Manage My Practice

Sometimes a job just gets a little old, and even the best employees need a little something to get them re-engaged and excited again.  Try one of the ideas below at your practice and let me know in the comments the ways you keep your staff energized and engaged!

1.  Provide a career track and offer multiple levels of learning jobs. For instance, break the receptionist job into steps (see below) and set time lines for attaining those goals.  You may want several steps to be accomplished at 90-days, more at 6-months, and more at 12-months.  There may be monetary awards, honor awards, or qualifications for other acknowledgements.

• Pre-registering patients by phone – demographics
• Making appointments & mini-register for new patients
• Registering patients face-to-face – demographics
• Understanding insurance plans and registering their insurance
• Taking photo ID or taking photos and explaining the Red Flags Rule
• Collecting co-pays
• Answering basic patient questions
• Answering advanced patient questions
• Reviewing the financial policy with patients
• Reviewing the Privacy Policy with patients.

2.  Offer certifications and credentials – support staff emotionally, time-wise and financially so they can attend face-to-face or online courses.

3.   Offer specific responsibilities and the title of lead person for that responsibility – don’t assume you know what staff are or are not capable of – they might surprise you!

4.  Meet every 6 months or every quarter to set goals.  A job can be a drag if there’s nothing new to learn or to accomplish.

5.  Set up process improvement teams to work on problems that everyone complains about – give them the responsibility to come up with solutions and try them out.

6.  Involve them in social media marketing of the practice.  Make sure they understand your social media plan ( you do have a plan, don’t you?),  give them guidelines to work within and let them work on your website, your blog, and your Facebook page.

7.  Install a wiki (many are free) and have them work on loading all the practice knowledge into the wiki.  Have different staff responsible for different parts of the wiki and set goals for adding all the information that runs your practice every day.

8. “Walk a Mile in My Shoes” – this is also great for getting the clinical and administrative staff to understand each other better.  Have the staff shadow each other and take turns seeing parts of the practice they don’t know much about.  I recently participated in this at my hospital and shadowed a nurse (and asked a million questions) for about an hour.  It was wonderful!  I felt better equipped to work with my hospitalist service after having been on a patient floor for just a short time.

9.  If you are a practice that receives referrals from others, have staff responsible for regularly touching base with staff from referring practices and asking how service can be improved.  Teach staff about relationship building and remember that it’s the staff that often choose where the patient is referred to instead of the provider.

10.  Have staff take turns going with you to meetings, seminars and local events where you represent the practice and introduce them to everyone.

11.  Forward listserv discussions to employees and have them monitor the discussions and bring things to you that they want to know more about.

12.  Encourage employees to become the practice expert in a payer, an employer, a referrer, a process or a protocol and help them learn about their topic by sending them information from the web or your professional organizations.

13. Have the staff put together an internal or external newsletter and help them with concepts of internal and external marketing.

Robert Sutton is one of my favorite thinkers.  Anyone who would write a book entitled The No Asshole Rule: Building a Civilized Workplace and Surviving One That Isn’t is okay with me.  Bob is Professor of Management Science and Engineering at Stanford University and he writes honestly about management on his blog “Work Matters.”  Here are his 12 Things Good Bosses Believe and my comments.

1.  I have a flawed and incomplete understanding of what it feels like to work for me (Robert Sutton discusses #1 in more detail here.)

Yep.  Give an anonymous satisfaction survey to your employees if you think you know what they are thinking.  As managers, we create our own little world based on what we think employees need and want and what we are doing in response to our perceptions of them.  It’s a beautiful world we create.  It can be a rude wake-up call when we find we don’t really understand what our employees think about us, our decisions or our management style.

2.  My success — and that of my people — depends largely on being the master of obvious and mundane things, not on magical, obscure, or breakthrough ideas or methods.

My mentor taught me “Take care of people’s paychecks and their vacation time – get it perfectly right or fix it quickly, and you’ll be fine.” Anyone who has ever done payroll or staff scheduling can tell you that these “mundane” tasks are two of the most complex and frustrating,  yet critical jobs in management.

3.  Having ambitious and well-defined goals is important, but it is useless to think about them much. My job is to focus on the small wins that enable my people to make a little progress every day.

