One of the founding principles when starting or scaling up a medical practice is the delineation of roles and responsibilities and the reporting structure for staff. Without these structures and clarity, employees can become confused and risk working on or prioritizing the wrong things. Additionally, there is a risk of duplication of tasks or failure to complete tasks. In an ideal world, all employees have a linear reporting structure and can go to one manager for all things. However, this is not possible or practical in many medical practices due to overlapping tasks and interdependent responsibilities.
In a medical clinic, a clinician, often a doctor, oversees the standard and implementation of patient care and has co-management responsibilities with an administrative manager who oversees recruitment, onboarding, payroll, vacation and sick days, and a host of additional important employee management-related duties. In this kind of situation, “matrix management” refers to the co-management structure in which an individual reports to multiple managers or supervisors. Managers may be equal or subordinate to one another, depending on specific duties or scope of responsibilities. It is incumbent that leadership in an organization of any size come to an agreement regarding where one manager’s responsibilities begin and end and then communicate lines of reporting to all staff so they can direct their communication to the appropriate manager.
RECOGNIZE AND ACKNOWLEDGE MATRIX MANAGEMENT
In medical practice, it is common for clinical staff members and providers to have dual lines of reporting. For example, when performing clinical duties, a medical assistant may report to a provider, such as a doctor or a nurse practitioner who directs them in day-to-day clinical care activities. However, this medical assistant will commonly also have an administrative manager who facilitates their team development, assigns a work schedule, and approves overtime and personal time off. Due to their overlapping managerial responsibilities, the clinician manager and the administrative manager must first be clear and come to an agreement regarding their respective roles; good and frequent communication is embedded in a matrix- management plan that works well.
WHEN MATRIX MANAGEMENT WORKS WELL
When managers and clinicians are in a co-management matrix and their respective roles are honored, things go well! For example, if a medical assistant asks their administrative manager how to re-constitute Botox®, she or he would refer them to their clinical manager or to a written clinical procedure protocol. If a medical assistant goes to a doctor they work with each day and asks if they can take an unpaid day off, the doctor will ideally respond by saying something like, “Have you spoken with Susan (administrative manager) and cleared this request with her? She oversees all our schedules, and it will be best for her to answer this question.”
WHEN THINGS DON’T GO WELL
When clinical and administrative managers have not clearly defined their reporting structures and philosophy, managers and providers can unknowingly undermine each other. For example, if an aesthetician asks the lead Physician Assistant (PA) if they can take next Thursday and Friday off since they have a slow schedule, and the PA approves this request without consulting their co-manager who is the administrative manager, the PA has undermined their co-administrative leader. The HR administrative manager is aware that the other aesthetician is already scheduled to be out, and they are running a flash sale for Friday and anticipate the aesthetician’s schedule to fill by the end of the week. In this scenario, the lead PA should say something like, “Have you spoken with Susan (administrative manager) and cleared this request with her? She oversees all of our schedules, and it will be best for her to answer this question.”
Matrix management is not just a structure but a frame of mind. Philosophically understanding that many people report to a couple of people will prevent clinical and administrative managers from undermining each other. Regular communication between clinical and administrative managers is essential for a working matrix- management protocol.
PROBLEM-PREVENTION PLAN
What is the best time to delineate matrix-management responsibilities? When forming a practice and then revisiting at each strategic growth point as the practice scales up. It is also critical to review the delineation of reporting at the onset of employment to help guide a new employee. Whenever an employee has dual-reporting responsibilities, communication is critical as part of a problem- prevention plan. A visual can help tell the story, so consider sharing an organization chart and review lines of reporting with a visual aid:
CONCLUSION
Matrix management works well when there is ongoing communication between clinical and administrative leaders. Periodically revisiting and revising matrix management protocols as the practice and teams grow will be essential to continued alignment. Clearly delineating roles and responsibilities and reporting structure will prevent managers from undermining one another. By onboarding staff and providers with a matrix-management roadmap, they are set up for success and increased efficiency in their day-to-day roles within the practice. It is best to align reporting structures when starting a new business, but it is never too late to implement matrix management for ongoing process improvements.
DOES YOUR PRACTICE HAVE PROTOCOL ROADMAPS CREATED BY BOTH ADMINISTRATIVE AND CLINICAL LEADERS?