Steven H. Dayan, MD, FACS is in private practice (www.drdayan.com) in Chicago. He is a Clinical Assistant Professor at the University of Illinois and author of the book Thrive.
Innovation is an integral and exciting aspect of medicine— especially aesthetic medicine. We eagerly anticipate the newest technologies and treatments that will allow us to offer our patients even better results and expand our practices with new services. While there is no doubt that we have been provided some ground-breaking aesthetic tools over the years, the reality is that technology can only go so far. Much depends on the skill and expertise of the cosmetic surgeon. In reality, the “product” that any cosmetic surgeon provides is not an injectable agent, a laser procedure, or a surgery. We manufacture, market, and distribute outcome. Ultimately, everything else falls down from that; everything that comes out of your office, from front desk personnel to the lasers, skincare lines, and even the efficiency of the software you use, eventually gets equated with you.
I believe, therefore, that some of the most significant innovations in aesthetics today aren't about technology and technique but about the way we run our practices in order to efficiently and skillfully provide patients the ideal outcome and an exemplary experience. You can read more about this in previous articles I have authored available online at ModernAesthetics.com or pubmed.org. Among the innovations that can most positively impact an aesthetics practice is, in my opinion, appropriate and effective delegation.
Delegation as an Innovation
The concept of delegation in medicine has existed for quite some time. So why is it an innovation? Because for so many physicians, being able to effectively delegate is a novelty. We are highly trained, highly educated, successdriven individuals who recognize the awesome responsibilities entrusted to us by our patients. We have medico-legal responsibilities for the outcomes in our practices, and we have reputations to uphold to ensure our long-term success. These factors, along with personality traits and preferences, all sometimes fight against the notion of delegation. After all, if something goes wrong in my practice, I am the one who is ultimately responsible. We cannot “pass the buck.”
I fought against delegation in my practice for a long time. But I learned that when I delegated appropriate responsibilities to my staff, it freed me up to make important changes and evolve and grow my practice. I was able to make innovations in my practice because I wasn't bogged down by details that didn't require my energy and attention. I could incorporate new techniques and services when I hired staff members to provide certain existing services. With time, my staff became increasingly more innovative as I empowered them to take ownership of their responsibilities and the success of the practice. Learning to delegate helped me save time and energy to develop my passions and create what I hope is a truly innovative aesthetic practice that provides exemplary outcomes.
Delegate or Die
It is crucial to delegate only what makes sense and what is legal. State regulations vary, so you need to assure that you comply with regulations regarding injections, use of lasers and energy-based devices, etc. Recognize that just because delegation is legal in your state does not mean it's appropriate for your practice; think about what makes sense for you, your patients, and your long-term practice goals. Consider securing the services of a lawyer or consultant to determine appropriate delegation strategies.
Principles of Effective Delegation
Once you decide what to delegate, there are four principles of effective delegation.
1. Understand and accept that there are risks. It wouldn't be honest if I didn't admit to the difficulties and setbacks I have had due to, at times, too liberal of a delegation strategy. There will always be some degree of risk associated with delegation. And I have had my share of setbacks. The greatest mistakes I have made have always been centered on my willingness to give too much authority to office managers and executive officers who have feigned execution because they lacked the skill set or haven't truly shared in my thoughts. I had situations where they didn't agree with my decisions and have let that be known to staff, which created an environment of disrespect for my authority. My liberality with office staff delegation without appropriate checks and balances has resulted in periods of massive growth along with periods of rapid demise of my designed culture. However, one area in which I am incredibly strict with delegation and have not nor will ever compromise is concerning direct patient care. Of course, there is a level of risk with any medical procedure. If you train your staff well and have established protocols for provision of service and management of unintended outcomes, and directly oversee these standard operating procedures are enforced, you can dramatically minimize risks and liability.
Of course, delegation is not limited to medical procedures, nor is risk. Like most providers, I hired a bookkeeper for my practice. I made sure I hired someone competent and that I believed I could trust. I did due diligence in checking references and doing background checks. Nonetheless, to minimize risks of embezzlement or improper handling of finances, I also hired an accountant to review the books and advise me. And I still review the books myself. Three sets of eyes better be able to catch any errors or improper transactions. And my system was tested and it worked when a few years back we discovered an attempt at misappropriate behavior from a previous employee. I took the steps necessary to delegate while also protecting myself and my practice.
