Christopher Zaenger, CHBCAdditional contributions to the article made by members of the National Society of Certified Healthcare Business Consultants: Judy Aburmishan, CPA, CHBC (Illinois), Mike DeVries, CFP, CHBC, EA (Michigan), Gail Levy (Maryland), Marc Lion, CPA, CFP (New York), Kathy Moghadas, RN, CLRM, CHBC (Florida), Steven Pelz, CHBC (New York), Debra Phairas, MBA (California), Tessie Quattlebaum, CHBC, FACHE (Georgia), and Christopher Zaenger, CHBC (editor-Illinois).
The average payroll cost so far this year for Major League Baseball is 45% of the combined team revenue. The range is from as little as 13% for the Houston Astros to as high as 88% for the Los Angeles Dodgers. This is a service business. According to the National Society of Certified Healthcare Business Consultants, roughly half of a practice’s operating costs are spent on staff. Player-personnel focus is major league.
Physicians are highly trained and skilled individuals. Yet, when I asked the head of a pediatric group how his staff was performing, seconds passed in silence, broken by his not uncommon whisper: “I do not know, but it’s a mess.”
Physicians are often ill-prepared, and sometimes reticent, to hire, train, manage, or fire staff. So how do you best manage your most costly and most required asset? More importantly, how do you take the underperformers and turn them into superstars?
It may surprise you to know, and delight you at the same time, that studies done in the last 15 years indicate that money is not even in the top 50 things that employees care about at work. Employees need to know how what they do adds value to the business and helps both the patient and the physician succeed. They also want to succeed and need to know how to do it.
Managing and improving staff performance is a learned skill. Below is a list of ways to create an environment that motivates your staff.
Know what you need
Make sure you provide written personnel policies and procedures, position list and job descriptions, clean furnishings, working phones and other systems, and flow and function so your staff can do their jobs.
Know how to hire
Michael Douglas said it in the movie, “The American President:” it’s all about character. Hiring skills alone does little if the person cannot get along with others or cannot prioritize tasks due to poor judgment.
Behavioral interviewing is key. So although asking “what did you like most about your last job” may be a good question to warm up a candidate, a better question is “do you remember a situation where you solved a problem at work? Describe what happened. Was your input recognized? How did you feel? What was the outcome?”
Many times future behavior is predicted by past behavior. Asking questions that get at actual experiences and highlight how the person acted in actual situations is significantly more telling.
Train for results
So many practices fail to train. They simply show new hires to the desk and put them to work, thinking that their previous experience will get them through. Rarely do I see two practices that operate exactly the same, say the same things to patients, have the same phone system, computer software, or forms, and the same locations for storage.
Good orientation and training requires hand-on experience with a skilled staffer showing the way and coaching the new hire. In addition, the new employee will need time to do and learn the task well before adding another task with high expectations.
Create performance expectations
Such items as dress code, work schedule adherence, and Health Insurance Portability and Accountability Act (HIPAA) compliance are requirements of the job where failure to adhere results in termination.
Other factors demonstrate superior performance. It is also important to demonstrate expected results while the work is being done each day, to address issues as they surface, and to reinforce the positive outcomes. Ongoing specific feedback is critical to success.
Conduct purposeful reviews
Have you ever chastised a medical assistant because she did not do the vitals, enter the chief complaint, or ask that diabetic patient to take her shoes off? That’s a “contemporaneous” review. Address problems as they occur with the goal of helping the employee succeed, not as a complaint.
Regular annual reviews (we like them based on hire anniversary date to spread the love and avoid comparison shopping) are not motivators. Employees expect a raise. So consider separating the performance review from the wage review.
Performance reviews are best conducted with previous targets having been established, employees giving their own impressions of their performance, notations taken, and the employee knowing how they are performing before they enter the session. Reviews should conclude with new being targets set.
Once a policy is established or a procedure created, do not alter it daily or for special circumstances. We cannot tell you how many times two physicians each instruct staff to perform a task differently and then change their minds repeatedly. The result is that employees are confused and embarrassed to ask, and the physicians are at odds with each other. So, they do what they think is best and neither physician is satisfied.
Praise publicly, give private feedback
The physician screaming at a staffer in the hallway for all to hear and in front of patients does little to solve a problem and less to build the image of the practice or respect of the physician.
Pull the employee aside and let them know you care about their success. Then tell them what you expect and why it matters.
Saying, “you need to take vitals correctly and enter them in the chart” has less impact than saying, “a misread blood pressure can cause me to inaccurately alter her medication and put her in the hospital” or “if each medical assistant failed to enter the vitals for us we would lose 2 hours per day of time and fall behind with patients, and some patients may not get in today who need to be seen. So please help me keep our patients happy and healthy.”
When it came time to give my executive assistant a review, she requested additional days off in lieu of a salary increase. What a concept!
You will note as you develop an understanding of your staff that employees are motivated by different things. What works well for one may fall flat for another. Do you have one employee that when she takes the desk it seems more cash is collected that day? Give him or her a $50 Visa gift card in front of other employees (and tell them why). They just got reviewed, and praised and motivating reinforcement in less than 2 minutes--and other staff members just got educated.
Here are 10 incentives that can work for your practice:
1. Gas and restaurant gift cards
2. Fresh flowers
3. Share your incentive dollars with everyone – it is a team effort after all and you may find targets will be easier to hit.
4. New computers (larger monitors) or better task chairs
5. Scheduled in-house and professional training
6. Certification support in time and reimbursement
7. Flex hours or work from home
8. Clinical in-service for non-clinical staff
9. Time off
10. Saying, “thank you”
When all else fails, fire
Consultants agree: Hanging on to a sub-par employee is demotivating to the other employees and pulls down team performance.
The practice owners set the tone, create or resolve confusion, mold staff behavior, and foster a spirit of fairness and mutual respect, all to build an efficient, vibrant motivated, creative and pleasant work environment from which the physicians, staff and patients enjoy and benefit.
The author is a medical practice management consultant in Barrington, Illinois, and a Medical Economics editorial consultant. Send your practice management questions to [email protected].
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