Manage My Practice

If the topic caught your eye it’s likely because medical practice managers are practical people.  Our job is to get things done and we do it with a passion for being efficient as well as effective.  So you are on the lookout for tips and advice to help you do your job, and (admit it) to confirm that your skills match those of recognized high performers.

But my goal today is to help you value certain skills you already have but may not appreciate their value to you.  These are my concepts of valuable skills.  I’m going to miss someone’s favorite, so when I do, send a comment, list your skill and share your knowledge.

The first skill is thievery; the honest kind.

The best managers I know are quick to recognize an idea and steal it to use in their own practice.  We expect to do this at the organized idea swaps we call conferences.  But I’ve watched managers scribble notes at a dinner table or at a sidewalk conversation when another manager offers an idea.  Good managers know that a manager-tested idea is worth twice that of a concept proposed in a research article.  I’m not denigrating research.  I love research; I read journal articles for fun.  (My son says that proves only that I am a nerd.)  But nothing beats a peer tested concept.  So listen carefully to your peers, subscribe to your state and national MGMA listservs and steal those ideas.   … and then pass them along to the rest of us.  And ALWAYS give credit to the person whose idea you stole.

The next skill is impatience.

While good managers analyze, research and cogitate looking for a solution, they don’t wait for the perfect one.  High performing managers instinctively use the try and adjust method, formalized in operational improvement programs as PDCA (Plan, Do, Check or Correct, Act) or  PDSA (Plan, Do, Study, Act.)  They try the best solution at hand, check to see if it is working, adjust it, refine it and then implement it.  Then they check it later to see if it is still working.  Good managers don’t wait for the perfect plan.  They go with a good plan and have the courage to improve it on the fly.

High performing managers are patient.

I know what I just told about being impatient, but good managers are patient.  They dig deep enough into a problem to know the real causes.  They ask why enough to get past the obvious.  In Operational Improvement the technique is called The Five Whys.  High performing managers use this without even knowing it has a name.  It requires patience.  It pays big dividends – fewer wrong moves and less stuff to redo.  Those without patience act on the first cause they find, and then have to undo the solution and start over.  You may have heard this described as: “There’s never time to do it right.  There’s always time to do it over.”

High performing managers share recognition and accept blame.

This can be tough, especially in a highly competitive profession.  Advancement as a healthcare executive often comes when a colleague is replaced.  Even if you work in a large organization with clear advancement tracks, you have to compete for the opportunity.  The result  is a temptation to avoid blame and to hoard recognition.  But the best managers share recognition with their team.  They are in touch with their own leaders and keep those leaders aware of their efforts.  That is prudent and fair.  But no one succeeds without the help of those around them.  Good managers recognize that and share credit.  As for the blame – it was your team.  If they failed, then you failed as the leader.  Accept it, correct it, learn from it and move on.  My first mentor reminded me that if I was right one time in three and I was playing baseball, I would have a .333 batting average and be my team’s MVP every year.

High performing managers are curious.

The best are curious about everything.  The Greek poet Pindar said “There is no knowledge without profit.”  Good managers consume information.  This serves to keep them aware of possibilities that others will miss.  It improves their luck factor.  It gives them the ability to be first with the great ideas that advance their practices.
High performing managers love to teach.  Having knowledge is not nearly as much fun as sharing it.  Good managers help their teams improve.  They share their knowledge.  They are enthusiastic when they do it.  They are excited when others gain new skills.  It’s not totally altruistic either.  Skilled teams take on more work, are more efficient and more effective.  This creates additional time for the manager to do things beyond extinguishing fires.  That’s a great thing.

And  last, high performing managers are realistic.

They know there are limits to what they can accomplish alone.  They know that life is not all work.  The very best find ways to be involved with their community.  They make time for their families and friends.  They participate in the world around them.  They are refreshed by their non-work life, so they can enjoy the work day.
What have I missed?  What have you admired in others or found in yourself that are important skills in your success?

Please welcome my long-time colleague and friend Lee Barbieri.  I am hoping Lee will be a regular contributor as he has a lot of interesting ideas and experience to share with MMP readers.

