure for making travel arrangements via the internet?

1) Gather all of your necessary supplies and equipment. Make sure that they are in good working order before beginning the procedure. For this particular procedure, you will need to have a travel plan; computer; and provider's or clinic's credit card to pay for reservations 2) Paying attention to detail, confirm the planned trip date, time, and place for departure and arrival; preferred mode of transportation (plane, train, bus, car); number of travelers; preferred lodging type and price range; and whether travelers' checks are required. Confirming pertinent travel details ensures that correct arrangements will be made 3) Go to the computer and access the internet 4) Show initiative by selecting a search engine to locate websites using the key terms "air fares". Websites may provide links to air fares, auto reservations, and hotel/motel reservations. Follow website instructions for making arrangements. Review and copy confirmation of your transaction. The internet can be a time saver and a cost effective way of securing travel arrangements. 5) Pick up tickets or arrange for their delivery, if necessary. Tickets purchased on the internet can be mailed or picked up at an airport, or they can be electronic tickets. 6) Make additional copies of the itinerary or create the itinerary. The itinerary should list date and time of departures and arrivals, including flight numbers and seat assignments. Note the mode of transportation to lodging (shuffle, bus, car, taxi). Include name, address, and telephone number of lodgings and meeting places 7) Maintain one copy of the itinerary in the clinic file. 8) Give several copies of the itinerary to the provider. This ensures that a copy is on file with the clinic and that there are sufficient copies for the travelers and families

What is the procedure for preparing a meeting agenda?

1) Gather all of your necessary supplies and/or equipment. Make sure that they are in good working order before beginning the procedure. For this particular procedure, you will need to have a list of participants, order of business, names of individuals giving reports, names of any guest speakers, and a computer with paper to print agendas. 2) Paying attention to detail, reserve proposed date, time, and place of meeting. This ensures that the facilities are available for the meeting 3) Collect information for meeting agenda by previewing the previous meeting's minutes for old business items, checking with others for report items, and determining any new business items. This ensures that all old and new business items have been identified. 4) Prepare a hard copy of the agenda and have it approved by the chair of the meeting. Confirmation by the chair of the agenda content ensures that agenda is correct and complete 5) Implementing time management principles, send agenda to meeting participants a few days in advance of the meeting. This permits participants to prepare for the meeting by completing any tasks required and preparing any necessary documentation

What is the procedure for completing a medical incident report?

1) Gather all of your necessary supplies and/or equipment. Make sure that they are in good working order before beginning the procedure. For this particular procedure, you will need to have an appropriate medical incident report form, a computer with incident report software, and notes taken regarding the incident. 2) Report situations that were harmful by discussing the incident with the employees involved and read notes of patient information. Ask those who witnessed the incident to describe when, where, and what they saw in their own words. This provides an understanding of what happened and ensures all of the information needed is documented 3) Pay attention to detail when completing the clinic-approved medical incident form. A single-sheet, multiple copy form is best. The form should contain basic patient information data, a checklist of different incidents, and a space for written comments. This ensures that all information needed is documented. 4) The person completing the incident report form should be the individual who witnessed the incident, first discovered the incident, or is most familiar with the incident. This ensures the most accurate recording of the incident. 5) Each selection of the form must be completed. The incident description should be a brief narrative consisting of an objective description of the facts but should not draw any conclusions. Quotes should be used when appropriate with any witnessed incidents (i.e. "Patient states...") The names of any witnesses should be included on the report as well as employees directly involved in the incident. This provides unbiased information without making any judgments. 6) Implement time management principles. Incident reports must be submitted in a timely manner to the appropriate administrator or office following protocol identified in the procedure manual for the clinic. This ensures that appropriate documentation and action is taken for follow up

What are the HIPAA requirements for developing, using, and maintaining the procedure manual?

1) HIPAA regulations require each clinic to develop a separate HIPAA manual that is in either an electronic form or a paper manual. The manual spells out all policies and procedures of the practice and security management measures; identifies the security officer; addresses workforce security issues, information access concerns, security awareness and training, security incidents, and contingency plans; evaluates security effectiveness; and contains copies of all business associate contracts 2) The HIPAA manual must be available to all employees and updated on a regular basis. During an audit, the clinic manager will be asked to produce the HIPAA manual for review and to establish compliance with all regulations. All documentation of policies and procedures are to be kept for 6 years even if the wording has changed or a particular policy or procedure has been eliminated. If an incident is under investigation, this allows an investigator to go back to what a policy said 6 years ago.

What the duties of a clinic manager?

1) Manage and encourage information technology services, relationships, and collaboration, ensuring the clinic electronic health records and relevant staff are kept updated and are involved in system protocols 2) Make travel arrangements and prepare an itinerary 3) Arrange and maintain practice insurance and develop risk management strategies 4) Supervise clinic personnel 5) Approve financial transactions and account disposition; generate financial reports as needed 6) Supervise the purchase and storage of clinic supplies 7) Prepare staff meeting agendas, conduct the meetings, and record minutes 8) Supervise the purchase, repair, and maintenance of clinic equipment 9) Assist in improving work flow and time management 10) Create and update the clinic procedure manual, Material Safety Data Sheets (MSDS), and Health Insurance Portability and Accountability Act (HIPAA) manual 11) Prepare patient education materials and arrange patient/community education workshops as needed

What are the guidelines that medical clinic staff must follow in regards to liability coverage and bonding?

1) Negligence is performing an act that a reasonable and prudent provider would not perform or failure to perform an act that a reasonable and prudent provider would perform. The common term used to describe professional liability or legal responsibility today is malpractice. It is much easier to prevent malpractice than to defend it in litigation; therefore, every effort should be taken to prevent negligence. Events that could result in a malpractice litigation invariably will occur from time to time in even the best of medical clinics. When such an incident occurs, complete honesty with the patient and insurance carrier is the best policy. Protocols should be implemented or existing ones revised to prevent any future occurrences, and all steps necessary to minimize risk to the patient should be taken. 2) Insurance policies specifically designed to protect the provider's assets in the event a liability claim is filed and awarded in the patient's favor are available. Any provider not carrying such insurance is said to be going bare and would personally be responsible for any court costs, damages, and attorney fees if a malpractice suit were lost. 3) Practicing medical assistants should carry professional liability insurance for protection. Medical assistants who are members of the American Association of Medical Assistants (AAMA) have the option of purchasing personal and professional insurance through the organization at corporate rates. 4) Some providers carry their employees on their policies. If this is the case, always ask to see the policy and verify that your name is printed on the policy--no name indicates no coverage. The manager may need to see that professional liability insurance has been purchased, all appropriate names are listed, and the premiums are paid in a timely fashion. 5) Professional liability insurance is important if the provider-employer is sued. In this event, the provider and the medical assistant could be named in the suit. If the case were lost, both the provider and the medical assistant could be liable. 6) Individuals who are responsible for handling financial records and money in the medical clinic may be bonded. A bond is purchased for a cash value in an employee's name that ensures that the provider will recover the amount of loss in the event that an employee embezzles funds. It is the clinic manager or the human resources manager's responsibility to ask prospective employees if they are bondable. Individuals who are not bondable may not be the best candidates for the position.

