Manage My Practice

You probably can’t.

But that doesn’t mean I haven’t been guilty of trying to in the past. I have typically had a policy in my personnel handbook saying staff can be terminated for discussing wages. But should you really follow through with that threat? Some managers probably have, but I wonder if it is just a convenient excuse to terminate an employee. I would not terminate an employee because s/he did something that is so, well, human.

Employees are going to talk and most will compare wages because they are anxious to know if they are being treated fairly or if someone else in a comparable job is making more per hour. Fair is a word I formerly hoped would be used to describe me as a manager, but the longer I work managing staff, the less I really believe there is a “fair.” There is no absolute fair in my mind because it is very difficult to treat two people exactly the same.  No two people have exactly the same training, experience and talents, or attitude, so trying to place an exact value on their services is difficult. Each of us believes we bring something special to the job, but how does one assess that quality?

The best that can be done, I believe, is to be ready to justify and defend why you are paying any staff member what you are paying them.  Be ready for that question, as it is sure to come.

Photo credit: © Elvinstar | Dreamstime.com

Sometimes employees do not understand or follow the most basic of workplace guidelines.  Here is a simple but comprehensive list that you can tweak to make your own.  It covers about 25 basics in a short list of ten “Golden Rules”.  Make it part of each job description or personnel handbook and/or post it in strategic places.

1. Report to work on time daily. Be ready at your desk to begin work at the designated time.  Leave promptly for lunch and return to work when you should, unless you’ve made special arrangements with your supervisor.  Take breaks on the honor system and do not abuse the privilege.  Clock in and out faithfully.
Command respect from the physicians, managers and employees of (your practice name here) by demonstrating total professionalism in the workplace with your dress, your demeanor and conversation. Represent the practice in a way that would make your Mother and your boss proud of you.  Treat your co-workers as you would like to be treated.
Be economical by not wasting time or supplies or doing sloppy work that must be re-done.
Give every patient your total attention, patience and courtesy. Do not assume you know what the patient is going to say, but listen carefully to the patient (in-person or on the phone) so you can assist them to the best of your ability.  Remember how good it feels to be the center of someone’s attention and give that gift to every single patient.
Keep your supervisor aware of any problems in your workload, whether too much or too little.  Do not expect your supervisor to know if you are falling behind or caught up.
Document all interactions with patients and other medical facilities to assist your co-workers in knowing what you have done, and document your resolution of the situation to the customer’s satisfaction.
Strive for a positive attitude every single day. Don’t whine.
Be a team player. This means both covering for your co-workers and knowing that they will cover you.  This means supporting your co-workers to their faces and behind their backs.  This means having (your practice name here) goals for your goals, and knowing that your success will be your team’s success, and ultimately, the success of the practice.
Clean up your own messes and act as an adult acts in the workplace: responsibly, maturely, and with thought for others.  Accept blame for your own mistakes, knowing that everyone makes them, and that if no one is making any mistakes, nothing is improving.
Contribute to making (your practice name here) a good place to work. Only you can create a place where everyone enjoys working.  Only you can make this place a good place to be.

Photo credit: © Barbara Helgason | Dreamstime.com

Why are staff meetings important?

They are important because face-to-face communication is important to people and bi-directional communication is important to people.  In other words, they want to see your face and they want to have a dialogue with you.  They want to hear what you’re thinking and they want to voice their opinions.

Teams that don’t have staff meetings where they can be face-to-face and dialogue usually get frustrated.  Conscientious staff care about the practice, and want to know what’s being done to fix problems.  Without regular communication, staff will make assumptions and speculate on things you probably don’t want them to speculate on.  Remember this: when you don’t inform employees, they will make something up.  Believe it.

Team Building During Staff Meetings

Staff meetings are also a great time to do team building.  Whether you give an update on universal precautions then split into teams to play Universal Precautions Jeopardy, or do a brainstorming session on what should be included in your new patient brochure, you are giving staff a voice, letting them be themselves, and helping them get to know employees they might not work beside on a daily basis.  You are a building a team.