Lee Barbieri is a Medical Practice Management Executive with over 25 years experience, and is a graduate of Va Tech, a medical laboratory technologist, MT(ASCP), and an avid reader.  Lee has worked in both private practice and in hospital networks, in healthcare IT and has also worked in a university hospital, managing diagnostic laboratory services.  Lee says “I am a native of Virginia but I have been a happy North Carolinian for 30 plus years.  My wife and I have two sons and four grandchildren.  I support my alma mater and still find time to be a Duke Blue Devil fan.”

Note: I am republishing this to my email subscribers because none of the links worked the first time around. I’ve fixed everything now – so sorry for the error – must have been healthcare fatigue!

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I’ve noticed that a lot of people in healthcare seem unusually tired and even, if I dare say so, somewhat cranky.  This includes me.  I’ve decided we’re all suffering from healthcare fatigue – fatigue from dealing on a daily basis with so much change, uncertainty, and financial stress.  Here’s my top ten list of healthcare management stressors accompanied by posts I’ve written that discuss the topic or suggest resources for the challenge.

10. Red Flags Rules – on again, off again, patients don’t want to have their pictures taken or let you copy their driver’s licenses.

• Red Flags Rules (RFR) Delayed for the Fifth Time – This Time Until December 31, 2010
• Red Flags Rule and Identity Theft Prevention: You Don’t Have To, But You Should!

9. HIPAA - don’t be fooled, HIPAA is not something we handled years ago and it’s taken care of; there are new requirements and penalties associated with HIPAA breaches.  HIPAA is a biggie and something that now infiltrates almost every facet of healthcare.

• ARRA Changes Rules for HIPAA – Did You Miss These Three February Deadlines?

8.  Employment Uncertainty – both for you and your staff – the aftermath of layoffs can be even more demoralizing to those who didn’t lose their jobs.  Also, many healthcare entities are still freezing raises.  If I hear one more time “we’ll just have to do more with less” I might just scream.

• My Take on “10 Ways to Keep Employees Happy” in Medical Practices
• Dear Mary Pat: Should Staff Be Allowed to Use The Internet on Their Smart Phones at Work?

7. Unrealistic Workloads – directly related to #9, most staff and managers have much more work to do than they did just two years ago. Couple that with the ability for managers to be available and work by computer, phone, text message, email or Skype 24/7 and you have fatique that you understand only when you truly, truly stop and wind down for more than three days at a time.

• Long Vacations are Good for Employees, the Company and Me!

6.  Hospitals Buying Practices – this could be a good thing or a bad thing, but as you and I know, change is completely unnerving to most people.  Hospitals have very different cultures than private practices and trying to marry the two takes skill, patience and excellent leadership.

• Change in the Group Medical Practice: Customers, Consequences, Control, and Culture

5.  Stimulus Money for Using EMRs – it’s a big decision and many practices are very nervous about purchasing an EMR.  Many think that meaningful use components are unrealistic and even more are fearful of the inevitable productivity drop when the EMR is implemented and for months afterwards.

• ARRA Eligible Providers: Who Is Eligible to Receive Stimulus Money and How Much is Available Per Provider?
• FAQ on HITECH, Meaningful Use, Eligible Providers, and the Stimulus Money
• Ten Reasons Why (Some) Physicians Aren’t Rushing to Adopt EMRs
• Electronic Medical Record Guru Rosemarie Nelson Reveals Best EMR Product on the Market Today

4. Unhappy Patients – lots of patients are also trying to do more with less (argghhh!) and are avoiding coming to the doctor whenever possible.  The front desk staff and the phone staff in particular are getting a lot more heat when they inform patients they’ll have to make an appointment.

• 50 Customer Service Ideas to Treat Your Patients to Friendly, Easy and Unexpected Service
• How To Be A Billing Advocate for Your Patients
• How to Apologize to a Patient
• A Memo to the Staff: The Preciousness of Patients

3.  PECOS – be glad if you don’t know what PECOS stands for, or be very, very afraid.

• Providers Without a PECOS Record Will Receive a Letter From Their Medicare Administrative Contractor (MAC)
• My Notes from the CMS Open Door Forum on May 19, 2010: PECOS, DMEPOS and Blue Ink on Paper Forms
• Is Your Practice Ready for the 60-Day PECOS Countdown?

2. Medicare Reimbursement – this year has been as exhausting as watching a single point of ping pong played for hours – there will be cuts, there won’t be cuts, there will be cuts, there won’t be cuts.  Gird your loins as the November 30 deadline looms for the next potential cuts.