What are the guidelines for making travel arrangements? What are the components of an itinerary? What are the guidelines regarding the development and use of itineraries?

1) The clinic manager may be asked to make travel arrangements for providers going on vacation or to conventions, symposiums, or out-of-town seminars and continuing medical education (CME) courses. If the providers do a fair amount of travel or if they live in a metropolitan area, they may use the services of a travel agent. Attention to detail is extremely important in preventing travel disruptions. 2) Read carefully the instructions for completing registration forms, complete them online, or mail them as quickly as possible to secure reservations to conventions. Next, make hotel and travel arrangements. General information regarding the provider's travel preferences should be maintained in file and referred to when making travel arrangements. Helpful information to maintain in this file includes: -Name of travel agents used in the past -Provider's or clinic credit card numbers (though this information must be properly safeguarded) -Transportation preferences -Preferred airline, class of travel, seating choice -Hotel/motel accommodations (bed size, suite, studio, connecting rooms, price range amenities) Next, contact the travel agent and identify the destination, date and time for departure and return, number traveling in party, and seating preferences. A travel agent can assist with rental car and hotel accommodations, if needed. Take your time and pay attention to details. When tickets are received, always check to see that all departure and arrival times match what is needed and that a confirmation number has been provided for car rentals and hotel arrangements 3) The internet can be used to search for the lowest-cost air, auto, and lodging reservations. The procedures do not require extensive knowledge of travel and airline reservation protocols. Searching for information on the internet requires the use of a search engine if you do not already have a list of favorite travel sites. Once you refine your search, you may have choices such as Travelocity.com, Expedia.com, or Priceline.com. Select the desired websites and follow its instructions. 4) If you have used a travel agent in making the travel arrangements, the agency most likely will provide several copies of the itinerary. An itinerary is a detailed plan for a proposed trip. The clinic should maintain one copy of the itinerary in case the provider must be reached for emergencies. The provider should have one copy to carry with him or her and a copy to leave with family members. You may need to develop the itinerary if you have made the travel arrangements via computer. 5) Important information to be included on any itinerary includes: 5a) Air travel- Departure and arrival date and time, meals, airline name and telephone number, airport 5b) Car rental- Name, telephone number, confirmation number 5c) Hotel/motel- Name, confirmation, dates, telephone number 5d) Meeting location- Name, address, room number, telephone number

What are the guidelines that clinic managers must follow in regards to risk management?

1) The clinic manager should formulate a risk management procedure that assesses risk to which he or she and the organization are exposed and take steps to develop contingencies that minimize probable risks. Some common risks and risk-control measures are: 1a) Loss of a critical employee- Have cross training of employees to permit them to assume the duties of an employee who is ill or terminates his or her employment 1b) Failure of a supplier or contractor- Maintain sufficient inventory to permit contracting with a secondary supplier before critical shortages occur. Monitor the status of orders so that you are aware of any failures in delivery before they have a negative impact and so that supplies can be obtained from a second source. Have a list of secondary sources. 1c) Accidental disclosure of confidential information through error or unauthorized entry- Have protocols in place regarding breach of confidentiality and defining steps to be taken in the event information is compromised. Define protocols to patients alerting them to the unlikely but potential possibility of accidental disclosure. Notify patients immediately if confidential information is compromised and work with them for resolution. 1d) Computer failure- Back up the system regularly. Have a secondary system that permits the clinic to operate until repairs are effected. Have a maintenance contract in place with reputable firm permitting overnight repairs 1e) Injury to a staff member or nonemployee- Continually review safety procedures and conduct safety surveys. Have adequate liability insurance for the medical clinic 1f) Managerial position change- Continuously work with friends and associates to permit you to rapidly seek a new position before experiencing a job loss. It's always easier to get a job while you still have a job 2) Incident reports are required to notify managers of events involving injuries to patients, visitors, or staff; medical errors or omissions; breach of confidential information; and potentially dangerous conditions associated with facilities or equipment. This reports signals the risk manager to implement existing protocols to minimize risk. Medical incident reports are confidential and cannot be released to anyone without a signed release of information agreement. The medical incident report form is an administrative document and is not considered part of the medical record

What is the purpose of a procedure manual? What are the three components of a procedure manual and how should the procedure manual be organized? What are the guidelines regarding the development, use, and maintenance of the procedure manual?

1) The procedure manual provides detailed information relative to the performance of tasks within the facility in which one is employed. Each procedure manual should be designed for that specific clinic setting and should satisfy its requirements. The procedure manual serves as a guide to the employee assigned a specific task and may also be useful in evaluating the employee's performance. If a temporary employee is assigned the task, the procedure manual will be invaluable in ensuring that each procedure is completed as outlined. 2) The three components of the procedure manual are the administrative section, the clinical section, and the administrative/clinical sections. The administrative section of the procedure manual must have subsections of personnel management, communication (oral and written), patient scheduling, records management, financial management, and facility and equipment management. The clinical section of the procedure manual, on the other hand, must contain subsections on physical examinations, infection control, collecting specimens, laboratory procedures, surgical asepsis, emergencies, material safety data sheets (MSDS), OSHA regulations in regards to the medical clinic, and CLIA '88 regulations for medical clinics. Meanwhile, the administrative/clinical section of the procedure manual must have subsections of HIPAA and ADA compliance, guidelines for creating a safe environment, evacuation procedures, emergency codes, fire safety, fire extinguisher safety, response to national disaster or emergency, and medical assistant response to disaster preparedness 3a) The providers and the clinic manager should have copies of the procedure manual, and all employees should have access to the procedure manual. Copies of individual sections may be given to the employee responsible for the task; the employee should be instructed to follow these guidelines and told that they may be used as employee evaluation tools. If all employees have access to the clinic computer system, the procedure manual can be made available in electronic format. 3b) It is best to use a loose-leaf binder with separator pages denoting each procedure. Many clinic managers find it helpful to divide the binder into administrative and clinical sections with subdivisions for each primary task performance. To facilitate using the procedure manual, a consistent format should be developed and used throughout the manual. Each procedure should be a step-by-step outline or list of steps to be taken to complete a task as desired in that facility. Providing the rationale for a step, when appropriate, enhances the learning process, especially for new staff members. Material safety data sheets (MSDS) are required to be maintained in the clinic and available for personnel to reference at any time. MSDS must be compiled for all chemicals considered hazardous and maintained in an appropriate manual. Some clinics opt to maintain these records in a separate tabbed section of the procedure manual. Others choose to maintain a separate MSDS manual. The information must be reviewed and updated on a regular basis. 3c) When new procedures are added to the clinic routine, a new procedure page should be developed immediately. The new page is useful as an educational tool or job aid while team members are learning new techniques. An annual page-by-page review should be done to ascertain if each procedure is still being used and to ensure that each page is correct in each detail and satisfies all criteria established by the staff personnel. This contributes to an efficient clinic and gives all employees a sense of pride and satisfaction that they are performing within the scope of their training and to their greatest potential. The procedure manual should be reviewed by personnel performing the various tasks, and their suggestions should be evaluated and incorporated into the revisions when appropriate. All new procedure pages and revisions should be dated (i.e. Rev. 02/15/XX)

What the guidelines in regards to clinic manager attitude and professionalism?

