a blog by Chris Barrow

Building the £10m micro-corporate – Step 5 of 7

Transition and assimilation Here’s what the owners and practice managers tell me when they are two or three acquisitions into their micro-corporate: 1. We had no idea that the initial negotiation, due diligence and exchange would take so long. 2. Agreement of the associate contract with the former owner took longer than we expected. 3. No matter how much due diligence and interviewing we did, there were still skeletons in cupboards and bodies buried in gardens when we got there. 4. We reluctantly came to realise that not everyone in the acquired practice would accept our culture and that they had to be replaced. 5. It took longer than we expected to ensure that all clinicians were compliant to our standards of governance and compliance. 6. The existing business systems were either non-existent or very primitive – it took time to align their systems with ours. 7. The shift in loyalty to our culture was relatively easy with the existing PAYE team but took longer than expected with the clinical team. 8. It took us 18-24 months to feel comfortable that the satellite practice could fend for itself. So it is, perhaps, appropriate here to pause and consider some time-served observations on leadership and management – if you don’t mind, I’m going to share a bit of vintage Coach Barrow material that relates well to the challenges mentioned above. Leadership is about people. Management is about systems. You can lead people but you cannot manage them. You can manage systems but you cannot lead them. Leadership is defined as: 1. You being the custodian of the vision and the culture – and communicating that vision and culture on a regular basis. 2. You setting the example of the vision and the culture through your own performance and behaviour. 3. Your ability to delegate. 4. Creating an environment in which people can become self-motivated. Management is defined as systems for: 1. financial control 2. marketing 3. the patient experience 4. clinical and non-clinical operational controls 5. human resources 6. clinical governance and compliance Each of these branches into many tributaries. We have already mentioned in this series of posts the importance of your organisational structure. It is in the leadership and management skills demonstrated by you and your senior management team that the difference will be made. I often quote the phrase “all problems exist in the absence of a good conversation” and the growth of your micro-corporate is an arena in which this phrase could not be more relevant. Your managers will need to meet face to face with the PAYE team in your satellite on a VERY frequent basis to begin with (perhaps the 18-24 month bedding in period mentioned in feedback). You will have to accept the role of Clinical Director and MENTOR the clinicians individually for a similar time period. Mentoring for you will mean regular conversation, constant case review, comradeship at post-graduate meetings and an invitation for the clinician being mentored to observe you at work and in communication with patients at your home practice. Part of this leadership and management responsibility will also include your ability to respond rapidly to the skeletons mentioned earlier and to the inevitable behavioural problems that will arise between people. NOTHING, absolutely nothing, can be left to fester, whether it is a system failure or a relationship challenge. Remember that the existing patients that you have paid handsomely for will be watching carefully as all of this plays out. They will be initially cautious and might see your arrival as the first sign of a decrease in quality of the personal relationship they have built with the people in the practice. The cynics will also be waiting for the next price rise. You have to ensure that no patient has an excuse to shop around. Ultimately, each acquisition has the capability to become a problem child or a star apprentice – the choice will depend on your level of engagement. There will be no such thing as spending too much time on transition and assimilation.

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