No One Gets Fired For Saying Nothing

Imagine it's Thursday afternoon, and your biller is chasing the same missing documentation from the same practitioner. She knows which charts will need another reminder. You know it too. You've been meaning to have that conversation, but he's busy, he's good with patients, and this week has been difficult enough. 

So she sends another reminder, and you say nothing. The work gets done eventually, which makes it easy to tell yourself the system is working. But the system is your biller compensating for a conversation you haven't had. 

In a recent Fast Company article, Mark C. Crowley describes a senior leader who waited until he knew where everyone else stood before offering an opinion. I recognized the pattern. Most of us aren't sitting in executive meetings carefully protecting our position. We're deciding whether today is the day to address something that everyone in the building already knows. 

The problem with being easy to work around 

In a small practice, there is no anonymity. The person you need to correct covered for you last Friday. The referral coordinator sending incomplete paperwork may have helped you get a patient scheduled when nobody else could. You have to work together tomorrow. 

That matters. But preserving a relationship and avoiding a conversation are not the same thing. 

Think about compensation the way you would in the clinic. Someone shifts their weight away from discomfort, recruits something else to carry the load, and eventually the compensation becomes part of the problem. It's a useful way to look at a practice, too. 

The office manager checks every chart because she doesn't trust the handoff. The technician stays late because nobody addresses unrealistic delivery promises. The front desk apologizes to patients for delays it had no part in creating. 

Nobody calls this a leadership decision. It looks like people pitching in, and sometimes it is. But when the same people keep absorbing the same preventable problems, we ought to ask whose discomfort we are actually protecting. 

The referral relationship you don't want to risk 

This gets especially uncomfortable when the conversation involves a referral source. You want the business, you value the relationship, and telling another office that something is missing can feel like giving them a reason to send the next patient elsewhere. 

So your staff makes another call, sends another request, and works around it. The delivery date gets closer, and the pressure lands inside your practice rather than with the process that needs attention. 

Your first reaction might be that this is simply part of working with offices you don't control. Fair enough. But I'd push back a little. 

“I want to make sure we're protecting your patient's delivery date. We've had several referrals arrive without the information we need, and I'd like to work out a simpler handoff.” 

That's not an accusation. It's an invitation to solve a problem you both have a reason to care about. 

Bring a specific example through an appropriate, secure channel. Explain what is missing and why it matters for that case. Ask who should receive requests and what would help their team get it right the first time. A short reference sheet based on the applicable payer's requirements may be more useful than another frustrated voicemail. 

The goal isn't to win an argument about whose office is busier. It's to stop making the patient and your staff pay for a process nobody has discussed. 

Don't make every decision equally difficult 

Not everything you're postponing carries the same risk. Trying a ten-minute morning huddle is different from signing a payer contract. Changing who checks a work queue is different from proceeding with a delivery when you haven't resolved whether an applicable requirement has been met. 

For an ordinary workflow change, try something small. Give one person responsibility, decide what improvement would look like, and set a date to review it. You don't need six weeks of discussion to learn whether reviewing incomplete cases together twice a week reduces last-minute scrambling. 

For decisions involving patient safety, payment, contractual obligations, or compliance, slow down enough to check the facts. Distinguish a regulatory requirement from a payer rule and from your own preferred process. If you're unsure, verify the applicable requirement with the payer or the appropriate compliance resource rather than treating yesterday's workaround as permission. 

The discipline runs in both directions. Be quicker with changes you can safely test and more deliberate with decisions that are difficult to undo. Don't spend a month debating a huddle and then rush the decision that actually deserves your attention. 

Have the conversation, then stay with it 

Pick one issue this week. Not the biggest one in the practice. The one you've rescheduled twice. 

Start with what you've observed, not what you've decided about the person. “These three charts were still incomplete when billing needed them” gives you something to discuss. “You never finish anything” gives you something to fight about. 

Explain the effect on the next person in the workflow. Then ask what's getting in the way, and listen long enough to find out. You may discover an unclear expectation, a training gap, an unreasonable workload, or an accountability problem. Those need different responses. 

Before you finish, agree on what changes, who owns it, and when you'll check back. Otherwise, you've had an uncomfortable conversation without changing the work. 

And when someone brings you a concern, remember what you're asking of them. If your first response is irritation, don't be surprised when the next concern takes longer to reach you. 

You don't need to become the person who challenges everything. You do need to decide what you're no longer willing to let other people quietly carry. 

The next time you think, “I don't want to make this a problem,” ask whether it's already a problem for someone else. Then have the conversation while there's still something useful you can do about it.