1a) Many managers share a common enemy--themselves. The part of ourselves that is our enemy is our mind and the outlook we have on the world. People who succeed attribute positive results to their own actions. People who underachieve or fail usually attribute negative results to someone else or to chance, over which they have no control. Because underachievers feel helpless to affect results, psychologists conclude that their motivation to succeed is diminished. A low achiever would be unlikely to have a personal risk management system in place. He or she would feel he or she could not affect events. The more positive person could easily take steps to avoid these problems. 1b) The effect of a negative mindset does not stop with failure to accept responsibility for the things that happen to each of us, it continues on. Unless we change our outlook, we lower our expectations and begin accepting the mediocre. Individuals who feel they are helpless to affect events become afraid of success as well as failure, and they subconsciously find a way to fail to avoid the challenges success will bring. 1c) How do you change your mindset? The following are a few suggestions considered helpful: -Come to terms with what you would have to change if you are to be successful, and be ready for the change -Identify what you really want to achieve -Put your goals in writing using positive terms (say "I will", not "I will try") -Begin with small, achievable goals -Eliminate poor habits such as procrastination -Tune out negative thoughts and focus on positive thoughts We are what we think we are. Be careful of your mindset, it can derail you and your job as a manager 2a) The medical assistant as clinic manager must exhibit professional behavior at all times. He or she must be courteous and diplomatic and demonstrate a responsible and positive attitude. All verbal and written communications should be accurate and correct and should follow appropriate guidelines. The clinic manager should demonstrate knowledge of federal and state health care legislation and regulations and must perform within legal and ethical boundaries. All documentation must be performed appropriately 2b) The clinic manager serves as a liaison between the provider, the patient, and other professionals. Therefore, professional demeanor in all respects must be followed. It is not uncommon to be called on to locate community resources and information for patients and employers. A good working relationship with community service organizations fosters the sharing of information vital to your patients' health care needs and promotes quality public relations

What are the guidelines that medical clinic managers must follow in regards to facility and equipment management?

1a) The physical plant or building must be observed and maintained with safety being a key ingredient. It should be the responsibility of each staff member to report to the clinic manager any facility repairs that require attention and suggest replacement or recommend new pieces of equipment as required by the practice to support the health care needs of its population. 1b) The clinic manager usually is responsible for maintenance of the clinic and may hire ancillary services to provide janitorial and laundry services, dispose of hazardous materials, and maintain aquariums or plants that may enhance the environment of the facility. The clinic manager must be cognitive of the importance of patient confidentiality when ancillary services are present. Ancillary services must not view confidential material. A signed business associate agreement must be on file for each ancillary service contracted. 1c) Magazine subscriptions and health-related literature for the reception area are the responsibility of the clinic manager. Selections should be made carefully, keeping in mind the interests of the patients and their cultures. These materials should not be kept once they become dog-eated, torn, or outdated. The use of plastic protectors and appropriate storage shelving aid in keeping the area and materials tidy. 1d) The clinic manager, together with the provider, is responsible for facility improvements, including any necessary repairs, decorating and color scheme, and floor plan suggestions. The wise clinic manager does not make these decisions independently but asks for suggestions from staff members. Remember, the team-building approach adds a cohesive element to any clinic environment. 2a) All administrative and clinical supplies and equipment in the facility must be inventoried. Maintaining a sufficient inventory of administrative and medical supplies requires implementation of a system for taking inventory of supplies frequently enough to permit placing and receiving an order before a shortage occurs. Large facilities frequently use the practice management system to inventory items that normally would be billed and part of a procedure, but this will not identify routinely used medical and administrative supplies. 2b) Medical clinics operate on a budget, so comparison shopping is prudent. Many companies have online catalogs with full descriptions and prices of their products. The cost of an item is not the only consideration when purchasing inventory. Consider the following: -Warranties -Bulk orders -Maintenance agreements -Quality and durability -Personal preferences -Cost factors 2c) Online ordering via the internet can save time and money. When placing orders, select those suppliers with secure websites; it is generally safe to use credit cards with these vendors. Supplies also can be ordered through hard copy catalogs. Benchmarking with other medical clinics nets invaluable information in determining reputable vendors. When an order is received, it must be opened and checked properly. Look first for the packing slip, which lists the items ordered and the items shipped. Verify that no items have been substituted or back-ordered. Each item unpacked must be checked against the packing slip to be sure there are no discrepancies. Write the date the shipment was received, who verified it, and any follow up information. The new stock should be stored appropriately. 2d) Some items purchased come with a warranty. A warranty usually is activated online at the vendor's website or by using a warranty card packaged with the purchased item. Warranty cards are similar to postcards and establish the purchase date and name and address of the purchaser. The returned warranty information provides the vendor with information should it be necessary to notify the buyer of recalls or defective parts. It is also proof of purchase and gives the length of time the warranty is in effect. It is important to create a file or a digital file, such as a spreadsheet, for each piece of equipment in the medical clinic. Information in this file should include: -Date of purchase and original receipt -Manufacturer name, address, and telephone number -Model number and owner's manual -Technical support information and telephone number -Warranty information -Service agreement -Date last serviced -Routine maintenance or calibration information 2e) Administrative and clinical equipment must be cleaned, calibrated, and maintained on a regular basis. Most clinics use a computer spreadsheet or relational-type database, depending on the size of the facility. The database identifies the equipment by name or type, its assigned facility identification number, location in the facility, warranty expiration date, service period, dates when service and calibration were last performed, and when the next service or calibration will be required. The database also may identify service contracts for equipment not maintained or calibrated by facility personnel and information on equipment service contractors such as contacts, phone numbers, and addresses. The database is backed up by a paper file containing operation manuals, warranty information, and service contracts. 2f) Administrative equipment such as computers should be cleaned and maintained regularly. Telephones as well as any other pieces of administrative equipment should be cleaned and working order checked. Laboratory and clinical equipment must be maintained and quality control measures utilized. Calibration checks are required for a number of pieces of equipment: sphygmomanometers and centrifuges, to name two. Microscopes and various types of scopes used during physical examinations and specialty procedures contain light sources that must be checked before each use. A replacement supply of bulbs should be available. Assigning a clinical laboratory manager to oversee the equipment is a good idea. 2g) The clinic storage areas should be well maintained, and each item should always be put back in its place with lids replaced properly to prevent any accidents. Medication storage requires special attention. Many medications must be stored at certain temperatures, kept dry, or stored in dark, airtight containers. All medications, including samples, must be kept out of patient access areas. Narcotics should always be stored in a separate locked cabinet. A daily inventory should be maintained

What is the purpose of marketing for the medical clinic? Which member of the medical clinic staff is responsible for performing marketing tasks? What are the guidelines that medical clinic managers must follow in regards to marketing?