• Deja Vu All Over Again: The Medicare Fee Cut is Pushed Back to November 30, 2010
• Attention Medical Practice Staff: Medicare Changes the Rules for Credentialing and Retro-Billing
• 91 Physician Organizations Sign Statement Naming Congress in “Mismanagement of the Medicare Program” and Imploring it to “Honor its Obligation”

1. The Bottom Line – we have RAC audits, more pre-certification and pre-authorization and pre-notification requirements, more denials, high deductible plans, formularies and 50 other things that are making it difficult to know which hoop to jump through to get paid.  Expenses continue to go up, reimbursement continues to go down, and the healthcare world spins faster and harder, making us all wonder when it will, or if it ever will slow down.

• There is No Such Thing as a 10-Minute Office Visit
• The ABN: The Most Misunderstood and Underutilized Document in Healthcare
• 101 Ideas for Increasing Revenue and Decreasing Expenses in Your Medical Practice
• How to Develop a New Financial Policy For Your Practice: A Short Course

Sometimes a job just gets a little old, and even the best employees need a little something to get them re-engaged and excited again.  Try one of the ideas below at your practice and let me know in the comments the ways you keep your staff energized and engaged!

1.  Provide a career track and offer multiple levels of learning jobs. For instance, break the receptionist job into steps (see below) and set time lines for attaining those goals.  You may want several steps to be accomplished at 90-days, more at 6-months, and more at 12-months.  There may be monetary awards, honor awards, or qualifications for other acknowledgements.

• Pre-registering patients by phone – demographics
• Making appointments & mini-register for new patients
• Registering patients face-to-face – demographics
• Understanding insurance plans and registering their insurance
• Taking photo ID or taking photos and explaining the Red Flags Rule
• Collecting co-pays
• Answering basic patient questions
• Answering advanced patient questions
• Reviewing the financial policy with patients
• Reviewing the Privacy Policy with patients.

2.  Offer certifications and credentials – support staff emotionally, time-wise and financially so they can attend face-to-face or online courses.

3.   Offer specific responsibilities and the title of lead person for that responsibility – don’t assume you know what staff are or are not capable of – they might surprise you!

4.  Meet every 6 months or every quarter to set goals.  A job can be a drag if there’s nothing new to learn or to accomplish.

5.  Set up process improvement teams to work on problems that everyone complains about – give them the responsibility to come up with solutions and try them out.

6.  Involve them in social media marketing of the practice.  Make sure they understand your social media plan ( you do have a plan, don’t you?),  give them guidelines to work within and let them work on your website, your blog, and your Facebook page.

7.  Install a wiki (many are free) and have them work on loading all the practice knowledge into the wiki.  Have different staff responsible for different parts of the wiki and set goals for adding all the information that runs your practice every day.

8. “Walk a Mile in My Shoes” – this is also great for getting the clinical and administrative staff to understand each other better.  Have the staff shadow each other and take turns seeing parts of the practice they don’t know much about.  I recently participated in this at my hospital and shadowed a nurse (and asked a million questions) for about an hour.  It was wonderful!  I felt better equipped to work with my hospitalist service after having been on a patient floor for just a short time.

9.  If you are a practice that receives referrals from others, have staff responsible for regularly touching base with staff from referring practices and asking how service can be improved.  Teach staff about relationship building and remember that it’s the staff that often choose where the patient is referred to instead of the provider.

10.  Have staff take turns going with you to meetings, seminars and local events where you represent the practice and introduce them to everyone.

11.  Forward listserv discussions to employees and have them monitor the discussions and bring things to you that they want to know more about.

12.  Encourage employees to become the practice expert in a payer, an employer, a referrer, a process or a protocol and help them learn about their topic by sending them information from the web or your professional organizations.

13. Have the staff put together an internal or external newsletter and help them with concepts of internal and external marketing.

I don’t know about you but I am emotionally exhausted thinking about and worrying about the on-again off-again cuts in Medicare fees for physicians.

Here’s the scoop: late Thursday evening, June 24, 2010, the House of Representatives passed the ” Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962)” which includes a delay in the 21+% fee cut. Because the same legislation was already passed by the Senate, it now goes to the President for his signature and it becomes law.  It is anticipated that this will happen quickly and CMS will have the MACs start processing new claims with dates of service of June 1, 2010 and later at the 2009 fee schedule plus a 2.2% increase.  The MACs will also have to reprocess the claims already paid for dates of service June 1, 2010 and later that were processed with 2010 fee schedule and that big fat cut.