Your staff want to know that the group is moving forward, but ultimately they don’t relate the big projects to their day-to-day job.  What they want (just as you and I do) is to have the small irritations, the glitches, and the bugs to be fixed.  They want to be able to stop wasting their time doing workarounds because the manager won’t take the time to fix something.

4.  One of the most important, and most difficult, parts of my job is to strike the delicate balance between being too assertive and not assertive enough.

One of my Mary Pat-isms is to say that the only time I tell people exactly what to do without getting their input is when the building is on fire.  This is a bit of an exaggeration, but I do think employees get tired of me asking “What do you think?” when all they want is for me to tell them what to do.  If I tell them what to do though, how do I know that their input might not produce a better answer? I also want them to think about solving the problem themselves or getting input from others.

5.  My job is to serve as a human shield, to protect my people from external intrusions, distractions, and idiocy of every stripe — and to avoid imposing my own idiocy on them as well.

I interpret this as my effort to make it safe in the organization to make mistakes and to be human. The tricky part is walking the line between making it so safe that people feel that mistakes don’t matter, and making it safe enough to stand the pressure of healthcare every single day. I tell the staff that my job is to free them to do their job.

6.  I strive to be confident enough to convince people that I am in charge, but humble enough to realize that I am often going to be wrong.

An employee once told me that she really likes a boss who says “I don’t know the answer, so let’s see if we can find the answer together.”

7.  I aim to fight as if I am right, and listen as if I am wrong — and to teach my people to do the same thing.

I would amend #7 to say that I tend to rely on my experience to guide my decisions,  but I often want to hear what others’ thoughts are to make sure the best solution is achieved.

8.  One of the best tests of my leadership — and my organization — is “what happens after people make a mistake?”

See #5.

9.  Innovation is crucial to every team and organization. So my job is to encourage my people to generate and test all kinds of new ideas. But it is also my job to help them kill off all the bad ideas we generate, and most of the good ideas, too.

Innovation is crucial in delivering healthcare.  One of my favorite techniques is to see how problems are solved in other fields and try to apply them to healthcare.  Teaching others to seek inspiration and to be comfortable with test-driving solutions is critical to giving a practice the competitive edge.

10.  Bad is stronger than good. It is more important to eliminate the negative than to accentuate the positive.

I agree.  I hate it, but it’s true.

11.  How I do things is as important as what I do.

Or maybe more important.  How I speak to staff, how I speak to patients, how I demonstrate compassion, how I deal with frustration, how I relate to someone who is going through something tragic, how I talk about my boss, how I ________ (fill in your answer here.)

12.  Because I wield power over others, I am at great risk of acting like an insensitive jerk — and not realizing it.

Being a manager carries with it an almost bone-crushing responsibility for doing the right thing for the organization AND the right thing for the employee.  Trying to achieve a win/win in as many situations as possible is a noble calling, but one that can wear you down to a nub, which is when most of us may be accused of acting like insensitive jerks.  Acknowledging this state (apologizing is good) and taking a time out is the right thing to do.

If you describe what you want in a boss, and you’re not describing you…think about it.

Front Desk/Check-In

• Greets patients and visitors to the practice
• Registers patients in the practice management system which may mean entering information given verbally or on registration forms
• Collects identification and insurance cards and copies or scans them for the record, may photograph the patient for the record
• May collect co-pays or other monies
• Prints encounter form (also called superbill, routing slip, or fee ticket) with updated information, or updates information on the encounter form
• Has patient sign financial agreement, receipt of privacy policy, benefits assignment, etc.
• May answer phone calls, take messages and make appointments
• Directs visitor (drug reps, salespersons, etc.) appropriately

Medical Records

• Primary responsibility for the integrity and management of the medical record, whether paper or electronic
• Controls record filing (paper) or indexing (electronic)
• Fulfills requests by patients, attorneys, insurance companies, and social security for release of records
• May manage paper faxes and messages by attaching to charts and delivering to provider
• May prepare paper charts for chart audits by payers or others
• May be the HIPAA Officer