1) Communication is just as critical when relating to external audiences, sucth as other organizations, potential new patients, and community members. Developing relationships outside the clinic is often called marketing, a concept that clinic managers may use to enhance the image and visibility of an ambulatory care setting while also providing benefits to patients, potential patients, and the neighboring community. 2) In its broadest sense, marketing can be defined as the process by which the provider of services makes the consumer aware of the scope and quality of these services. Although marketing is a tool traditionally used by for-profit organizations to promote and sell products and services, it has become increasingly acceptable among health care organizations, whether they are for or not for profit. 3) Marketing functions and materials are diverse and can include presence on social media sites, seminars and workshops, patient education brochures, brochures that describe the ambulatory care setting and its scope of services, HIPAA policies, newsletters, press releases, and special events such as open houses or participation in community health care events. Depending on the size and resources of the medical clinic, the manager may choose to use all or some of these tools. When producing written material and organizing events, it is essential that ethical guidelines be respected at all times. Marketing tools should be appropriate, in good taste, and designed to quietly enhance the reputation of the clinic. Cultural issues should always be considered. For example, patient education brochures for a practice with many spanish-speaking patients should be produced in bilingual editions, with english on one side and spanish on the other. Legal issues are important as well; when presenting material of a medical nature, it is extremely important that information be accurate and up to date. 4) Effective marketing is a valuable tool for the clinic manager, especially as managed care calls on all health care professionals to become more competitive to survive. Marketing can increase visibility and credibility. The effective manager enlists the talents and skills of the entire team in developing a marketing plan. 5) Compared to the earlier means of social communication (telephones, newspapers, radio), social media, on a very basic level, allows a website visitor to interact with the site and with other visitors on the site. Social media can take on many different forms, such as the following: 5a) Webinar- A seminar or lecture delivered over the internet. It can be one-way (webcast) or with audience interaction 5b) Social networking- Interact by adding friends, commenting on profiles, and joining groups and having discussions. Facebook and LinkedIn are examples of this form of social media, as are Twitter and Instagram on a micro scale. 5c) Blogs: A websites on which an individual or group of users record opinions and information in a more conversational and and informal manner, called blogging. 5d) Social photo and video sharing- Interact by sharing photos or videos and commenting on user submissions. YouTube and Instagram are examples of this form of social media. 5e) Wikis- Interact by adding articles and editing existing articles. Wikipedia is an example of this form of social media 5f) Social news- Interact by voting on articles and submitting comments. Examples of this form of social media are Reddit and Digg. 6) The social media revolution has forever carried over to business. A purposeful and carefully designed social media strategy must become an integral part of any modern, complete, and directed business plan or job-seeking strategy 7) Social media gives you a voice and a way to communicate with patients and potential consumers, to find qualified employees, and to verify the background of persons seeking employment with your organization. It personalizes the medical clinic and helps you to spread your message in a relaxed and conversational way. Social media projects your clinic as a personality. You want the clinic to become a respected source of information to the patient. Purpose, direction, consistent updating, and posting of relevant content will go a long way in making social media sites places where time is well spent by visitors. The main focus should be on providing a source of information for patients, caregivers, and families. Social media provides the perfect platform for the medical community to present facts and reasonable data, and encourage the patient to consult with a medical professional in the clinic in order to properly address health concerns. 8) You must always remember that in no way should social media be a place for offering medical advice. However, the effort to present accurate, valuable information that gently guides the patient to the correct and safest course of action while providing an enjoyable and more personalized experience can be achieved. 9) Many clinic managers are perplexed over whether social networking should be allowed by employees while at work. Many managers have a perception of employees hanging out on cyberspace wasting time. Experts on the subject do not support this perception. They feel that social networking can contribute to team building and can motivate employees, especially in small companies where the staff may be isolated from each other. The result has been increased productivity in most instances. Prohibition of social networking can result in the loss of valuable employees. The answer to the question probably lies between total prohibition and uncontrolled use resulting in abuse. If social networking is allowed on the job, protocols should be in place to prevent HIPAA violations, to define where and when social networking is acceptable, and to prohibit bullying of colleagues. A manager must use caution in monitoring employee actions online to avoid overstepping legal boundaries

What are the guidelines that medical clinic managers must follow in regards to supervising personnel?

