Keith A. Reynolds 0:00
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Speaker 1 0:24
Think we just underestimate uncertainty, and we don't plan for those unexpected circumstances. So, maybe it would be ideal if we could launch at 100% but maybe we only have the budget to launch at 50% or 20% and that's okay, I welcomed

Austin Littrell 0:48
off the chart, a business of medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of medical economics, and I'd like to thank you for joining us today. In today's episode, Physicians Practice managing editor Keith Reynolds spoke with Melinda Mastell, a financial advisor at the Medical College of Wisconsin, about moving from spreadsheets to strategy and medical practice finance. They get into why medical groups miss budget for reasons that have nothing to do with money, what strategic thinking actually looks like as a daily discipline, and not just an executive skill, and why curiosity may be the most important thing an early career finance professional can develop. With that said, thank you, Melinda, for joining us. And now let's get into the episode.

Keith A. Reynolds 1:39
Hey there, folks. Today we're talking to Melinda Mastell, financial advisor at the Medical College of Wisconsin. How you doing, Melinda?

Speaker 1 1:47
Doing great, thanks so much for having me.

Keith A. Reynolds 1:49
Oh, it's our pleasure to have you. So, let's just dig right in. When someone brings you a budget problem, what's the first question you ask that gets you past the numbers and into what's really happening operationally?

Speaker 2 2:01
It's

Speaker 1 2:02
a great question. I think when I really thought through this, it was what's changed in the numbers. So, really looking at that, that kind of gets you into context, right? So, maybe someone's bringing you that problem, or maybe you're noticing it yourself, but kind of breaking that down, seeing what changed around it, it helps kind of reveal possible workflow changes or issues, as well as just possible changes to data definitions that might be driving some changes. So, just really looking at what had changed in the data, whether that's operational definitions, it could be workflow, it could be staffing volume documentation, it kind of gets at all of those different pieces.

Keith A. Reynolds 2:42
Okay, so in your experience, what's the most common reason a medical group misses budget that has nothing to do with finances?

Speaker 1 2:49
Yeah, I mean, in a way it kind of all connects back to finance, right? But I think the most common thing I would say is just these kind of hidden operational shifts that we're unaware of, right? They kind of go below the radar, so it could be slight changes in how people's time is being spent, or how efforts being deployed that we don't officially get approved or get documented that isn't built into our financial assumptions or projections. It could be a change in workflow, it could be a change in standards, coding rules that shift, all of these little things that just kind of drift us away that don't get captured, I would say, would be the biggest reason.

Keith A. Reynolds 3:26
All right, so what does strategic thinking actually look like for a finance leader on a normal Tuesday?

Speaker 1 3:32
Yeah, awesome question. So part of my presentation is really wanting to take this kind of bigger concept of strategic thinking, which we all know is a really important skill, and really making it something that we think about is not just for executives or leaders, but for people at every single level, and then also breaking it down because it can come across as a little bit conceptual into some of these habits or questions that we can ask. So, what does it actually look like to implement strategic thinking as a discipline, and that's what my presentation is mostly about, so just some examples, and it can be kind of alarmingly simple, I think, at its roots, but just getting in the habit of applying these questions to anything that comes across your desk, right? Do we agree on the actual problem that we're solving? Who else is affected downstream? What decisions were made upstream that are coming to me. Do I know what precedents are out there? What is our scope? What decision are we in charge of making here? Just making sure that we're defining success, bringing the right people to the table, and asking good questions. I think that is really strategic thinking at its core.

Keith A. Reynolds 4:37
All righty, so you mentioned your session, you know, you talk about moving from spreadsheets to strategy, which is a great turn of phrase. Gotta say, you know, what's one moment where finance helped, you know, change a big decision just by reframing, you know, the story of it?

Speaker 1 4:53
Yeah, awesome question. And the framing is, is so key. The simple example that came to mind that. Was pretty impactful was just looking at our basic accounting structure, so we had a subspecialty program that was growing, we were intentionally investing in it, recruiting for it, but we weren't tracking metrics separately, right, and so really simple change was this is being combined with a bunch of other programs in our data, we can kind of manually filter it out, but any of the KPIs or metrics that we were looking at, the financial reports were not isolated for this program. It's always being combined with a lot of other things. It's just really hard to tell kind of what's noise, what is actually related to this specific specialty. So just recommended a change in how we were accounting for that to help isolate some of that data. So when we're kind of spotlighting those metrics, and we're looking at dashboards, when we're building the budget and the finances, just separating that out has been really impactful, because we can track that separately and just make better decisions and more intentional decisions, and so often those senior leaders are just looking at those, you know, key pieces and those key metrics, right, they're not taking time necessarily to sift through all the background data, and so just thinking about how you're tracking, how you're isolating, how you're presenting that. I think actually can make bigger operational changes than we would sometimes expect.