Medical Assistant, LPN or RN

• May assist Physician, Nurse Practitioner or Physician Assistant with procedures
• Depending on state laws, may give injections
• May perform procedures independently (ear wax removal, staple removal, etc.)
• Provides Medicare patients with an Advance Beneficiary Notice if any lab test or procedure to be performed in the office will not be covered by Medicare
• May perform phlebotomy (draw blood)
• May collect specimens, perform basic laboratory tests and chart results
• Provides patient education verbally and by providing written materials
• May schedule tests or procedures ordered by the provider
• May schedule surgery and prepare surgery packets for providers (*this may be delegated to a surgery scheduler if this position exists)
• Calls patients about test or procedure results; returns patients calls with answers after consulting with provider
• Prepares exam room for procedures (PAP smears, excisions, etc.), marks specimens for lab and pathology
• Cleans exam room after each patient and stocks exam and procedure rooms with supplies
• May be responsible for ordering office medications and medical supplies
• May perform lab controls daily and check and record temperatures on lab refrigerators and freezers

Triage Nurse

• Takes incoming calls from patients and gives them medical advice according to predetermined nursing protocols
• Makes decisions about patients needing to be seen urgently, same day or next day
• May be delegated callbacks from providers or other nurses
• May see walk-in patients and triage their condition

Lead Nurse, Charge Nurse, or Nurse Supervisor

• Assigns clinical staff specific responsibilities
• Manages clinical staff schedules, using agency or temporary staff as needed
• Performs annual competency exams on staff
• Ensures all staff are current on licenses, continuing education and CPR
• Problem-solves patient issues
• May be responsible for ordering office medications and medical supplies
• Has responsibility for medication sample closet upkeep
• May perform annual evaluations fro clinical staff
• Responsible for equipment maintenance and makes recommendations for medical equipment as needed
• May be the Patient Safety Officer and the Worker’s Compensation Coordinator

Referral Clerk

• Reviews orders written by providers and determines where test and procedures may be performed based on patient’s insurance
• May provide the patient with information about the test or procedure cost and what the patient’s financial responsibility is estimated to be
• Pre-authorizes, pre-certifies, or pre-notifies the test or procedure if required by the patient’s insurance company
• Schedules the test or procedure
• Provides the patient with information about preparation for the test or procedure

Lab Technologist/ Phlebotomist

• Receives laboratory requisitions from provider and collects specimens according to provider order
• Provides Medicare patients with an Advance Beneficiary Notice if any lab test or procedure to be performed in the office will not be covered by Medicare
• Performs tests or packages specimens to be transported to reference lab
• Receives results back from the labs and matches them to charts
• Performs lab controls daily and checks and records temperatures on lab refrigerators and freezers

Check-out Desk

• Reviews services received by patients, checking to make sure that all services received were checked on the encounter form
• Enters charges in the computer system for services received
• Tells patient if any additional monies are owed if co-pay was collected at check-in
• May sign patient on to a payment plan if needed
• Takes monies owed, posts monies and produces a receipt for the patient
• Makes return appointment for the patient if needed, or enters recall into the practice management system

Biller or Collector

• Corrects claims that are rejected from the claims scrubber, clearinghouse or payer
• Files secondary and tertiary claims as needed, electronically or via paper
• Posts receipts from insurance companies and patients and edits any electronic remittance advice; may post from lockbox account on the web
• May prepare deposits and/or make deposits
• Generates patient statements
• May check eligibility on patients with appointments and call patients whose insurance is not active (*may be delegated to a financial counselor if this position exists)
• Calls patients who have not made payments in response to statements
• May turn patients over to third-party collectors
• Takes phone calls from payers or patients about billing issues and resolves issues

Coder

• Reviews notes from inpatient or outpatient encounters and codes them according to the documentation
• May post charges for services rendered
• Audits chart documentation for quality purposes to ensure that provider coding and documentation is synchronous
• Introduces changes in procedure (HCPCS) and diagnosis (ICD-9) codes and educates staff on the use of new codes
• Ensures encounter forms and practice management software is updated appropriately with new and deleted codes
• May be delegated the Compliance Officer

Billing Supervisor

• Reviews the work of coders, billers and collectors and performs quality audits to benchmark acceptable error rates
• Prepares or reviews deposits and tracks daily charge, collection, write-off and deposit information, watching for monthly abberations by payer or date
• Reviews Accounts Receivable (A/R) reports, looking for trending or specific problems to be addressed with staff or payers
• Brings to the attention of the Office Manager or Administrator any issues with non-standard payment trends, denials or non-covered services.
• Performs evaluations for billing department staff
• Takes escalated patient complaints
• May credential providers with new payers or recredential providers with payers or hospitals