1) Creating an atmosphere in which open and honest communication can take place is critical to supervising personnel. This type of communication may be encouraged through the establishment of regular staff meetings, with each staff member sharing ideas for improvement and areas of concern. Eliciting the help of others in problem-solving strategies promotes harmony 2a) Staff and team meetings: The clinic manager usually initiates staff and team meeting idea and should officiate at such meetings. Failure of the clinic manager to be present may convey a message that the meeting is an event not worthy of attention. It is important that the clinic manager be familiar with basic parliamentary procedures. The purchase of books such as "Robert's Rules of Order" or "Parliamentary Procedure at a Glance" is an excellent investment. Successful staff and team meetings are announced well in advance or on established timelines to enable the majority of clinic personnel to attend. An agenda identifying the subjects to be covered during a given meeting should be issued before the meeting so that each attendee arrives prepared with input or questions relevant to the topics. Each meeting should end with opportunity for nonagenda items to be discussed or suggested for inclusion in the next meeting. The meeting should have a fixed time to end. 2b) A written record in the form of minutes should be maintained and sent to all team members regardless of whether they attended the meeting. This policy keeps all members informed about policy changes and decisions that impact the clinic operations. The minutes also trigger a reminder for any new procedures or revisions to be made in the procedure manual. The minutes for a staff and team meeting should record action plans under each agenda topic. Summarize all action items agreed to in the meeting in one section of the minutes. This facilitates easy access to information at a later date should it be required. The date, time, and place of the next meeting should be included. The person preparing the minutes should always sign them. A copy of the minutes should always be maintained in a book for easy reference. 3a) Conflict resolution- Conflict resolution is a time-consuming and necessary task not only for the clinic manager, but the providers as well. Conflicts can arise between staff members and providers, patient and provider, and even between the healthcare staff and the patient's family. These conflicts can escalate to litigation or even violent reactions. Conflicts have a direct impact on morale; clinic efficiency; and ultimately, patient care. Without resolution, high turnover and lack of proper work environment will create serious setbacks for the clinic as a whole. The hostile work environment has been significant attention in recent years, and action is available for those who feel that they are working in such an environment. Abusive behavior by other employees, managers, supervisors, or even providers may take the form of a condescending attitude, ridicule, inappropriate comments or jokes, sexual harassment, threats, and fear. This type of behavior in the workplace is now less tolerated, if at all, and an organization can be held responsible for allowing the hostile work environment to continue and failing to act 3b) The most helpful preventative measure is to have a code of conduct in place. By establishing clinic policies for all members of the medical staff, these rules make it easier to correct and administer discipline where necessary. By imposing limits on unacceptable behavior, and delineating the path of discipline through a chain of command, everyone understands the process to resolution, and can often intercept and solve issues at a lower level. Another useful tip is to recognize how conflict starts in the first place and put preventative measures in place to avoid it. Misunderstandings, lack of communication, favoritism, inequality of any kind, unreasonable expectations, and unfair or inappropriate criticism are just a few of the workplace triggers to watch for. Taking others for granted, not keeping promises, not accepting responsibility for mistakes, and personal issues interfering with work objectives and time management are also areas that can create conflict. The following are some guidelines that may be helpful in preventing conflicts: -Listen to your employees. What do they say? What do they communicate nonverbally? -Manage by walking around and talking to your employees -Do not tolerate negative comments or actions among employees -Encourage an open door policy for concerns and complaints -Be a role model for all employees. Practice what you preach -Keep confidences and treat each person with respect and understanding 3c) When conflicts arise, do not avoid taking immediate action to resolve the issue even if it appears to be superficially resolved. It will resurface at the first instance of stress between the individuals. A good manager/leader will stay level and cool headed when confronted with conflict. Should the conflict not be easily resolved, allow it to rest for the day, and come back to it when emotions are better able to be controlled, but do so within a day or two at most. Prolonging the issue can exacerbate the situation with unfavorable results. Intervening early is the best course of action, and truly understanding the problem is the first and most necessary step to successfully defusing the situation. When addressing conflict between a provider or a supervisor and an employee, mediation is the only appropriate approach. In all other instances, the best approach is to use a confrontational approach. The two persons having a conflict are asked to express their conflicting opinions without interruptions. The purpose is to communicate what each perceives to be the problem. If an obvious solution that is acceptable to both parties does not appear, the manager must insist that the parties come up with an acceptable solution to the conflict. (This latter step is not appropriate for conflicts between an employee and a superior in the organization). In doing so, both parties have ownership of the resolution. 4a) Harassment in the workplace- As a manager, you are legally responsible for ensuring nondiscrimination and preventing harassment. You, as a manager, may be innocent of any kind of sexual harassment yourself, but if the workplace you manage is construed as hostile by any one of your employees and you do not take appropriate action, you and your clinic can be held liable in a court of law. 4b) When an employee contacts you or you become aware of harassment, you should immediately contact your human resources equal opportunity office (EOO). If your facility does not have an EOO, you should collect facts and confront the offending individuals or group, clearly notifying them that the offensive behavior must stop immediately. A report of the incident should be placed in the file of the offending individuals with a written warning that a future incident will result in termination. The manager must carefully evaluate the facts surrounding an incident. It is not uncommon for innocent events to be perceived as harassment. When there is a conflict between people who are in some way different from each other, simple misunderstandings can be perceived as harassment. Although some situations do involve malicious intent, many are largely the result of poor communication, and it is the manager's responsibility to differentiate between the two. 4c) Every employer needs a written comprehensive policy that prohibits all types of harassment. The policy needs to include a definition of what could constitute harassment or create a hostile work environment, information on who to report to, and a nonretaliation provision. The law forbids retaliation when it comes to any aspect of employment, including hiring, firing, pay, job assignments, promotions, layoff, training, fringe benefits, and any other term or condition of employment. The harassment policies and procedures must be made available to all employees 5a) Assimilating new personnel- The goal in the assimilation of new personnel into the workplace is to make it happen as seamlessly as possible. The clinic manager and human resources representative usually assume this task jointly, with the clinic manager being responsible for orientation in medical protocols and procedures, and the HR representative handling orientation regarding medical practice rules and regulations and any legal implications. 5b) New personnel orientation- If the procedure manual is detailed and accurate, this manual becomes a guide for new employees. It is important to introduce new employees to other staff members and assign a mentor who can respond to questions that new employees may raise. Depending on the responsibilities of the new employee, a supervisor may be asked to monitor all procedures for a period for accuracy, safety, and patient protection. The orientation should clearly present what is expected of new employees and explain that, at the end of their probationary period, their performance will be evaluated to determine if full-time employment will be offered. The same procedures followed for new employees should be followed for student practicums, with the exception that expectations and the evaluation process may vary. 5c) Probation and evaluation- It is common for a new employee to be placed on probation for 60 to 90 days. During this period, both the employee and supervisory personnel determine if the position is a suitable match for both employer and employee. Near the end of the probation period, the employee should be officially evaluated to determine how completely he or she is performing the assigned tasks/duties. The employee should also be given an opportunity to express his or her personal thoughts relative to job satisfaction. The evaluation becomes part of the employee's personnel record at the end of the probationary period. 5d) Supervising student practicums- The number of hours for the practicum are predetermined together with criteria for site selection and tasks to be performed by the student. The clinic manager should schedule an information interview with the student before the practicum begins. During this time, the expectations of the clinic manager and the student may be established. A tour of the facility and introductions to key personnel aid the student in feeling more comfortable on the first day of work. Because the student will be writing in medical records where correct spelling is mandatory or may be scheduling appointments and must write telephone numbers without transposition, some pretesting may be offered. By giving a spelling test of 10 commonly used medical terms or verbally stating five telephone numbers for the student to write down, an immediate evaluation is attained. The clinic manager should directly supervise or identify someone else to supervise the student. During the first few days of the practicum, the student may simply shadow the supervisor, learning the routine, provider preferences, and protocols for that particular clinic. As the new student begins to feel comfortable in the new environment, minimal tasks should be assigned. Based on the student's ability to follow directions and perform tasks, increased skill level tasks may be added. The supervisor will direct and evaluate the student's progress; schedule activities that will provide experience in all aspects of medical assisting, including administrative, clinical, and laboratory procedures; maintain accurate records of attendance and hours worked; and communicate the student's progress to the medical assisting supervisor from the educational institution. When working with students, it is important to remember that they still have much to learn and will need lots of reassuring guidance. When you take the time to explain each step and to provide the rationale for each, students will learn more quickly. Demonstrating new or different techniques and approaches helps students by providing them with options that they find more comfortable. 6) Employees with chemical dependencies or emotional problems- Employees with chemical dependencies or emotional problems are to be treated as such. Approach the situation constructively rather than punitively. Make a commitment to the employee, to the rest of the staff, and to the patients that at no time will patient care be put at risk. Help an employee with a problem to find the support and counseling necessary. No staff member should be permitted to remain on the premise with impaired judgment while under the influence of alcohol or controlled substances. If chemical dependency treatment is necessary, make accommodation as seems appropriate or is warranted. Everyone occasionally feels discouraged and distressed. Hopefully, the provider-employer and the manager are able to recognize problems before they become too serious. Work-related stress is the base cause of a significant degree of mental strain. Plan for and create a work environment that reduces as much stress as possible. Actions to consider may include the following: -Properly educate and train all employees for their positions -Encourage teamwork and reward those who help each other -Mandate "break periods" in the day for each employee -Create a pleasant work environment (plants, water, music, and so on) -Establish a blowing off steam place for when employees are especially frustrated -Take everyone out for lunch at least once a quarter -Have regular staff meetings to discuss employee concerns and clinic improvements -Celebrate birthdays and special occasions (i.e. length of service) Keep in mind that a happy employee who feels valued in his or her position will stay much longer than someone who is unhappy and does not feel valued 7a) Evaluating employees and planning salary review- It is important that all employees know whether they are performing their job as expected and know how they can improve their performance if necessary. Not only is evaluation of employees necessary during the probation period, but it is necessary for current employees as well. Evaluations should be performed no less than once a year on the anniversary of the hire date. Some clinic managers may wish to evaluate an employee more often, especially if a problem has surfaced in an evaluation. The evaluation may take many forms; it can be formal or informal; it may involve more than one person. The results of the evaluation, however, must be a part of the employee's personnel record. For that reason, a formal evaluation is preferred. Many practices use a written evaluation that requires that the employee evaluate himself or herself before meeting with the clinic manager. The clinic manager uses the same form for evaluation. During the meeting, notes are compared as the evaluation is conducted. 7b) The climate of the performance evaluation should be comfortable and provide privacy. The meeting should be friendly, but the employee must sense the importance of the evaluation. Do not allow any disagreements to escalate into arguments during the evaluation. Without reading the employee's self evaluation, ask the employee to tell about the self assessment. Acknowledge the employee's point of view and identify where you agree or differ from the self assessment. Be prepared to describe specific examples of positive performance and negative performance. When negative performance is identified, ask the employee for possible solutions. Then a plan can be determined to alter the negative performance. In this way, a trusting atmosphere is established in that both of you are working together for a solution that will benefit the medical practice. Always look for and seek a win-win situation whenever possible. The action plan determined should then be evaluated at the next performance evaluation. At the close of the evaluation, always express your confidence in the individual to make any changes necessary, offer assistance where needed, and thank the employee for participating. End any evaluation with a positive statement about some portion of the employee's performance. 7c) There are occasions when reviews are performed more frequently than annually. A review would occur 2 to 3 months after a significant promotion to measure how things are progressing. Reviews occur more often when general performance falls well short of past efforts or a serious error in judgment has been made. This type of review may end with a reprimand; a warning to correct the problem by a given date; or possibly immediate dismissal. 8a) Salary review- Although the practice is common in some areas, it may be better not to tie salary increases or bonuses with the annual performance evaluation. Conduct the salary review at the beginning of the new year separate from performance evaluations. Salary review is important. Unfortunately, in smaller medical clinic and ambulatory care settings, the review of salary may have to be raised by the employee. Provider-employers tend to forget that their employees have been with them for over a year without a raise or a discussion of financial remuneration. If this is the case, it is perfectly acceptable for the employee to raise the issue on a yearly basis. However, the best approach is for the clinic manager to conduct salary reviews at the beginning or end of each calendar year. 8b) Data should be collected before a salary review. The clinic manager should network with other clinic managers in the local area to determine wages and salaries for comparable individuals with comparable skills. Remember, also, that it is far more cost effective to reward good employees with a salary increase than it is to train a new employee who commands a lesser salary than current employees. Reward employees well and provide benefits that encourage them to stay with the practice. Employees who stay with the practice for a long time not only fully understand how to best serve their provider-employers, they have established a relationship with patients that is beneficial. How much of a raise is to be awarded at the time of salary review is difficult to determine and depends on many factors that might include the profits of the year, the patient load, workload, and the current cost of living. 8c) Because it is costly in time and resources to replace employees, it is best to invest that cost into a fair and just salary increase for valued employees. 9a) Dismissing employees- The written performance evaluation establishes the format for employee dismissal when necessary and is more likely to remove the emotion from the situation. Even involuntary dismissal is difficult when it is necessary. Involuntary dismissal results from two primary causes: poor performance or serious violation of clinic policies or job descriptions. When it becomes apparent to the clinic manager that the effectiveness of an employee is dropping well below expectations, it will be known in the annual review or a performance review may be called. The review allows the employee to be informed of the shortcomings, to explain any reasons for the present situation, and to determine a plan to alleviate the problem. If the problem is a serious one, probation is usually invoked and any lack of significant improvement in the time provided results in immediate dismissal. 9b) When the problem is a violation of either clinic policy or procedures, both a verbal and a written warning are given to the employee. Involuntary dismissal follows if the situation persists. Dismissal may be immediate if the action is a serious violation of clinic policy. Serious violations depend on the clinic practice, but some causes for immediate dismissal include theft, making fraudulent claims against insurance, placing the patient in jeopardy by not practicing safe techniques, and a breach of patient confidentiality. Some points to keep in mind when dismissal is necessary are: -Make the dismissal in private -Take no longer than 10 minutes for the dismissal -Be direct, firm, and to the point in identifying reasons -Do not engage in an in-depth discussion of performance -Explain terms of dismissal (keys, clearing out area of personal items, and completing final paperwork) -Listen to the employee's opinion and emotions; it is not necessary to agree -Accompany the employee to his or her desk to pack his or her belongings -Escort the employee out of the facility; do not allow him or her to finish the work of the day 9c) Other reasons for dismissal may be more pleasant. Changes in personnel occur for many good reasons, and people to voluntarily leave their jobs. They may relocate, seek advancement at another facility, or simply have personal reasons for leaving. These employees will give their manager proper notice and will be able to turn their current projects and duties over to their replacements. They have time to say goodbye to their friends and leave with a good feeling about their employment

