Administrative Eyecare
The leadership dyad—building core strength in ophthalmology group practices

“The greatest need we have in this whitewater world, this permanent whitewater world, is something that does not change … a changeless core.”
—Stephen Covey

Solo ophthalmic practices, for all their challenges, have one strong advantage over group practices: The enterprise generally speaks with the voice of one, clear surgeon-owner. By contrast, group practices with many owners can sprout many power centers, many voices, which often leaves the administrative team blowing back and forth in a storm of conflicting aims and priorities.
Yet for real success, your group practice needs to first develop its core strength, much as gymnasts strengthen their core ahead of strengthening arms and legs.
In the best-managed practices, this core strength almost always flows from the paired leadership of the managing partner and practice administrator. Their unified, lock-step, on-the-same-page, speak-with-one-voice relationship is a prerequisite for becoming a great practice.

Core strength

Another metaphor for understanding core strength is the oak tree. The stronger, more deeply, and firmly rooted it becomes at its base, the more secure it will be when adverse weather strikes. A healthy oak can withstand hurricane-force winds. Limber branches bend nearly to the breaking point while the deeply rooted trunk barely strains.
Do you have the same deep roots for your practice? Do you have the flexibility required to bend rather than break when challenged by crisis? One of your main jobs as a practice leader is to foster both the core strength and flexibility of the organization.
Group practices must establish “roots.” Think infrastructure, the kind of grounding that comes with authentic vision and mission, and values statements, written rules that are followed and that have real consequences, boards and administrators who are both competent and aligned. All of this creates an organizational structure that thought leader Stephen Covey calls a “corporate immune system,” enabling resistance to virulent threats.
These threats are now endemic in our environment: pending fee adjustments, higher operating costs, greater competition from peers and institutions, and a regulatory storm that obliges every practice to have a de facto compliance officer.
Organizations with mature, stable cores can flex under pressure and simultaneously pursue entrepreneurship. Conversely, practices with unstable, weak cores most often demonstrate surface-level rigidity. Such practices commonly retreat toward the status quo in the face of uncertainty.

Simple key to success: the leadership dyad

How can ophthalmic group practices develop the security that flows from core, corporate strength, and set the stage for more nimble growth and development? The answer lies in a simple, familiar concept with a funny Greek name—“dyad”—which in this context refers to a pair of leaders, the administrator and elected managing partner of the practice.
As Nathaniel Williams wrote in The Affordability Factor: The 4 Cs of Change, “One of the hardest things to do in life is to suppress our individuality and work as part of a team.” There is no more important structural catalyst for your practice’s purposeful growth than the managing partner and administrator working productively in tandem.
Think of how this works in a familiar, personal context. Children at home and adults in the workplace need a foundation that secures and empowers them. The most functional two-parent families enjoy relative stability and peace while nurturing the growth and development that embraces change as the kids grow up.
Misaligned parents can ruin young lives, just as misaligned practice leaders can ruin their businesses. We’ve witnessed numerous practice settings where a disengaged physician leader or defensive manager can lead to perpetual crisis rather than forward movement.
In both family and business settings, the “offspring” (real kids, or the adults working in your practice) invariably play, divide, and conquer when they recognize that the “parents” are not aligned. In such cases, authority ultimately shifts away from the nominal leaders and an unstable and chaotic core results.
The highly effective practice dyad mirrors an appropriately stern-but-benevolent, parent-like authority and responsibility within group practices. A unified, mutually respectful, and complimentary relationship between lead doctor and practice manager looks just like the effective co-parenting dyad.
In practices with this kind of dyadic core strength, today’s rampant changes are seen as exciting opportunities, not as a source of paralyzing dread.
It may seem paradoxical, but setting up your managing partner and administrator in this model—having them provide limits, boundaries, and consequences to the rest of the “family”—ultimately creates more freedom for everyone in the practice to grow and adapt to change.
Although your organizational chart probably casts the administrator as subordinate to the managing partner, in the most effective settings these two become peers, creating a palpably unified quasi-parental dynamic. This builds respect and confidence in the practice work force at all levels, especially among owner physicians. Such doctors (even if once quite at odds with each other) will commonly settle down once they respect the authority they have formally granted to the dyad.