Office Manager, Practice Administrator, or Practice Manager (see the Library tab for job descriptions) see my posts on what an administrator does here, and a day in the life of an administrator here

• Performs all human resource functions for the practice
• Has ultimate responsibility for all money flowing in and out of the practice – makes deposits, pays bills, etc.
• Contact person for all computer system, equipment and phone system issues
• Responsible for day-to-day operations, advises supervisors on issues and problems
• Resolves escalated patient complaints
• Meets with vendors and researches possible practice purchases
• Negotiates all practice contracts
• Meets with staff and providers on a regular basis

These descriptions will not perfectly fit most practices, this is just a generalization.  Each practice divides duties based on the number and skills of the staff in their office, and their specialty.  These descriptions should help to define what the basic tasks are in most practices.

When Matthew Browning first described YNIO (Your Nurse Is On), I was really surprised to learn what his product was.  I don’t know what I expected, but it wasn’t the elegant solution to staffing he described.

Here’s the description from the YNIO website:

Your Nurse Is On^TM was developed in 2000 by a trained Family Nurse Practitioner in response to the inefficient relief staffing procedures found in healthcare today. With today’s challenging environment of cost savings and instant communications it became apparent that calling replacement staff one at a time was no longer an adequate solution.

With the improvements in internet telephony that occurred around 2005, we created a system that allows you to call any available nurse to fill your vacant shift. You now have the power to contact many nurses, in any order you choose, on whatever device they prefer. Since the nurses on our system make their availability known in advance, you will never disturb another unavailable nurse or waste your time calling them.

I could really relate to this solution! Who among us hasn’t spent hours on the phone filling staff slots, getting coverage for unexpected medical leaves, and trying to piece together coverage for routine vacations?

YNIO distills the product down to four easy steps:

1. Scheduler creates a request for staff.
2. YNIO contacts all available staff – instantly.
3. Staff receives the request and accepts or rejects the shift.
4. Scheduler is immediately notified.

And what are the proposed benefits to a facility using YNIO?

• Save time – system can call dozens of nurses simultaneously
• Save money – no more dollars wasted calling nurses who are unavailable
• Fill shift vacancies – expanded pool of available nurses
• Increased employee morale – decreased shift vacancies can decrease shift call outs, injuries and burnout
• Increased efficiency – leverage technology to save money, save time, quickly fill shift vacancies and save paperwork with our paperless billing and performance tracking systems.

This sounds like a needed solution for practices, nursing homes, hospitals, and home health agencies.  I am also fascinated by the creative process of innovation and delivery to the market and asked Matt a few questions about the development of his product.

MARY PAT: Matt, what does it take (emotionally, financially and otherwise) to conceive an idea and bring it to the market?

MATT: I believe it begins with a personality that is inclined to analyze situations and procedures with an eye toward improvement. “How can we make this, or do this, better than we are today?” As this behavior becomes internalized and part of our daily routine, we begin to generate ideas, “maybe this could work” type of thoughts that can result in some solid ideas, proposals and hypotheses. This stage of innovative thought is rather common and many people have an idea that could “change the world,” however an idea at this stage is often lacking a “vision” of how it can interact with our current realities, change existing processes, improve outcomes, save time and reduce expenses. The basic business infrastructure, legal processes, finances and team that are very important considerations to bring an idea from conception to market are often not understood, at this point of the innovation cycle, by the inventor and are definite challenges. These challenges may be the reason that many potential innovations are never brought to market.

So, besides an idea, and a ‘vision’ of how it fits into the world, flexibility, determination and persistence may be the most required traits for the innovator. The key to this game is teamwork, assemble the highest quality team you can, rely on experts for knowledge outside of your personal domain and remember that the objective is bringing the product or process to the world to make it a better, safer, more enjoyable place for as many people as possible. Success is often a direct result of service to others and bringing your innovation to the world can be a great service.

On the emotional and financial fronts, expect the endeavor to take twice as long as you expect and to cost twice as much as you expect. Having an awesome team and a supportive social network are invaluable to the eventual success. I am fortunate to have a very supportive family that believes in me and our innovation and they have been very tolerant of the extraordinary amount of hours and obligations that are part and parcel of this innovator’s life. To summarize, I believe a good idea can become a vision that with a very dedicated individual can become a team working toward the release of an innovation commercially. Hard work, perseverance, flexibility, ability to learn and the ability to delegate are all requisite as well.