I like to have two staff meetings a month, even if they are only 20 or 30 minutes long – I find the ideal length to be about 45 minutes long.  I have the meetings on a standing date (2nd and 4th Thursday of every month, for instance, and make sure everyone is perfectly clear when the meeting will take place.  The first meeting of the month is typically a department meeting, so that clinical staff and clerical staff can each meet to discuss issue specific to them.  In a larger office, you may have more than two departments that will need to meet.  The second meeting of the month is an all-staff meeting and at certain times of the year, the meeting may actually be a “meeting for eating” and this time can be used for a holiday breakfast or luncheon.  It is easy to cancel a meeting when there is nothing on the agenda, but it’s hard to get one scheduled on short notice without messing up everyone’s schedule.

The Oreo Cookie Method of Agenda-Setting

Prepare an agenda and invite everyone to add topics that they would like to have addressed.  Make sure you understand their items and can address them, as some staff will not want to be identified as being the ones who asked to have “the policy on making personal calls at work” reiterated.  Use the Oreo cookie method of setting an agenda – start with something pleasant (welcome new staff members, congratulate the staff on specific accomplishments),  then put in any very serious or uncomfortable topics next (raises are frozen, overtime is not allowed or mandatory overtime is in effect), then finish with something pleasant (the quarterly employee event is upcoming, we will sing Happy Birthday and have a cake after the meeting for Susie.)  Some staff do well with a roundtable to finish the meeting, others will not say a word when asked if they have anything to bring to the group – this is entirely dependent on what kind of office you have.  Every office has its own culture and that culture will show itself in staff meetings!

Here are some ideas for your staff meetings:

Annual Training:

• OSHA, Infection Control, HIPAA, Fire Safety, Disaster Communication
• Computer – Practice Management, EMR, Office, Outlook, Lab
• Diversity Training
• Benefits Enrollment & Ask the Expert
• Retirement Plan Enrollment & Ask the Expert
• Customer Service

Team Building:

• Brainstorming
• Who Am I? (find out interesting facts about each employee and have them ask each other questions to identify the person)
• Jeopardy, Pictionary, Family Feud about any office topic
• Breaking into cross-departments teams and choosing one problem to focus on solving over the next 3 or 6 months

In-services:

• Have your physicians give talks on illnesses or problems they address in their practice – most staff really like to learn more about the medical issues the patients face
• Invite physicians from other practices to speak with the office about their specialties
• Invite staff from practices you refer to, to speak about the tests or procedures they perform on your patients
• Stress Management
• Personal Safety
• Advance directives, living wills

Holidays:

• Decorate pumpkins, gourds, or papier mache eggs to look like the physicians and invite the patients to vote on the closest resemblance
• Give the staff a Halloween theme (scarecrows, witches, black cats) and award prizes (have the nearest office come over and judge) for decorating or costumes
• Invite someone from the community to come and talk about a holiday that no one on the staff celebrates
• Provide the goodies for valentines and have the staff send thanks and letters to hospitalized soldiers
• Sponsor a needy person or family  at the holidays and use staff meeting time to plan for purchase, wrapping and delivering gifts

Some specifics about staff meetings:

1. Announce the meeting date and time well in advance.  Place reminders on the doors that staff enter and exit the practice from, especially if the time is earlier than they usually arrive to work.
2. Post an agenda, or more informally, let staff know what some of the topics are that will be discussed.
3. Have everyone sign in, and place the sign-in sheets in a folder documenting that staff meeting were held.  This may be needed for annual evaluations, accreditation surveys, etc.)
4. Include enough time for Q & A, or roundtable.
5. If everyone seems stiff and uncomfortable, plan something fun early in the meeting, or bring something good to eat, or do something that relaxes everyone (put on marching music and have everyone march around the room to get some smiling going!)
6. Produce brief minutes from the meeting and include any new policies or guidelines that were introduced.  Place these minutes either in a binder centrally located or online so that anyone who missed the meeting can find out what happened.

Photo Credit: © Maigi | Dreamstime.com

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A reader recently posed the question “Should a medical office manager eat lunch with the staff?”  This question is more complex than one might originally think, and a lot of psychology actually plays into the answer.  Here are some guidelines to help managers find the right times to eat lunch with the staff.

A manager should follow the rules set for the staff.  If the rules say that lunch is to be eaten in the break room and not at desks, then the office manager should not hold her/himself above the rules and eat lunch at her/his desk because it is more convenient or relaxing.

The manager should appear in the lunchroom periodically to eat lunch as the staff likes to see the manager casually once in awhile and it’s a good chance to catch up with what everyone is talking about.  It’s not good to eat with the staff in the break room too often, as sometimes they can’t relax or be natural or enjoy their lunch if they feel you are there watching them or listening to their conversation.