Q: What should we be doing for the next 5 months and 6 days?

A: Have someone in your practice take a video of your providers introducing themselves, telling how many Medicare patients they have and how they can’t afford to see Medicare patients unless the SGR formula is replaced with something that works. The video doesn’t have to be slick – just real.  Send it to your senators and representatives.  Send it your local TV news.  Post it on YouTube.  Imagine hundreds of thousands of providers introducing themselves and talking about their patients.  It would be powerful.

Robert Sutton is one of my favorite thinkers.  Anyone who would write a book entitled The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t is okay with me.  Bob is Professor of Management Science and Engineering at Stanford University and he writes honestly about management on his blog “Work Matters.”  Here are his 12 Things Good Bosses Believe and my comments.

1.  I have a flawed and incomplete understanding of what it feels like to work for me (Robert Sutton discusses #1 in more detail here.)

Yep.  Give an anonymous satisfaction survey to your employees if you think you know what they are thinking.  As managers, we create our own little world based on what we think employees need and want and what we are doing in response to our perceptions of them.  It’s a beautiful world we create.  It can be a rude wake-up call when we find we don’t really understand what our employees think about us, our decisions or our management style.

2.  My success — and that of my people — depends largely on being the master of obvious and mundane things, not on magical, obscure, or breakthrough ideas or methods.

My mentor taught me “Take care of people’s paychecks and their vacation time – get it perfectly right or fix it quickly, and you’ll be fine.” Anyone who has ever done payroll or staff scheduling can tell you that these “mundane” tasks are two of the most complex and frustrating,  yet critical jobs in management.

3.  Having ambitious and well-defined goals is important, but it is useless to think about them much. My job is to focus on the small wins that enable my people to make a little progress every day.

Your staff want to know that the group is moving forward, but ultimately they don’t relate the big projects to their day-to-day job.  What they want (just as you and I do) is to have the small irritations, the glitches, and the bugs to be fixed.  They want to be able to stop wasting their time doing workarounds because the manager won’t take the time to fix something.

4.  One of the most important, and most difficult, parts of my job is to strike the delicate balance between being too assertive and not assertive enough.

One of my Mary Pat-isms is to say that the only time I tell people exactly what to do without getting their input is when the building is on fire.  This is a bit of an exaggeration, but I do think employees get tired of me asking “What do you think?” when all they want is for me to tell them what to do.  If I tell them what to do though, how do I know that their input might not produce a better answer? I also want them to think about solving the problem themselves or getting input from others.

5.  My job is to serve as a human shield, to protect my people from external intrusions, distractions, and idiocy of every stripe — and to avoid imposing my own idiocy on them as well.

I interpret this as my effort to make it safe in the organization to make mistakes and to be human. The tricky part is walking the line between making it so safe that people feel that mistakes don’t matter, and making it safe enough to stand the pressure of healthcare every single day. I tell the staff that my job is to free them to do their job.

6.  I strive to be confident enough to convince people that I am in charge, but humble enough to realize that I am often going to be wrong.

An employee once told me that she really likes a boss who says “I don’t know the answer, so let’s see if we can find the answer together.”

7.  I aim to fight as if I am right, and listen as if I am wrong — and to teach my people to do the same thing.

I would amend #7 to say that I tend to rely on my experience to guide my decisions,  but I often want to hear what others’ thoughts are to make sure the best solution is achieved.

8.  One of the best tests of my leadership — and my organization — is “what happens after people make a mistake?”

See #5.

9.  Innovation is crucial to every team and organization. So my job is to encourage my people to generate and test all kinds of new ideas. But it is also my job to help them kill off all the bad ideas we generate, and most of the good ideas, too.

Innovation is crucial in delivering healthcare.  One of my favorite techniques is to see how problems are solved in other fields and try to apply them to healthcare.  Teaching others to seek inspiration and to be comfortable with test-driving solutions is critical to giving a practice the competitive edge.

10.  Bad is stronger than good. It is more important to eliminate the negative than to accentuate the positive.

I agree.  I hate it, but it’s true.