MARY PAT: What’s been your lowest moment to date in bringing your product to market and what has been your highest?

MATT: My personal and corporate nadir occurred, ironically, during one of the best events of my life, the birth of my son, Arthur. Our product, YourNurseIsOn.com, was struggling through the “proof of concept” phase, after nearly a year in development and design, when my wife had an unexpected, emergent delivery of our son. We were traveling in Florida on a doctor-approved combination business and family trip, when our son decided he was coming into the world, nine weeks early. Aside from a very difficult and dangerous birth experience, we were over 1500 miles from our home in New Haven, CT. Our company was being run from my laptop and mobile phone and I was juggling a fully packed calendar of business obligations all while running from ICU to NICU, for 5 weeks. It was two months before I was able to safely return my family to our home in New Haven. In addition the amazing amounts of time needed for both my wife, Phoebe, and my son, I still needed to meet with potential customers, conduct regular tech meetings, solicit further investment and continue to work on intellectual property issues, technological challenges and personnel needs.

We had invested our life’s savings to get to this point and now, with this amazing, yet traumatic family event, we began to question many of the decisions that had brought us to this place and time. Out of time, out of money and out of my home, it was easy to think how much ‘better’ it would be if I ‘just’ worked as a Family Nurse Practitioner as I was trained to do and could bring home a regular ol’ paycheck for ‘only’ 40 hours. Those questions never last for long, the ‘vision,’ never sleeps, it never relents and it can become all-encompassing and turn us into 4am to 11 pm machines but, occasionally, even entrepreneurs are human

Conversely, our highest point to date has been our attendence at HIMSS 2010 this March. We were selected to present at the Healthcare IT Venture Fair and after an exciting presentation we were no longer unknowns to the major players in the healthcare arena. When big names like Intel, Blue Cross, GE, McKesson, Blank Rome and the United States of America take note of your product and want to engage in investment, customer and business development discussions, you begin to realize that the power of the innovation is becoming recognized. The time since HIMSS10 has been a constant blur of inquiries, customer demos, partner requests, commercialization deals, amazing pilot discussions, customer implementations and, of course, investors.

MARY PAT: Is this a product that can be affordably scaled for any customer, or do you anticipate the ROI being on target for a specific type/size of customer?

MATT: Our product, YourNurseIsOn.com, is a Software as a Service (SaaS) product that helps allocate the right healthcare staff, where they are needed, when they are needed there, by instant, 2-way text, phone and/or email communications. We are a Software as a Service (SaaS) platform that allows for quick and easy adoption, keeps customer costs low and removes their maintenance responsibilities.

We offer a number of value propositions for the customers including faster speed of fulfillment, decreased nurse vacancy, reduced overtime spending, increased patient-provider contact hours, improved patient outcomes, license management, call order adherence, expanded communications capabilities and amazing compliance reporting performance. Flexible scheduling, with all the extra communications needed, has become a best practice for healthcare workforce recruitment and retention. YourNurseIsOn.com makes these communications effortless. For organizations that rely on communicating with a distributed workforce, to operate around the clock, our solution is quickly becoming indispensable.

The ROI metrics are being compiled presently and should prove to be favorable for any size organization. We expect the return on investment period to be very brief as we can provide over 8 hours of phone calling in under 30 minutes and provide the 2-way text and email channels for improved efficiencies. Our soon to be announced pilot with a nationally recognized health provider network will soundly demonstrate our scalability for any sized facility, organization or governmental body.

MARY PAT: Where do you want YNIO to be in 5 years?

MATT: YourNurseIsOn.com is focused on excellent customer experience, and service, for every single client that engages our services, and we will continue with that focus relentlessly as we continue to grow and scale our platform. YourNurseIsOn.com is well poised to become the de-facto communications method for healthcare organizations that need to contact and confirm their specialized, distributed workforces on demand. The ability to easily reach specific individuals, that are qualified and available for a specific function, in a quick and easy manner on any device of their choosing will only become more important given the coming increases in healthcare demand and simultaneous scarcity of all healthcare providers. YourNurseIson.com has the ability to efficiently deliver caregivers where they are needed, not only in institutional settings, but in the communities where the majority of care is being delivered. YNIO, with its international patent -pending status will be the communications ‘glue’ that holds it all together.