As to eating lunch outside the practice with the staff, choose your occasions wisely. I think it is acceptable to take the staff to lunch one-on-one for their birthday or anniversary as long as you take EVERYONE throughout the year, but typically it would only be appropriate to go out with all the staff for a practice occasion.  You can take a team of managers or supervisors that report to you out for a lunch meeting or a special occasion.

If you go to lunch with one employee regularly, you can be sure the rest of the staff is thinking that your lunch buddy has special information that they don’t.  Employees will worry about your ability to keep information confidential if you seem to be more friendly with some employees than you are with others.  Some employees will even intimate that they have a closer relationship with you than they actually do.

If you’re tired of eating alone, connect with other practice managers in the area and use the time to compare notes on issues without divulging any proprietary practice information, or just to connect on a personal level.

Managers of smaller practices might not have these kinds of decisions to make as their staff lunch breaks are separated, or the culture is such that everyone always eats together.  I once worked with a practice many years ago where the staff cooked lunch most days for the physicians (2) and the staff (3) – it was both surprising and charming!

If you have any management questions you’d like me to answere, send an email with your question to marypatwhaley@gmail.com.  Your name will not appear in the article.

I don’t often find articles that reflect my own views as closely as the article “10 Ways to Keep Employees Happy” from HowStuffWorks by Cristen Conger does.  Not only does Ms. Conger hit the list with 10 strong concepts, but she also gives great sources to back up her points.  Here are her 10 points – click each one to go to the page for more information.

10. Offer Flexible Work Options Some jobs in medical practices are ideal for flexible work options, but most are not. Any position that requires face-time with the patient will likely need to adhere to appointment hours.  My question: is it “fair” to allow some positions to have flex-time and others not?  If you have a group of people all doing the same general job, letting some people have flex-time and others not may lead to a mutiny.  Consider carefully the precedent you are setting when allowing flex-time, and make sure employees understand that as the needs of the organization change, work arrangements may need to change.

9. Practice Open Communication I couldn’t agree with this one more.  Communicate, communicate, communicate.  One-on-one, in departments, in all-staff meetings, in all-organization meetings.  I typically send out an electronic newsletter every Friday (an idea from my mentor, Tom Girton) that announces/reminds people of events, clarifies policies and acknowledges achievements.  Oh, and don’t forget to make sure that people are understanding what you’re trying to communicate.  Touch base every once in awhile to make sure the message you’re sending is the one they’re receiving.

8. Pencil In Face Time When beginning a new job I often meet with every employee who reports to me (and sometimes meet with everyone in the organization in a smaller practice) for at least an hour to learn a bit about them and hear what they think the practice is doing well, and what the practice could be doing better.  Yes, it takes a lot of time, but it starts to form a bond with individuals and it gives me more information that anything else I could do to start to learn about my new group.  People are fascinating and I really enjoy an uninterrupted hour with someone – it’s almost a luxury in this day and age.  Once you’ve established that bond, make sure to nourish it by connecting with individuals on a regular basis.  Letting people know you truly care about them as individuals is how dynamite teams are created.  And the karma ain’t bad either.

7. Recognize Success and don’t save it all up!  Recognizing efforts, going the extra mile, dealing with a difficult patient, all deserve a pat on the back in front of other employees.  Remember to always praise in public and counsel in private.  Share the joy of something well done, and let the employee have the privacy of a critique.

6. Set Goals I like to establish individual goals every six months during the annual performance review and six months later during a less-formal touch base.  12 months is a long time to keep a goal in mind, so I prefer to deal with 6-month goals.  Performance evaluations should not be a rehash of what was done right and wrong over the year, but rather should be a time to review the goals from the last six months and see what wasn’t accomplished and why, as well as celebrating the goals that were accomplished. See my simple evaluation for more information.

5. Explain the Big Picture I’m often surprised how many medical practice employees don’t understand how their job (especially done well) contributes to the big picture.  Check-in staff might not understand how their job impacts billing.  Scheduling might not understand how their job impacts the nurses.  Nurses might not understand how their job impacts the check-out.  No one may understand what their efforts mean to the financial viability of the practice.  If all the staff know that they haven’t had raises for two years yet new medical equipment is being purchased for a new service line, they need to have some insight into why a decision was made and what potential it may have for keeping the practice viable.