What are the qualities of a successful clinic manager? Why is it important for medical clinics to have a good manager?

1) In order to be a successful medical clinic manager, you will need to have both technical and soft skills 2) A clinic manager should not feel the need to be superior to employees but should strive to develop a synergistic organization. The best manager is like an orchestra conductor. He or she constructively blends together the skills and abilities of diverse people to produce a smooth and efficient team. The result is an organization with greater capability than would be achievable by the individuals acting independently. 3) The clinic manager should have two overarching goals: 3a) Get the job done 3b) Make the process enjoyable 4) New approaches to making the most of time management, adapting to different employees, finding ways to enable collaboration across generations, and creatively gapping those bridges will become increasingly important. Clinic managers will need to understand that each individual has his or her own set of skills, and with the potential of up to a 50-year age difference in the work environment, being able to co-mingle and use cross skills to the benefit of all will emerge as useful tools 5) Emerging technologies offer an opportunity for the younger generation to teach how to use these products in the workplace effectively. In turn, the older generation has much to offer by instilling the value of interpersonal communication, and building sound relationships with coworkers based on experience and longevity. There is a unique opportunity for the comingling of these skilled generations to mutually benefit each other in the workplace 6) A good clinic manager needs to be two persons in one body: manager and leader. The two functions are different, and the good manager will use some of each persona in meeting objectives. 7) Good managers are leaders, providing their coworkers with vision, guidance, and a feeling of ownership in the process. They do these things without threats, usually through the power of their personal charisma. It is also important that managers clearly convey their expectations to their employees. Possibly nothing leads to ill feeling between the manager and an employee more than failure to let the employee know what is expected of him or her. Furthermore, a lack of expectations stifles career growth and organizational vitality. Good leaders need to blend many admirable personality traits of leadership to be successful and still control the resources entrusted to them 8) Before proceeding with a listing of qualities of a manager/leader, a rule that defines almost all of the ethical qualities needs to be mentioned. This rule is treat others as you would like to be treated. Commonly known as the golden rule, it will make the difference between a manager who is successful and one who fails miserably. The rule needs no explanation and will serve any manager well in any circumstance.