11.  How I do things is as important as what I do.

Or maybe more important.  How I speak to staff, how I speak to patients, how I demonstrate compassion, how I deal with frustration, how I relate to someone who is going through something tragic, how I talk about my boss, how I ________ (fill in your answer here.)

12.  Because I wield power over others, I am at great risk of acting like an insensitive jerk — and not realizing it.

Being a manager carries with it an almost bone-crushing responsibility for doing the right thing for the organization AND the right thing for the employee.  Trying to achieve a win/win in as many situations as possible is a noble calling, but one that can wear you down to a nub, which is when most of us may be accused of acting like insensitive jerks.  Acknowledging this state (apologizing is good) and taking a time out is the right thing to do.

If you describe what you want in a boss, and you’re not describing you…think about it.

In 2001, the Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health System for the 21st Century, which outlined fundamental changes that must be made in order to improve healthcare in the United States.  Here is a quote from the book:

“The U.S. health care delivery system does not provide consistent, high-quality medical care to all people.  Americans should be able to count on receiving care that meets their needs and is based on the best scientific knowledge–yet there is strong evidence that this frequently is not the case.  Health care harms patients too frequently and routinely fails to deliver its potential benefits.  Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.”

Although the concepts in the books have been widely implemented in the inpatient setting (100,000 Lives Campaign and now 5 Million Lives Campaign), not as much has been done in the outpatient setting, predominantly because inpatient safety has been (rightfully) highlighted by needless deaths and injury (The Josie King Story, The Dennis Quaid Story.)  These same concepts must be applied in the outpatient setting to achieve improved patient care and patient satisfaction.  Ultimately, patients will demand to know what medical practices are doing to provide safe, effective, patient-centered, timely, efficient and equitable care.  This is a great book to read (you can read it online) and think about in preparation for the changes coming with healthcare reform, “Payment for Performance” (P4P) and electronic medical records promulgation.

Aim #1: Care should be SAFE: Patients should not be harmed by the care that is intended to help them. Current estimates from the Agency for Healthcare Research and Quality place medical errors as the eighth leading cause of death in this country. About 7,000 — people per year are estimated to die from medication errors alone — about 16 percent more deaths than the number attributable to work-related injuries.

Aim #2: Care should be EFFECTIVE: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit. Estimates are that about half of all physicians rely on clinical experience rather than evidence to make decisions. But should they? Experts say that physicians in most practices do not see enough patients with the same conditions over long enough time to draw scientifically valid conclusions about their treatment.

Aim #3: Care should be PATIENT-CENTERED, respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. One study of physician-patient interactions showed that physicians listen to patients’ concerns for an average of 18 seconds before interrupting. Medical schools are beginning to place greater emphasis on the development of good patient-interaction skills.

Aim #4: Care should be TIMELY: reducing waits and sometimes harmful delays for both those who receive care and those who give care. Many hospital Emergency Departments (EDs) are symptomatic of a system that cannot reliably give timely care. One recent survey revealed the average wait at “crowded” EDs was one hour. One third of U.S. EDs report they must periodically divert ambulances to other facilities.

Aim #5: Care should be EFFICIENT: avoiding waste, including waste of equipment, supplies, ideas and energy. Some experts estimate that most physicians are productive only 50% of their time, in part because the system works against them. Working smarter, not harder, can reduce non-clinical work and increase “face time” with patients.

Aim #6: Care should be EQUITABLE: care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status. There is a growing number of studies showing disparities in care and treatment for some population groups. The implications can be dramatic: for example, the life expectancy of a black child is seven years shorter than that of a white child in Baltimore, Maryland, USA.

You can download a PowerPoint program from the Institute for Healthcare Improvement (IHI) that cover the concepts in the book for free here.  Registration is required, but it is free and gives you access to lots of tools and resources.

You can also read the book for free online by clicking on the “READ” icon below.  No registration is required.

What books, websites, blogs, organizations or people would you add to the list of resources to prepare us for the changes of the future?

The last conference I went to might be the last conference I ever go to.  I do like some parts of conferences, but not all, or even most. Medical manager conferences do not seem to have changed since I first started going to them in the late 80′s.  Big sessions with big names. Little sessions with little names. The Exhibit Hall. Parties. Get-togethers. Late nights and early mornings.

I usually expect to accomplish two things during the conference.

