Practice Management

Carmel Harfield at the front desk of her practice

“I probably fell into it; I didn’t decide that I wanted to be a practice manager as such. One of my initial roles was to assist an orthopaedic surgeon who had recently set up a new practice. He wanted someone who could assist in the treatment room, manage the front desk, and manage the back office. That was a very exciting and busy time.”

Carmel Harfield was reflecting on her eventful journey from registered nurse to practice owner.

“It was certainly a very different practice to what we work in now,” she told Medical Forum.

Compassion and business nous

Soon after starting as a practice manager, Carmel completed a business degree, allowing her to combine her clinical knowledge with managerial skills.

“After several years with the orthopaedic surgeon, I found a fondness for the business side of general practice.”

Carmel started her own practice management consultancy, Professional Practice Development (PPD), leveraging her experience and skills to help clients start their own general practice.

“I see so many doctors wanting their own practices. Some doctors wanting assistance; just starting from a pile of sand, while others I help through to accreditation. I see many wanting to buy into practices although unsure how to complete their due diligence.”

She purchased Kelso Medical Group in Kardinya in 2007, a practice that was initially founded in 1897.

“That was an exciting and challenging time and I started to appreciate the need to micro manage and understand all of my KPIs in order to make the business sustainable. We implemented a lot of rigid business disciplines, and we adhered to those while we reviewed the business on a regular basis.

Carmel’s business discipline has not led her to lose sight of the identity of a general practice.

“Our practice has a wonderful history of servicing the community. We like our doctors to take their time with patients, getting to know them and to understand their needs. We attribute our sustainability to our philosophy of ‘we care’, and our patients being our primary priority. That will never change.”

Business of general practice

Carmel is sensitive to the fact that with the emergence of larger groups, smaller groups with one or two doctors have been forced to close but there were positives and negatives.

“The positives are being able to provide medical services throughout the day every day, which takes the pressure off of the public hospital system. However, the commercialisation of general practice has led to challenges of patient retention with price and quality being weighed up by the patient.”

New age practice manager

“It does not even look like the same job, when I think back, over 40 years,” Carmel said.

The most significant change is IT developments which have become integral to the management of the business.

“When doctors tell me they are going to manage their own practice, I fear they don’t really understand the challenges. It’s no longer about running a practice; it’s running a sustainable business. Unless someone has the skills and foresight to understand these challenges and how to get past them, then they are almost doomed from the beginning.”

“Having a multiskilled practice manager is pivotal – the multitude of responsibilities increase and vary on a daily basis. The modern day practice manager is required to have professional attributes and values to be able to lead a practice. They should have strong IT skills, be knowledgeable on current HR requirements, quality and accreditation requirements and OHS regulations and procedures to name but a few.

Has her passion lessened over time?

“I have certainly enjoyed the journey, but I am a long way from the finishing line. It has been a wonderful and at times a humbling experience, and if I could do it all over again, I would.”


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