Core-building leadership principles

Once the managing partner and administrator are annealed (and your practice may, as you read this, be missing one or both halves of the team), the dyad’s effectiveness begins with a clear understanding of three well-recognized leadership skills:
• Humility with resolve
• Emotional intelligence
• Inspiring others to find their voice (after you have found your own, of course)
Humility with resolve
As Jim Collins describes in his classic text Good to Great, leaders channel their ego needs away from themselves and into the larger goal of building a great company. “It’s not that leaders have no ego or self-interest,” Collins writes. “Indeed, they are incredibly ambitious—but their ambition is first and foremost for the institution, not themselves.”
Inspiring leaders credit their people for successes while taking personal responsibility for failures. Trust is multiplied when the dyad functions as an advocate for, rather than a competitor or obstacle to, success. Great leaders are more like “plow horses” than “show horses.” They have a humble, unpretentious nature. Their strengths are not worn on the surface for others to see, but demonstrated modestly and regularly through persistent hard work and service toward the greater good of the organization. This is in line with the servant leadership concepts of Ken Blanchard, who wrote, “Servant leaders understand that everyone needs to be heard, praised, encouraged, forgiven, accepted, and guided back to the right path when they [sic] drift off course.”

Emotional intelligence

These leadership realms are also described by Daniel Goleman, author of the classic management psychology primmer, Emotional Intelligence, as “Being able to motivate oneself and persist in the face of frustrations; to control impulse and delay gratification; to regulate one’s moods and keep distress from swamping the ability to think; to empathize and to hope.”
Negative feelings tend to hijack our thought processes and drive our worst choices. By strengthening both leaders’ emotion management skills, especially during tense, conflict-filled situations (never far away even in harmonious practices), each member of the dyad develops five key personal strengths and models these strengths for others in the group to emulate:
• Knowing one’s own emotions
• Managing those emotions
• Motivating oneself
• Recognizing emotions in others
• Handling relationships
Any team with high degrees of aligned emotional intellect wields great power, and when that potency is understood to be benevolent rather than ego-driven or malicious, it enhances respect and draws more power to itself through loyal followership. This is one fundamental difference between leaders who become more admired and effective every passing year and leaders who come to be resented, disrespected, and ultimately terminated.
Finding your voice and inspiring thers to find theirs
Covey called this success trait his “8th Habit,” saying, “The path to greatness is a process of sequential growth from the inside out. Those on this path find their voice and inspire others to find theirs.”
Practicing this “8th Habit” begins with exploring our personal strengths and potential for excellence. These are unique to each individual. The habit presupposes that each of us has inherent, unrealized greatness awaiting fruition. First, we have to find and express our “voice” to manifest the highest demonstration of our potential. Second, we encourage and liberate others to do likewise.
Max DePree, CEO of office furniture manufacturer Herman Miller, Inc., has expressed this another way. “When we think about leaders and the variety of gifts people bring to corporations and institutions,” he says, “we see that the art of leadership lies in polishing and liberating and enabling those gifts.”
The dyad you work to build in your own practice becomes more powerful in direct proportion to its effective public message, voiced in tandem, and your creation of opportunities for others to do likewise.
So there it is: “Group Practice Leadership 101.” Excruciatingly simple and intuitive in principle, sometimes subtle and frustratingly slow to emerge when applied in your own practice, even with the best intent. You’ll know you’re getting better at it when the following signs emerge in your own practice:
The board and entire staff view the managing partner and practice administrator as a single unit, speaking with one voice.
Members of the practice come to trust the benevolent intent of their leaders, who are acting on behalf of the entire group.
There is growing respect for the written values, rules, and structure that the dyad both represents and is entrusted to secure.
The practice team is not just grudgingly acquiescent to the dyad’s role and authority, but is periodically inspired by their vision.
Such practices and their constituent staff members will often start taking bigger risks because their core is strong enough to withstand any misjudgment or lapses in execution.

Craig Piso, PhD (570-239-3114; cpiso@pisoandassociates.com), is president of Piso and Associates LLC, an organizational development and psychological services consulting firm based in Pennsylvania. John B. Pinto (619-223-2233; pintoinc@aol.com) is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979, with offices in San Diego, Calif. This article will be included in a forthcoming book being written and edited by John Pinto: Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams, to be published by ASCRS•ASOA in 2012.