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Successful practice management is about the people, not the processes

8 November 2018

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Practice manager Daniel Vincent on the importance of empowering others, building trust and getting the job done 
I became a practice manager by chance. In August 2009 I joined a brand new Darzi centre two weeks before opening and, two weeks in, the existing practice manager decided the role wasn’t for him and left with immediate effect.
That day I was asked to step up and since I have always been one to seek out a challenge, I accepted the role without hesitation.
I had to learn very quickly how to not only run a practice but also manage a team. I started delving into books, articles and videos on management theory and also embarked on a Diploma in Primary Care Management.
I enthusiastically put policies, protocols and frameworks in place and ensured there was a clear hierarchy within the practice and that everyone knew who did what. We were open seven days a week, 12 hours a day, so there was huge potential for things to go wrong. However, it all worked pretty well.
After about a year and a half I noticed that things felt different. We had put in the hard work to set up a brand new practice, created our systems and processes, worked out the intricacies of operating a walk-in service, and dealt with demand tenfold what we originally expected the service to deliver.
Now things felt a little flat. We lost a few very good people and others, who had previously been very positive, started displaying some quite challenging behaviour.
I felt a little lost, and there were a number of challenges. A good example is holidays, an issue that caused an immense amount of controversy within the team. We reviewed the holiday booking policy more times that you can imagine, working together to create a fair system, but it still led to upset and anger.
I realised that no amount of systemising was going to resolve this and that’s when I started to explore leadership as a concept.
Leadership in theory and practice 
In leadership I found a powerful set of tools to help me exponentially achieve more, in a way that management strategies alone would not have made possible. On reflection I could see that I had restricted the ability of my team by enforcing tight protocols and working practices.
I needed to shift my way of working in order to empower others, building trust and focusing on the people rather than the processes. I needed to encourage proactive change, setting principles and guidelines rather than policies and procedures.
Which was much easier said than done. People had come to look at me as the solution provider; if they had a problem I could fix it and I found changing this a real challenge.
I started by sharing my thinking with a few senior members of my team, to ensure that they understood why I was trying to not give them all the answers anymore, why I instead wanted to allow them space to come up with their own solutions.
Slowly but surely I started to see a shift in how people worked and sometimes they surprised me with the changes they had made, although I tried hard not to show my surprise. The process showed me the power of leadership in action.
Career development

The Darzi centre had a five-year contract and during the third year, I started looking for another role, to keep evolving. There were two roles being advertised and, by chance, the interviews were on the same day.
One was at a city centre practice in Bristol, and the other for a rural dispensing practice just about to embark on a new build. I interviewed in Bristol in the morning and with the rural practice in the afternoon and was offered both roles. I found the idea of a new build exciting and opted to join the rural dispensing practice.
I took the opportunity to move practice to continue to progress how I worked. At my new practice, I created a leadership team from each head of department and for the first time I wasn’t line managing each and every team member.
My focus was on responsibilities rather than processes and I tried to care less about how people achieved their results, provided they got the job done.
This is not easy for a control freak. On occasion, I got too involved in how things were done, but I was trying, some would say very trying. We built a second site and together we changed our way of operating to deliver the service our patients required across our newly expanded practice area.
It’s also perfectly possible to shift your way of working within your current practice, it just takes a bit longer as other people need to adjust to the new you. Share your plans with your trusted colleagues so they’re not surprised when you start responding differently to things.
If you are moving on, or thinking of doing so, take time to carefully plan how you want to work in your new role to give you the best possible chance to initiate impactful change.
I’ll leave you with a quote ‘Before you are a leader, success is all about growing yourself. When you become a leader, success is all about growing others.’ —Jack Welch
Daniel Vincent is practice manager at Ryalls Park Medical Centre in Somerset

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