One is to pick up some little pearl of wisdom from a random conversation that goes like this:

THEM: Blah blah blah blah.
ME: Hey, what did you just say?
THEM: Blah blah blah blah.
ME: You do that? At your practice? And it works?
THEM: Blah.
ME: How do you do that?
THEM: Blah blah blah blah yadda yadda yadda.
ME: I’ve gotta try it – thanks so much! Hey can I get your card and call you if I get stuck?
THEM: Blah yadda yadda.
ME: Yeah, great to meet you too!

The second is the brain time I get during a totally boring session when I can think without interruption about a problem I’m trying to solve.  I can reflect, scribble notes and no one cares. The phone is not ringing, there’s not a line at my door, there’s not a to-do list to do in my to-do book.  One thing I can never get enough of is time to think.  Work is full, almost every minute, with noise and interruptions and lots of people needing something.  What I need, what we all need, is more time to think.  If you never have time to think, or plan, or process, there is no managing going on.

Here is what my dream conference would look like:

1. Speakers on big screens – What is the value of having a big name speaker come personally to a conference?  Have them speak virtually.  Save a lot of money for us and save a lot of time for them.  Come to think of it, what do the big names actually contribute to the conference?  I’m not sure.
2. Infomercials – Why not have the exhibitors do infomercials at breaks in the programs? Anyone can make a video explaining their product. The videos could be available on the conference YouTube Channel for anyone who misses the infomercials and wants to flip through them.
3. No exhibit hall – I’ve heard so many vendors say they won’t have the budget soon to attend conferences.  How do vendors raise the money to attend conferences, give out goodies and door prizes and sponsor parties? By raising their product price, of course.  When I hear people say “We couldn’t have a conference without the exhibit hall,” I think “I bet we could have a better conference without the exhibit hall.”  No exhibit hall means a lot more time to meet with people I really want to see. No exhibit hall means I don’t have to carry home a bunch of literature I don’t want. No exhibit hall means I don’t have to feel guilty about finding the fastest way from the front of the hall to the coffee stand/food/bar.
4. Breakouts on demand – I’d like to go to smaller breakout sessions when I want to fit them into my schedule.  If I get into a great discussion with someone, I don’t want to drop it to run to a session, I want to go with the flow.  Breakouts could be constantly running on screens in dedicated rooms, or I could get them on my laptop whenever I was ready for them.
5. The Unconference - there are several versions of the Unconference, but the version I’ve been exposed to is one where a huge block of time at a conference was completely unprogrammed.  It was the second day of a two-day conference and all throughout the first day, attendees wrote things they wanted to talk about on Post-it notes and stuck them on a big blank wall.  The conference organizers were responsible for combining like ideas, assigning a time and a room and finding a facilitator for the topic.  I came to a conference with a need and my need was met!  Conferences, especially large ones, by necessity must choose topics and book speakers far in advance.  With as fluid as healthcare now is, conferences need to match the fluidity of healthcare to be pertinent.
6. Networking, networking, networking – What can’t I get ANY other place? A conversation with my peers.  People with different experiences, different perspectives and different ideas.  That’s the best thing I can bring home from a conference.

What does your dream conference look like?

Congratulations on your promotion to Office Manager!

It can be very hard to successfully move from being a co-worker to being the office manager, but it can definitely be done.  It took me a long time to be able to separate my relationships with the staff from my responsibilities as a manager.  I tell people who work for me that if we have a personal friendship, it will in no way change any decision I make as a manager and I stick to that.

This is my recommendation:
Meet with each of the staff one on one and talk to them about your concerns.  Tell them you value their friendship and the relationship you’ve had, but in your new role you might be called upon to fulfill some duties that they would classify as “unfriendlike.”  Let them know that you are taking your new responsibilities seriously and that you will need to protect the organization first and foremost.  Tell them that the best outcome for everyone is a win-win situation where the employee and the organization are both winners, but if it comes down to a hard decision, you will need to act in the best interest of the practice.

As far as how you act:
Read my article on eating lunch with the staff.  Do not get drawn into discussions about work with the staff when at social events.  Try never to drink with co-workers so you don’t say something you’ll regret in the morning! No matter what, keep things confidential.  Be careful what you share, even with the physicians, as they sometimes are unable to keep confidences.  Make sure to tell the same thing to all staff, for instance, put policy changes or protocol changes in writing so everyone hears the same thing.  Be very careful to not be seen as having favorites.

I hope this helps and please write back with more questions!