Keith A. Reynolds 6:13
All right, so you know, when leaders looking to launch something new on a tight budget, what blind spot shows up the most, and you know what's how do you fix it?

Speaker 1 6:22
Yeah, so when I heard this question, I really thought about if anyone like me kind of enjoys the home renovation shows, right? And we often see them uncover things that they were not expecting, and you often see them kind of build in this contingency factor, and so my mind immediately went there, where I think we just underestimate uncertainty, and we don't plan for those unexpected circumstances. So, practically speaking, I think on the cost containment side, this comes in in terms of just scaling down what you're trying to do, right? I think sometimes we look at what the ideal version is, and we want to just implement that right away, but one of the principles I'll be going over in the presentation is about starting on a smaller scale, and that really comes from kind of corporate innovation as a discipline, but looking at what a minimum viable product is, looking at what a pilot of this would look like, right? Maybe it would be ideal if we could launch it 100% but maybe we only have the budget to launch at 50% or 20% and that's okay. What is this version that we can do that's still testable, that still gives us good feedback, good results, helps us to pivot, helps us to improve moving forward, helps to prove the value of what we're doing that isn't going to run out the whole budget, and that leaves us some of that cushion and contingency there for those unexpected changes that can occur, and sometimes be out of our control, right. And then more on the revenue side, I also think is just being creative as well with how we think about obtaining revenue. So, coming from academic medicine, something that I really enjoy is that we're not just doing patient care, there's also this research component and academic component that's involved in our work, but really looking at what are those other funding sources like, right? Like maybe it's a sponsored funding, you know, grant or some kind of project where you can really look at the impact of what you're implementing if that's affecting health outcomes, but maybe it's just partnering with another organization, right, leveraging the best of your strengths, hedging risk a little bit there. Maybe it's looking at other philanthropic sources of revenue, or just other things where we can kind of get creative, because I think healthcare, it can feel so constraining sometimes, because there are limited levers we can pull, but I would say kind of looking at the cost side, building in contingencies, starting small, leaving yourself room, and then just getting creative on the revenue side would be ideal.

Keith A. Reynolds 8:54
Hey there, Keith Reynolds here, and welcome to the p2 Management Minute. In just 60 seconds, we deliver proven real-world tactics you can plug into your practice today, whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch. But the best ideas don't all come from our newsroom, they come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way. I want to be true. Shoot me an email at K Reynolds at mj life sciences.com with your topic, a quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 Management Minute. Bye. so if you could give finance teams one project management tool they should start using tomorrow, and let's not say tomorrow because it's Friday, let's say Monday. Yeah, you know what is it, and why does it work in healthcare?

Speaker 1 9:58
Yeah, so there's so many different. Disciplines and frameworks in formal project management, but I actually think some of the real gems in project management come more from the mindset and some of the purpose behind those frameworks, and so two of my favorite takeaways from project management as a discipline are stakeholder management and getting clarity on scope, so stakeholder management, I think it's so key to make sure we're bringing the right perspectives to the table and at the right time, but not just relying on who we might typically invite into those conversations, but ensuring end users are represented, bringing in people who might be from different functions but have those skill sets, or maybe they're really great at bringing creative approaches, or they have, you know, great background in detail-oriented process improvement, or different things into your work. Even if it's, you know, an operations person coming into a finance project, they can lend another angle. So, making sure you're pulling in those people, getting feedback, and really driving value from people that are already on your team, or already in your network, I think, is so important, and something that's maybe not always leveraged, and then just getting clarity on what is our scope, what are we trying to solve, what are we tackling, what are we not tackling, because scope creep is so real, and I think you know something that leads to projects that just can kind of drift and just lose their steam and their motivation. We've probably all been on some kind of task force or committee, right, where it started off really strong, and then we're getting pulled in a million directions, and we kind of forget why we're here in the first place. So just establishing that scope and that purpose up front is so important, and I think those are two really key tools from project management that may not strike people initially, but that are so important to keep in mind.

Keith A. Reynolds 11:47
Okay, so how do you get cross-functional teams aligned when everyone has a different definition of the problem and the urgency is like really high?

