The Culture of Complex Healthcare Systems
Can you convince a surgeon to accept help? Helping my husband and serving alongside him in his surgical practice has been a very interesting experience.
In the first three years of our marriage, I threw myself wholeheartedly into partnering with him—working behind the scenes to strengthen his business, leveraging my 20 years of organizational development and culture consulting to enhance his processes, and ultimately, the care his patients received.
Convincing a surgeon to apply tried-and-true people systems to their practice is a monumental task. Surgeons are trained to focus on precision, outcomes, and patient safety—not organizational design or people strategy. But he trusted me, and together we made real progress in bringing efficiency, calm, and order to what had previously been an overwhelming environment.
One of the most pivotal pieces in that puzzle was hiring the right Medical Office Assistant.
The right MOA is a gatekeeper, a patient advocate, a workflow stabilizer, and often a surgeon’s “right hand.” The right MOA can elevate an entire practice. The wrong one can unravel it. But the question is:
How do you find the right MOA in a high-pressure, complex healthcare system without taking short-cuts?
Several years ago, a different surgeon discovered my background in executive leadership and tried to hire me on contract solely to fire their staff—because they couldn’t face doing it themselves. He wanted to take the least painful short-term path. I refused the role. I knew that stepping in to fire employees within a broken system would only guarantee the same problems would resurface. Without structure, expectations, and a well-defined culture, nothing changes. And in this case, the surgeon was not willing to shift how they ran their practice, which meant the cycle would simply repeat.
The Long Game
A decade of exposure to surgical practices has left me with mixed emotions. I’ve had access to surgical sites and teams across Mississippi, Texas, Saskatchewan, Alberta, and New Brunswick. At first, I was energized by the possibility of meaningful change. However, after several years, I became discouraged by the lack of appetite for it. I stepped back, reevaluated where I fit—and whether I fit at all.
It has taken nearly a decade of seeing the system for what it is to develop a more sustainable approach. Now I focus on contributing to systems change at a micro level rather than attempting large-scale interventions—which, in the past, generated an ambitious and exhausting cycle. Today, my energy is much quieter. I try to see where I can facilitate change gently, without pushing or grinding my way through. It is far less stressful, and I feel more calm and peaceful about my life.
But let’s return to surgeons and what they truly need.
Writing a book for surgeons—grounded in my executive-level leadership experience—was an unexpected joy. My intention was simple:
Help surgeons hire, train, and retain exceptional Medical Office Assistants so their practices can flourish, and their patients can receive timely, compassionate care.
Back to the real question:
How do you find an MOA who can thrive in high-pressure, complex systems—someone who is committed to patient care, supports office efficiency, and also protects and balances the surgeon’s needs (not placing them below the patient, but aligning them with patient care)?
Well, at the heart of this is one crucial principle:
Healthy surgical culture begins with healthy practice boundaries.
Sound policy—established at the surgeon level—is what differentiates a chaotic office from a high-functioning one. Good policy is not restrictive; it is protective. It reduces crisis-mode decision-making, stabilizes workflow, lowers unnecessary urgency, and allows the surgeon to focus on what matters most: patient care.
With these changes applied—yes, I’m going to mention my husband here—Dr. Tim Riegel’s practice transformed. He shares more about his experience in the foreword to my book.
Formal procedures replaced chaos, disorder, and mistrust.
Calm, clarity, and confidence became the new norm.
His practice began to thrive—and so did he.
If you’d like deeper insights into creating a strong culture within your medical practice, along with policies, procedures, and templates you can begin using immediately, my resources for physicians and surgeons are available here.
Nancy Riegel is a three-time author, Harvard Healthcare Economics Online graduate, and Royal Roads University alumna. She is a Certified Executive Coach, Certified Life Coach, and certified in Korn Ferry Leadership Architect and Voices 360. Nancy is passionate about disease prevention, and supporting surgeons to prevent burnout—both personally and professionally.