2. Trust and empower your staff. Once you decide to delegate, you have to trust and empower your staff. This is really hard for many doctors and not inherent. You must accept that you will have to give up some authority in your own practice.
One of the first delegation decisions I made in my practice was to hire an injector for fillers and neurotoxins. I still do a lot of injections, but now I have three other providers in my office that I taught to provide fillers and neurotoxins according to my protocols and my aesthetic. I also taught them how to do laser hair removal, which I don't anymore. I trained them rigorously and assured their level of competence before allowing them to treat patients, so I trust that they will do so skillfully.
3. Accept that you can always do better. You also must accept that no matter how well you train an injector, an office manager, or front desk person, you can always do it better—or at least you will always think you can do it better. Therefore, be sure to avoid criticism for the sake of criticism and focus instead on educating and mentoring the injector with the goal of facilitating meaningful improvement. If you simply criticize staff members, they'll become disenfranchised.
4. Commit to communicate. You must commit to becoming a better communicator. The main reason that delegation fails in practices is that the physician doesn't communicate well enough. It's so easy to say, “My employee just didn't get it,” but in the end it's your responsibility to ensure that the employee is able to see your vision. When they “don't get it,” it's not their fault; it's yours.
Your staff is a reflection of your brand. Hire the right people, fire the wrong people. And effectively communicate with and cultivate the former group.
Communicating Isn't Telling
I have learned that a key aspect of communicating is not so much telling as it is facilitating learning. If I have a vision for a project and try to convey it to my employees, they may spend weeks to develop something that they think fulfills my vision but in the end is nothing like I imagined. I get frustrated, they get frustrated, and the project doesn't progress.
Instead, I have to make my staff see my vision. I have to keep asking questions until we come to the same vision. Once we see the same thing, then they can go ahead and take the steps to implement the vision.
Similarly, I and my staff try to work through major problems together. I ask questions and I listen to what staff members say. Many times, their vision turns out to be better than mine. When there is a problem or I find a mistake, I don't necessarily tell staff how to fix it. I try to ask the questions that guide them to a solution, and it makes them better problem solvers going forward.
When I delegate a project to staff—once we have achieved a shared vision—I ask the staff member for a timeline. This becomes their timeline, and for the most part I let them set the pace, so long as it's reasonable. Then I have them send me an email confirming that we're on the same page. After all, once you write something down, it becomes more official.
Finally, if there is an error or the project does not develop as anticipated, this, too, is an opportunity to communicate and facilitate learning. I ask staff to tell me what went wrong and why and how they can ensure it is not going to happen again.
Delegate Problem Solving
On my desk sits a plaque that reads, “Make it happen in facts and solutions.” Staff are not permitted to come into my office with just a problem. They have to give me the facts and give me a solution. Once they come up with the solution, they're empowered to fix problems in the future.
This technique has proven to be a great way to encourage resourcefulness. Because my employees have to think two steps ahead, it prevents me from micro-managing them. I take a staff member, I make them potent, I make them strong, I empower them, and they become professional. They grow faster, and hopefully we grow.
Regular employee reviews are essential. The proper conduct and benefits of a review are fodder for another article. Note, however, that during the review the employee should be actively involved in describing what they've accomplished and how they can improve. I ask staff members to tell me how they will grow the business in the next six months.
Free Yourself to Innovate
Some of the greatest innovators of our time were people who could formulate great ideas that others ultimately developed. Consider Steve Jobs, who was without question a brilliant marketer but by no means a genius software developer. He oversaw development, but he delegated crucial aspects to talented individuals who executed his dream. In the realm of aesthetic medicine, it's no different.
Cosmetic surgeons who effectively delegate accomplish two goals. They free themselves to excel and evolve in those areas of service and practice development that appeal to them, and they establish an environment that encourages creative thinking and problem solving for staff. This sets the stage for ongoing evolution and growth for the individuals and for the practice.