4. Provide Career Growth Opportunities This fits in well with the 6-month performance evaluation when you set goals with your employees.  Goals may include projects, new skills, improved skills, shadowing other jobs, cross-training on other jobs, conferences and workshops, and online or classroom training.  Never think that someone can’t do something as predicting success is one of the hardest things in the world.  Encourage everyone!

3. Give Employees Respect Give everyone respect.  Know that every single person is much deeper than you will ever know and more fragile that you would ever expect.  Never forget that you can make someone’s day and break someone’s day.  Being a manager is making a choice to care for and respect the people who have chosen to work with you.  In many ways, management is the most powerless job (next to parenting) there is.

2. Provide Consistent Feedback For you to effectively provide feedback, positive or negative, the employee must have been trained, must have resources to help them do their job and must understand the expectations of the job.  Do not take for granted that your front desk person knows instinctively that your expectation is to have the day’s charges posted and reconciled before the end of the day.  Have written performance expectations for each person, then explore the reasons why those expectations are not being met (communication, misunderstanding, workload, etc.)

1. Build Trust I’m so glad Ms. Conger put this as #1 -I agree!  Here’s how I build trust: Keep confidences.  Follow the same rules I set for the staff (if they can’t eat at their desks, neither can I.)  Make promises sparingly and fulfill all promises.  Don’t mess up peoples’ payroll or their time off.  Understand the details of their job.  Don’t allow the doctors or the patients to abuse them.

What’s not on this list that you would add?

My personal list of new employee orientation best practices has been shaped by my experiences in private practices as well as hospitals. Every organization has different resources to draw upon, but each group has core goals that must be fulfilled by a good orientation:

• completion of paperwork including federal and state W-4s, I-9, direct deposit and benefit elections
• emergency contact information (included in hospital employee health intake)
• orientation to the organization, including designations, specialties, departments, sites, affiliates and an organizational chart
• completion of mandatory annual training such as safety, standard precautions, and HIPAA
• mechanics of name tags, parking tags, lockers, keys and codes
• signing off on understanding and agreement to confidentiality, compliance and personnel policies

In addition to these core goals, critical information to be shared during this time should minimally include:

• personnel policy review with emphasis on important (typically abused?) policies
• code of conduct/ shared basic competencies (mission and values, professionalism, communication, chain of command)
• computer security (passwords, internet policy, protection of PHI)
• workstation ergonomics and patient lifting policy (sadly lacking in many medical practices)

Important training that is rarely covered:

• Customer service (what is it and how do we measure our success or lack thereof?)
• Cultural sensitivity and diversity training
• Non-clinical employees’ role in medical emergencies
• Personal safety (coming in early or leaving late, patients threatening staff by phone or in person)
• Expectations for the first 90 days (training, communication, questions, problems)

Making Orientation Memorable

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Most of us have heard that interviewers make up their minds about applicants in the first minutes, or even seconds of an interview.  But what about once the applicant has been hired, or even once an employee has been with us for several years?  Do we base our beliefs on an employee’s ability to take on a new challenge or improve their performance on something real, or things we believe to be real?

New research shows that managers with a fixed view of people’s attributes tend to “ignore improvements or deterioration in the performance of their staff, and are also less likely to ensure they receive the training they need.”  The research findings, reported on the British Psychological Society Research Digest Blog, are as follows:

One study, for example, gave managers negative background information about a fictional employee before they were shown that same person performing well at a negotiation task. Managers with a fixed view of personal attributes (they tended to agree with statements like “As much as I hate to admit it, you can’t teach an old dog new tricks. People can’t change their deepest attributes”) subsequently rated the employee less positively than managers with a belief that people can change.

Another study found that managers who think people’s attributes are fixed gave their staff less coaching, presumably because they think such interventions will be ineffective.

The good news is that once managers become aware of these findings, they can change their minds about employees being able to change and improve!  Read the article here.

New employees must complete the new I-9 form (Employment Eligibility Verification) beginning Friday, April 3, 2009.   Here is the link for the new form: New I-9 Form

Managers, you do not need to to use the new form for employees whose hire date is prior to April 3.

What is the purpose of the I-9?  The form states that it “is to document that each new employee (both citizen and non-citizen) hired after November 6, 1986, is authorized to work in the United States.”

Reading the instructions, I was surprised to learn (more…)