How “The Dictator’s Handbook” Can Help You Be Happy



Serena was a puzzle.



And the source of her superpower was surprising.



It lead me to write these words to share her wisdom.



I first met Serena in her office.



A physician, a generation younger than myself, she was smart and pleasant and friendly.



And content.  Very, very content.



For that matter, those same words described her office and her staff.



They smiled with confidence and looked their patients in the eye.



They reminded me of my own world-class office staff.



This was certainly not the norm for her organization.



So I asked her for her secret.



How was she able to carry on where the rest of her fellow clinicians, even the best paid, had sunk into corporate drone-dom?



She was one serious outlier.



She told me about a conversation she had had with her supervising administrator—her office manager’s boss—a few years before.



She caught her alone in a place they wouldn’t be overheard or disturbed. Like most mid-level administrators, this boss treated her with that mixture of fear and respect.



After complimenting her supervisor on a doing such a good job, she asked her what she, Selena, could do to help her succeed.



It took some prodding but she finally got to the heart of the matter.



What did her bosses boss look for to see if a good job was being done? What was his priority?



The answer?



A high number on the “percent of owed, collected” metric.



That’s what she got hammered on, nearly every week.



And since it’s not a clinical metric, she never thought to discuss it with a doctor—despite the fact that the clinic is structured so that the doctor is the perceived leader.



Armed with this nugget of gold, Serena took a few minutes with her office manager to learn about the metric and what drove performance.



Together, the drew up a plan for the staff, scheduled a lunch and sat down with them. There, they involved them with planning and strategies—finally coming up with a system to boost and then maintain their collection metrics.  Part of the plan was Serena personally, though tactfully, urging the patients to pay what they owed.



“I made it very clear to the staff, ” Serena told me, “that despite all the other measurements thrown at them, these collection metrics were the ones that counted. They were their number one priority, not patient satisfaction, not even patient care, but collections.  I would take care of the patients, they were to collect the money.”



“A month later, my office manager called me into her meeting with her boss—and her boss was euphoric. She had just had a meeting with her own boss who had complimented her in front of her peers about her good work with collections, and then privately took her aside to tell her to keep it up.”



“Interestingly, no one ever asked her how she did it, which is good because she didn’t know.”



“When she found out, she was very appreciative.”



“And ever since that day, she has left me alone.”



When Serena slacked off on non-clinical responsibilities, her boss covers for her.  When special projects come up, she makes sure Selena is either excluded or doesn’t get hassled when she doesn’t actively participate. Behind the scenes, her boss is Serena’s biggest supporter.



Serena gets to control her practice of medicine without being overly “managed.”



Because all the many layers of supervisors care about is this collection percentage.



Serena finished, “I don’t care about collection percentage, but I do care about working in a happy place.”



I called her on the “collections is more important than patient care” bit. She wasn’t the least bit apologetic.



“That’s what the company cares about. If that main message isn’t passed down the ranks honestly, everyone senses it and gets stressed. If she (that is, her boss) had come up with some patient care metric instead, that’s what we would have looked at.”



“But even though they measure them and make a big deal about meeting them, they really don’t care about the patient care metrics. It’s kind of funny, you would think that the docs that do the best or pull in the most money would be the ones with the most influence and maybe that’s true at the highest level, I don’t know.  All I know is that the doctors who excel at the patient or income metrics don’t have the easy ride that I do.  It drives them crazy.”



Then she let fly with her secret.



“You have to remember, these administrators aren’t doctors, they’re businesspeople.  If you want to work in a business and be happy, you have to understand how they think.”



I asked her where she found such wisdom at such a young age.



She responded “The Dictator’s Handbook.”



And so a series for this blog was born.







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