What are the differences between a manager and a leader? What are the qualities necessary to be a successful manager and leader in the medical clinic?

1) The differences between a manager and a leader is that a manager organizes and allocates talent and resources; plan and budget using available resources; control and solve problems, with the ability to adapt to changes seamlessly; establishes structure by organizing, staffing, and implementing policies and procedures; and consistently achieve goals and targets. A leader, on the other hand, provides vision and goals, setting reasonable and clear standards; communicates direction, promotes teamwork and creativity to reach goals; is an inspiring and motivating influence, able to mentor and direct in ways that keep the team moving forward; overcome resistance to change and resolves barriers; and serves as the role model and go-to for the team 2) The qualities that are necessary to be a successful manager and leader in the medical clinic are: 2a) Effective communication skills- Communication skills include written and oral methods. The manager must communicate clearly, diplomatically, tactfully, and with respect for the feelings of others 2b) Fair mindedness- It is important to always be fair with coworkers. Decisions that impact one fellow employee create a ripple effect. That is, you may have to make the same decision for another employee at another time. Decisions should be based, as much as possible, on the assumption that what is granted to one employee will be granted to others in similar situations. This approach will decrease the risk of being accused of playing favorites or being unfair. 2c) Objectivity- The clinic manager must be able to view challenges without bias or prejudice. For example, when promotions are made, the clinic manager must be able to focus on the job description criteria and individual qualifications without introducing personal preference 2d) Organizational skills- Being organized includes being able to prioritize tasks, working efficiently and methodically. Know when and be willing to delegate tasks when others have the expertise and time to complete the task within the timelines 2e) People skills- The clinic manager must like people in general and enjoy working with them. Building confidence and self-esteem in others and being interested in promoting constructive relationships are essential qualities of the clinic manager. The ability to function as an effective team leader provides a role model for other staff members to emulate. 2f) Problem solving skills- The clinic manager must be a problem solver. This may include being creative and doing away with old paradigms and traditional approaches to solving a problem. When difficult issues arise, focus on the situation, issue, or behavior, not on the person. A discussion about solving the problem without laying blame is much more productive. Positive solutions may be more readily attained when discussing what was observed rather than what was told by someone else. 2g) Technical expertise- Have a working knowledge of each procedure performed in the clinic, although it is not necessary to be the acknowledged technical expert. In the medical environment, there are many changes, including updates to laws, insurance guidelines, and various business challenges that occur frequently. A good clinic manager is continually learning and encourages subordinates to seek opportunities to continue their education and advance their technical skills 2h) Truthfulness- Lead by example! If an honest mistake is made, be the first to admit to the error and seek the best solution for preventing it from happening again. Respond honestly to requests. For example, two staff members ask for the same day off. The clinic manager will make the decision that only one member may have the day off and will review the policy manual to determine the appropriate criteria for designating whose request will be granted.

Why is the use of teamwork important for medical clinics? How can medical clinic staff be successful in teamwork?

1) The use of teamwork to improve the efficiency of the clinic at first may seem incongruent to your desire to improve clinic efficiency, because it seems that several people are now involved in solving a problem that you as the manager should solve and explain. Teamwork builds morale and actually results in getting more accomplished with the resources you have because the team members develop ownership of the solution to a problem and want to make it work. When it works, it flatters them and builds their self esteem. 2) The efficiency of a team results from collectively working together to plan how to "work smarter" and how to dovetail tasks and support each other so that wasted effort is avoided. To achieve all of these things, a team not only must be given the responsibility and the authority to plan and execute their plan to solve a problem, but they must know your expectations for them. Sometimes, this means that you, the clinic manager, must stick your neck out for them. They will reward you handsomely for doing so.

What are the guidelines that medical clinic managers must follow in regards to records and financial management?

Providers entrust a great deal of responsibility to their medical clinic managers. The daily payments received through the mail and clinic visits must be processed and prepared for banking. Clinic expenses must be processed and paid in a timely fashion to capitalize on any discounts available. Employee requirements and records such as social security records; withholding allowance certificates (W-4 forms) indicating the number of exemptions claimed; and employment eligibility verification forms (form I-9) ensuring that all persons employed are either U.S. citizens, lawfully admitted immigrants, or citizens of other countries authorized to work in the United States must be completed and file with the appropriate federal agencies. Also, state and local tax records must be maintained for each employee. 1) Electronic health records and the clinic manager: The practice management system and electronic medical record is the nerve center for the clinic manager as he or she orchestrates a smooth-running organization. It provides all of the data needed by the clinic manager at the click of a mouse or a few keyboard strokes. 2a) Payroll processing: In some cases, it is the clinic manager's responsibility to prepare payroll checks for each employee and record all deductions withheld. A W-2 form summarizing all earnings and deductions for the year must be prepared for each employee by January 31 of the following year. The social security administration must receive a summary report of W-2 forms each year. 2b) To comply with all federal, state, and local government regulations, it is important that the clinic manager who processes payroll maintain complete, up-to-date records on every employee. This information should be gathered from new employees and updated every year, including any changes in employment status. For more specific information regarding printed and electronic filing forms, consult the internal revenue service website (www.irs.gov) for detailed instructions. It is a good idea to have employees update their W-4 form each year in case they want to adjust their deductions or make any other change. To accomplish this, many payroll managers include a new W-4 form with the first paycheck at the beginning of each year. Every employee file should contain the employee's social security number; number of exemptions claimed on the W-4 form; employee's gross salary; and all deductions withheld for all taxes, including social security, federal, state, local, and unemployment tax (where applicable), and disability insurance (where applicable) To process payroll, the provider's clinic must have a federal tax reporting number, obtained from the internal revenue service. In some states, a state employer number is also needed 2c) When preparing payroll checks, it is important to keep a record of all tax and insurance amounts deducted from an employee's earnings. For those clinics that still operate on a manual bookkeeping system, the write it once system is one of the most efficient ways to accurately maintain these records. Payroll records should include: -Employee name, address, and telephone number -Social security number -Date of employment Each paycheck stub should contain the following information: -Number of hours worked, including regular and overtime (if hourly) -Dates of pay period -Date of check -Gross salary -Itemized deductions for federal income tax, social security (fica) tax, state tax, and city or local tax -Itemized deductions for health insurance and disability insurance -Other deductions such as uniforms, loan payments, and so on -Net salary (gross earnings minus taxes and deductions) 2d) When figuring federal income taxes and social security taxes, use the circular E, also known as publication 15, which contains federal income tax tables provided by the internal revenue service. Federal tax is based on amount earned, marital status, number of exemptions claimed, and length of pay period. State and city or local taxes are typically a percentage of the gross earnings. All federal and state taxes withheld must be paid on a quarterly basis to the appropriate government offices. These monies should be accompanied by the required reporting forms. It is important to observe deposit requirements for withheld income tax and social security and medicare taxes. These requirements, which change frequently, are listed in the federal employer's tax guide, available from the U.S. government printing office, internal revenue service (or online at www.irs.gov). Additionally, there are third-party providers that offer software and support for payroll preparation, tax filing, and even direct deposit. Examples include ADP and Paychex. Implementing the services of a private bookkeeper or accountant to tend to these responsibilities is another solution when performing in-house payroll is not feasible 2e) Benefits, or additional remuneration to the salary earned by full-time employees, must be managed and records maintained for each employee. Examples of benefits include paid vacation, paid holiday, health/dental insurance, disability insurance, profit-sharing options, and complimentary health care. Some ambulatory care settings may refer to all or some of these benefits as fringe benefits. Other responsibilities of the clinic manager are include maintaining a personnel file for each employee, providing his or her history with the facility, application for the current position, evaluations, promotions, problems, awards, entitlements, legal forms required by state and federal agencies, and so on. All occupational safety and health administration (osha) data, hazard material training and documentation, HIPAA training documentation, cardiopulmonary resuscitation (CPR) certifications, immunization records, AIDS education, and confidentiality agreements must be recorded and maintained

What is the legal issue that medical clinic managers will face? What can the medical clinic manager do to solve this legal issue?