Speaker 1 11:56
Yeah, so I think something so important was that in the question here, which is different definitions of the problem, and one of the key things that I'll be speaking to is actually coming to that shared understanding of what the problem is. We can all see different facets of things, right, especially when we're working across functions, across levels, across practice settings, and there is a tendency to, you don't want to prioritize exactly what you're closely experiencing, but really zooming out, seeing that whole picture is so important, because often the pain points we're experiencing can be caused by some common root issues, so really agreeing on what the problems are they're being faced and coming to that shared definition, I think is so important upfront, because when we're making decisions downstream, coming back to that is what's going to actually speed up the process, and so sometimes I think we need to slow down, take a little more time to document, to establish what's actually going on, what we're trying to fix and solve here before we go on to the next step, and that can involve avoid a lot of that rework an extra time later on,

Keith A. Reynolds 13:03
so for someone who's early in their finance career, you know what's one skill that will most quickly turn them into a trusted advisor?

Speaker 1 13:12
Yeah, I would say curiosity. Honestly, I mean, there's so many good skills that I'll be covering and drawing from corporate innovation and change management, navigating the people side of things, communication, listening - all of these are so important, and I think it's really important to build a multifaceted kind of tool kit of these different skills and make yourself a versatile professional. But I think curiosity is so key, especially early on in your career. You know, something I'm so grateful for is that I asked a ton of questions. I gained a reputation for asking questions. If there was extra time at the end of a meeting, don't just leave, you know, ask for a different angle. Why are we making this decision? You know, who's bringing this up? Perspective taking, right? Learning what's on someone's plate, understanding the whole process, understanding pressures outside of your own role, challenges outside of your own role, understanding what pain points your manager is facing. That's really what's going to set you up to not just be someone who takes work and executes it and runs with it well, but someone who's really sought out for advice and for recommendations, because you understand the big picture, you care about the causes behind things, and really helps you function as that trusted individual and thought partner, and not just someone who's executing and analyzing work.

Keith A. Reynolds 14:33
All right, so this is physician's practice. We're all about tips. So I'm going to ask you, you know, what's one tip you would give a practice leader that they can implement again, not today, it's Friday. They're not going to implement shit that we're talking about. Let's say, let's say next week.

Speaker 1 14:49
So, two came to mind, actually. One is challenging assumptions. So, I will be opening my presentation with that concept, because I think it's a really important mindset. Shift to just be open to thinking outside the box, right? Again, healthcare can be really, it's regulated, it's constrained, depending on your kind of practice environment and culture. There can be a lot of red tape approval layers, right, status quo things that we just kind of take for granted and assume need to function the way that they're functioning, but I think really rethinking that is so important, and some of those things may not be things that we can realistically change, or it may be a slow change process, but sometimes there are things that we can change, we can have a discussion around that we may not have initially thought that we could, so I think that that's really important, and then second, I would say, expand who you're hearing from, really think about what perspectives you're taking in, what parts of the organization they're seeing, you know, I used to love the show Undercover Boss when that was on, right, but it really is that thing where we can all get in our, in our own bubbles, right, of we have our go-tos, we have our people that we're working with most often are in our roles. It's no different for practice leaders, and so I would say anything you can do to just expand that exposure, have an open door policy to the extent that you can. Maybe you start office hours, maybe you could do some rounds, right, but just expand your perspective, so that you're getting to know those people on the front lines, so that you know all of the different leaders in your organization well, and just avoid having the same voices in the same room all the time. I think that that is so key, and that's something that you can implement right away.

Keith A. Reynolds 16:33
I think that's all the questions I have for you. Is there anything else you want to add? Anything you think I'm overlooking?

Speaker 1 16:39
Think this sounds good.

Keith A. Reynolds 16:41
Awesome. All right. Thank you so much, Melinda. It's been a pleasure to talk to you.

Speaker 1 16:45
You too. Thanks

Austin Littrell 16:51
once again. That was Physicians Practice Managing Editor Keith Reynolds speaking with Melinda Mastel, a financial advisor at the Medical College of Wisconsin. On behalf of the whole medical economics and physicians practice teams. I'd like to thank you for listening to the show, and ask that you please subscribe, so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts, and if you'd like the best stories that medical economics and physicians practice publish, delivered straight to your email six days of the week. Subscribe to our newsletters@medicaleconomics.com and Physicians practice.com Off the chart, a Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds, and produced by Allison Latrell. Medical Economics and Physicians Practice are both members of the MJH Life Sciences family. Thank you.

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