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to downsize is yourself?

What if the best person
to downsize is yourself?

(First Person features local businesspeople relating–in their own words–experiences and lessons that have shaped their professional development.)
Managers are paid to make decisions. Some decisions are harder than others. The hard ones often involve guessing about the future, conflicting or incomplete information, competing interests and egos.
Being objective can be tough. But when you are a manager, that is your job.
In 1988, I was appointed executive director of Plaza Sports Medicine and Rehabilitation P.C., an outpatient physical-therapy organization with four offices in the Rochester area. About five or six years ago, I–and every other health care manager–began to face decisions created by a rapidly changing health care industry that, armed with the noble intention of stabilizing health care costs, did not come across as too concerned about the fate of small, independent health care providers.
Reducing the cost of health care, or reducing the increases in the cost of health care, is the driving force behind the health care revolution. Providing the best care possible, while reducing the cost, also is the goal.
It has been up to the myriad of health care providers to figure out how to do this. I will spare you the raging debates about reimbursement rates, capitation, limiting choice and conflicts of interest. Let’s just say that it is all here to stay.
Health care is a real challenge if you are committed to quality care for your patients–and you are committed to your employees as well.
When it comes to patient care, there is no debate. No matter what, you have to give the absolute best care to your patients. No matter what your reimbursements, no matter how much paperwork, you just do it.
When the squeeze is on to economize, patient care has to be preserved. You do not compromise. If you cannot do it, you should turn off the lights and go home.
So you look to other areas. You try to be more efficient and reduce non-essential expenses. Profits can be sacrificed.
But that is tough in the long run if most of your profits are customarily put back into the company to reward employee performance, pay for training and education, and buy new equipment. These are closely correlated with good patient care, so they cannot be eliminated.
In a labor-intensive business like physical therapy, which often requires hands-on one-on-one care, you cannot just “double productivity.” Not if your care providers always have strived to be as efficient as possible while still providing quality care. There is only so much economizing you can do before it impacts patient care.
That was the predicament I faced as the health care revolution rolled through Rochester.
So what to do? Where to look next for savings?
First, consider all the options. Second, be objective when you consider all the options.
Ultimately, everyone has had to make some sacrifices, but there was one issue we felt strongly about. We decided that our employees–the people who come in each day, provide the services and process all the never-ending paperwork with a smile on their faces–were not expendable. Actually, we were lucky to have them.
After studying the issue continuously and, I believe, objectively, I determined that one layoff was necessary: me. The changes in the health care system had not only tightened the purse strings, it changed my job description. We no longer needed my role–which was often entrepreneurial–on a full-time basis. And we could no longer afford me.
So in late 1996, I gave up my position.
And you know what? The roof did not cave in. It has worked for Plaza Sports Medicine. The company is in the capable hands of my successor, a physical therapist with lots of management savvy to go with her MBA, and the ability to treat patients.
It has worked for me, too. Far from being discouraged, I welcomed the chance to pursue full-time my work as a free-lance writer and management consultant. I write for businesses, schools, non-profits and publications. I am doing work that I love, learning every day and I even get to pick my daughter up from school many days.
(I still work part time for Plaza Sports Medicine, helping in areas that I specialize in.)
Good management means being objective and ethical. When I was hired as executive director in 1988, it was explained to me that the company was committed to providing quality care and a quality work environment.
It is easy to be a supportive employer when things go smoothly. The true test of that commitment is when the road is rocky, and the health care system is filled with potholes these days.
(If you have a story to tell, fax a one-page synopsis to Associate Editor Catherine Roberts at 546-3398, or e-mail it to rbjournal@aol.com.)


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