The clinic manager must be aware of and follow all state and federal regulations impacting the medical practice. Information related to the Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) and the Occupational Safety and Health Administration (OSHA) can be found on the OSHA website (www.osha.gov). The Centers for Medicare and Medicaid Services website is also helpful (www.cms.gov)

What are the three styles of management? What are the guidelines that medical clinic managers must follow in regards to the use of each style of management?

The three styles of management are: 1) Authoritarian style- A manager who adopts the authorization style of management exercises his or her authority over those that report to him or her as a means to achieve goals. Without seeking or considering the input of the staff members, this manager controls the decision making, controls policies, and puts operational plans in place. While this style may seem regimented and inflexible, there are workplace environments where this style of management is beneficial. 1a) For example, in a medical clinic, there is a tendency for there to exist targeted areas of specialty tasks within the support staff. These may be accomplished by just a handful of people, or an extensive group of individuals with focused areas of responsibility. Such is the case in the roles of administrative front desk staff, those working in coding and billing, the clinical staff (including medical assistants, laboratory and diagnostic technicians, physician assistants, and nurse practitioners), in essence, every member that provides total patient care experience within a clinic. While each member has a specific function, the whole is very much interdependent, and the workflow needs to have a beginning, middle, and end in order for all the parts to be cohesive and accomplish goals for the patient's care, as well as proper reimbursement for the clinic. At the same time, everything must be done within compliance requirements. 1b) Authoritarian management needs to be executed carefully; otherwise, staff may begin to feel resentment and tasks may seem too rote or rigid. This style can foster absenteeism and high turnover, results which can be devastating to the efficient operation of the clinic where every staff member's contribution is of utmost importance. Each facet of the tasks collectively done by the entire staff are interdependent in the medical environment, creating an opportunity to actually blend management styles to best utilize resources, achieve goals, and maintain a motivated staff. 2) Participatory style- A manager who utilizes the participatory style of management encourages input and feedback from those that report to him or her. Decision making, policies, and operational plans will at least in part include the suggestions, opinions, and views of those on staff. As an operational whole, each staff member feels that he or she can or has made a contribution, and this increases the sense of value within a team effort. Additionally, the staff can more easily take ownership of the goals, and make adjustments with the assistance of the manager when fine-tuning is necessary. As with any management style, care must be taken with this approach as well. While this style encourages contributions, there will be those that do not contribute, those that are overeager, and in the end, not everyone's ideas can be implemented. Risk of alienating those whose ideas are not used and resentment for others who minimally participate can create unique challenges. However, the opportunity to blend authoritarian and participatory styles can positively influence the needed interdependencies in a clinic, where each person's responsibilities have a direct impact on the total care of the patient and smooth operation of the business 3a) Management by walking around- Management by walking around (MBWA) is not really a management style but rather a technique for keeping the manager informed and promoting face-to-face conversations, obtaining feedback, and listening to staff ideas or comments. This style consists of just what the title says--the manager walks around looking at what is going on in the organization and talks with employees. The motives are not to micromanage and to convey this to the staff. 3b) To this end, some tips are offered here to make the most of using the MBWA technique effectively in the medical clinic: -Make this part of a routine, and stay consistent- When staff see you on a regular basis, and not once a month or only when there is time, the MBWA becomes part of the management culture in the clinic. This does not mean that a set day and time needs to be adhered to, but rather, simply a consistent habit of stopping by work areas to chat, see how things are going, and gather ideas. You will get more candid and useful information by dropping in unexpectedly, when the staff member was not prepared for your visit. -Make it worthwhile- If you will be stopping by, then make it a point to ask for ideas on improvement, suggestions, and also acknowledge a good idea when presented. When a good idea or suggestion is implemented, give credit where due without showing favoritism. Encourage support from staff that curbs resentment but still allows recognition -Follow up on questions and concerns- If you are presented with an issue for which you do not have an immediate solution or response, take the time to follow up and get back with an answer in a timely fashion. The staff will appreciate that you have not forgotten or given less than your full attention to a problem they are experiencing. -Stick to fact finding- Do not utilize the MBWA as a means to identify procedures incorrectly done, criticize, or discipline staff if problems are identified by you during the walk around. These should be noted and addressed in a different setting and time, appropriate to the circumstances 3c) The idea of the MBWA technique is to build rapport and keep on top of the state of the organization through staff feedback. Keep to this objective. Employees are more likely to be engaged and productive when they see the manager and have an opportunity to speak with you frequently than if they do not. We are now in a time where managing people is taking place through email, texting, and formal staff meetings, and the manager can literally be a person always in her office and not easily accessible. Even with an open door policy, most staff are reluctant to initiate a discussion as opposed to having a touch-base visit that takes place frequently in their own work area

How can medical clinic staff manage their time well?

Time management is an item of critical importance to the manager. You may have upward of 20 staff members putting demands on your time, and added to this are vendors, your superiors, business associates, and a host of others. A manager has not a moment to lose in the day, so managing time makes the difference between a normal 8 or 10 hour day and a 15 hour or more a day. The following suggestions are some proven means of managing your time whether in management or as a salaried employee: 1) Handle items once: Once the mail is opened, sorted, and prioritized, try to handle it only once more, when action is taken with it. Picking it up, reading it, and setting it down again without taking action is a real waste of time 2) Develop a to-do list: At the end of each day, prepare a list of things you plan to complete the next day and try to work down this list. Prioritize the list by importance or by practical order. 3) Guard your time: Schedule meetings with personnel and vendors so that they do not fragment your time, making you have to restart a task and get up to speed over and over again. Although modern management practice is to have an open door policy with employees, this does not mean you should allow them to come into your office whenever they think about it. Have them schedule a time with you. Make them think about what they want to discuss and do not let them monopolize your time. This is also true of meeting with your vendors; require vendors to schedule ahead of time to meet with you. 4) Delegate work: Assign others or a team to perform some tasks for the medical clinic, such as having a team prepare weekly work schedules and vacation schedules results in less bickering and feelings of favoritism that you would have to spend time defusing if you made the schedules yourself. This does not mean that you do not have to approve them and, in some instances, make the hard decisions, but it results in your people having ownership in the decisions