Free to Focus

How a Management Support Organization can help group practices streamline work flows and cast a vision for growth

Co-Authored by Rhonda Gonano Mullins and Jill Nesbitt

Large group practice, multi-specialty groups, multi-location groups, even emerging groups – no matter the style, each of these dentist-owned entities is juggling the balance between day-to-day operations and the movement towards the owner’s vision. As each group expands, the daily tasks of scheduling, treating patients and handling billing can quickly take over the owner’s attention. This leads into a “working in the practice” rather than a “working on the practice” situation that can cause serious frustration for an owner with a scalable vision.
Even when the busyness of a dental group is a result of initial success, daily operations can become the only focus.

A new solution to the challenges of managing a group practice is the MSO – Management Support Organization company. An MSO helps the dentist owner to accomplish the practice vision through facilitation, execution and implementation. Made up of specialized management strategists, an MSO steps into a group practice both to inspire and encourage the team through establishing organized systems to smooth out the daily operation as well as direct energy into accomplishing measurable goals to move the group toward the vision. The MSO works hand-in-hand with each department and team member, providing necessary training and organization to allow them to reach their full potential – and with owner support, identifying and removing existing road blocks.

This article will explore the three ways a group practice can work with an MSO:

  1. Owner dentist sets the vision, MSO designs and supports the implementation to make it happen
  2. Develop existing office managers / team leaders for accountability to run the day to day operations – MSO provides solutions for systems/processes for seamless function
  3. Special projects: Marketing, Acquisition, Recruiting – MSO handles these to set up the approach and measure performance and outcome, then hands off to onsite individuals to maintain

Owner sets the vision, MSO supports the implementation
Dentists with an emerging group practice vision often talk about a future where they hire associate dentists, reduce their patient care hours and earn an income through the ownership of a group. This mirrors the premise of a popular business book, Built to Sell by John Warrillow. Built to Sell is a parable about Alex, the owner of a small marketing agency who works as hard as he can, but struggles to build a successful business even though he is involved in every aspect. Through the story, he discovers how to focus on his vision and set up systems to streamline operations and grow the skills of his team so he can relax and enjoy a solid income working as he wants to, not because he has to.

Dentists with this type of ownership vision are tasked with the challenge of building a successful group practice in their community with brand insistence and establishing systems so the dental care can be provided consistently without micro-management. This begins with the owner dentist developing clinical aptitude with the associate dentists – expanding their skills as well as their ability to facilitate patient needs through effective treatment planning and case acceptance. For owners distracted with a variety of other investments and activities, career development of associate dentists can fall to the bottom of a priority list, with difficult and challenging consequences including unrest and dentist turnover.

An MSO works hand-in-hand with the owner dentist to refocus on the vision for the group practice. Through establishing a level of excellence of best practice standards and patient care delivery expectations that penetrate the soul of the organization, regular meetings with the existing management team and the owner dentist plus onsite purposeful agendas, follow- through and deadlines, a group practice owner can feel confident that their ideas will be implemented – and therefore, the meeting time justified. As tasks are assigned and completed, the owner can develop trust in the team and move into a solid leadership role.

Existing management team runs daily operations, MSO establishes systems
Beyond working with the owner of the group, an MSO works closely with the team members in each office to support their training and smooth their day. Most office managers want their offices to be successful and their dentist owner to be pleased with their performance. However, they often feel overwhelmed and under-supported and settle into an attitude of “I’m doing the best I can”. As practice performance reports reveal poor results – large over 90 days receivables, holes in schedules, missing metrics, no forward movement, etc. an office manager can feel attacked, embarrassed and view themselves as a failure.

The MSO role in working with office managers and the administrative team is key. As the MSO professionals begin to understand the issues each administrative team member is facing, empathize with the challenges and then gain the trust of these team members – the foundation for change has to be initiated within the individuals as well as the practice platform. Then, and through systems and training, each team member can be supported to increasing levels of performance – and with measurement, we can set up these team members to succeed and be there to cheerlead their accomplishments! Either the people change or you change the people.

For large group practices, the MSO develops team leaders. A representative from the hygienist team, the assistant team and the administrative team are identified and given authority and support to help manage the practice through each departmental contribution. With regular meetings with the owner dentist – and/or other associates depending upon their interest and motivation, these team leaders are essential to the success of the group. The MSO provides leadership training, solution finding and encouragement to these team leaders.

MSO handles special projects: marketing, acquisition, recruiting
As the owner and team leaders begin to manage the daily operations successfully, special projects will arise. These special projects can include a need for an overhaul of the technology, evaluation of the marketing return on investment to identify the best avenues for generating new patients, acquisition of a new office or recruiting new associate dentists. For a team leader gaining ground with people management skills and handling a higher responsibility load in terms of team schedules, training and performance monitoring, a special project can throw them into overload. Plus, special projects often involve the selection of vendors and comparison of expense vs. value. The MSO brings a level of sophistication into these purchasing decisions that allows the owner to select the right partners to meet their needs and budget.

The MSO also brings expertise from other group practices to bear when tackling a special project. This increases the speed that a major decision can be made and a solution implemented. Existing management teams appreciate the time saved by outsourcing these tasks. Let’s say that a group practice identified a need for more new patients (beyond the success achieved through internal marketing protocols already in place) and the decision was made to tackle the special project of increasing new patients. This is a great project for an MSO – this group of professionals knows the practice, understands the strengths and can identify external marketing opportunities such as online, direct mail, etc. The MSO can work with vendors to craft marketing programs, establish budgets and systems to measure return on investment.

No matter what type of special project the MSO tackles, the heavy lifting of designing the program, approving the budget with the dentist owner and then establishing the performance measurement system all stay off the shoulders of the existing management team. Then, once the special project is running effectively, the MSO professionals bring the team leaders and office managers up to speed on their role to make the program successful. This expands the knowledge and confidence level of the existing management team when they are well supported by experienced professionals.

Growing the right way
Dentist-entrepreneurs who own a single large group or multiple locations face the challenges of increased complexity and a growing time drain to manage day to day operations. For dentists with a vision of ownership as opposed to full time clinical care, it can feel almost impossible to handle both the leadership needs of a growing organization as well as the daily management tasks. This is where a Management Support Organization (MSO) can step in to partner with the dentist owner and leverage his/her time by establishing systems and processes to support the existing team and increase both the efficiency and effectiveness of patient care.

The MSO working closely with the dentist owner also can handle special projects such as marketing, new practice acquisition/on-boarding, recruiting and major purchasing decisions. By bringing experience from other practices to bear, the MSO can facilitate the owner to select the best vendors and establish a plan for implementation and performance measurement. An owner can also rapidly increase the knowledge and skills of the existing management team through MSO support and coaching. This new approach to support emerging group practice allows a dentist owner to focus on vision and clinical leadership with the added confidence that the MSO professionals are in place to solve, support and smooth the unique challenges of group practice management.

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About the Authors

Rhonda Gonano Mullins, CEO
Acquisition, Transition & Operation Management, Solo, Emerging Large Group & Multi Location Design Strategist
As an “Innovative Creative Consultant” in business enterprise and care driven clinical outcome, she delivers! Her contribution to Solo, Multi and Large Group practices nationally has been, and continues to be, a passion with GREAT persistence in impact and innovative solutions for this industry and its providers.

Jill Nesbitt, MBA, COO
Large Group & Multi Location Operation Consultant
Jill is a group practice dental consultant with over 18 years experience in dental group practice management. Her expertise with the Baldrige statistical management approach supports decision making for staff management, marketing, vendor management, finances and strategic planning.

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