MARY PAT: Many people are predicting that NPs and other mid-level providers will be the future of primary care if physician shortages play out as expected.  What do you think?

MATT: Personally, as a nurse practitioner, I feel that this is all too often the focus of discussions about the future of healthcare and is, just as often the beginning of contentious debate that ends in a turf war between doctors and other providers. I do not believe that either of us are the future of healthcare. I believe that we cannot possibly train sufficient numbers of providers to care for the onslaught of demand that is quickly approaching. The future of primary care will lie in the hands of the individual, their families and their communities. This will be supported by tele-medicine, bio-sensors and smart homes to begin and eventually lead to caregiver robots and software algorithms diagnosing and treating your ailments:

• A wristwatch, scale and shoes that track your fitness regimen, downloaded nightly into your Personal Health Record and gently recommending tomorrow’s diet or workout schedule.
• Personal reminder software to gently prod you to take your medicine, engage in physical activity or to remember a wellness event or medical appointment.
• Accentuated reality software to help make informed dietary, activity or purchase selections based on wellness scales, provider recommendations or personal preferences.
• The ability to export this information to your Electronic Health Record to share with your providers, specialists or family
• A smart home with a bed that signals that Grandma woke up later than usual after a restless night, a chemical sensor toilet that signals she may be a bit dehydrated, a pill bottle that alerts when she hasn’t opened it- these types of events triggering personal reminders, check-in requests to a neighbor, visit requests to family, or send an alert to her community caregivers, etc. If no one is able to check on her status, emergency services could be automatically notified.

Couple these technologies with instant, 2-way, verifiable communications systems, and these networks will provide the bulk of care in the near future. There simply are not enough resources to provide care any other way. I hope to see NPs continue to expand their roles, earn autonomy and continue to provide excellent care to millions of people. NPs, MDs, therapists, etc. are all going to be in short supply and high demand. All of these professionals are important to the healthcare delivery team and will have to be allocated with, supported by and communicated to with advanced technologies to expand their practice reach, improve their collective effectiveness, begin to decrease costs, and continually improve outcomes.

******

It was a real pleasure talking with Matt and getting to know more about YNIO and more about him (the geek in me enjoyed the geek in him!)  I truly appreciate how open he was in the interview. Thanks, Matt!

The YNIO (Your Nurse Is On) website is here. Matt recently guest posted on HealthcareIT Today which can be found here. You can connect with Matt here:

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1. How would you describe a work environment that fits your personality best?
2. What are the signs that an employer is good to work for?
3. What do you consider your pet peeves in the workplace?
4. How do you learn best? Seeing? Doing? Hearing? Taking Notes? One-on-one? In groups?
5. Do you have a computer at home? What do you use it for?
6. What computer programs have you used most?
7. What might make you angry at work?
8. Do you prefer to have a window visible from your workstation?
9. What’s the best vacation you ever took in your life?
10. What’s the worst vacation you ever took in your life?
11. What do you know about our practice?
12. What do you think the responsibilities of this job are?
13. What do you think compassion is?
14. How do you have compassion for a patient who is yelling at you?
15. Have you ever been asked to do something at work that made you uncomfortable? What was it and how did you handle it?
16. What’s the best present you ever received?
17. What’s the worst present you ever received?
18. What was the very first job you had as a young person where you got paid?
19. Is it difficult for you to see people in pain?
20. If you were asked to bring a home-cooked dish to a work gathering, what would you make?
21. How would you describe appreciation in the workplace?
22. What are some ways you like to be appreciated?
23. Give me an example of a project that you made a significant contribution to (at work or any other environment.)
24. Tell me something about yourself that would surprise me.
25. What was your favorite task at your (present or last) job?
26. What was your least favorite task at your (present or last) job?
27. What skill that you learned at another job do you think you could use in this job?
28. What interests you about this practice?
29. How do you define compassion?
30. If you consider yourself a compassionate person, describe how you display it.
31. Do you enjoy movies? What kind?
32. Do you enjoy books? What kind do you like?
33. What is your best mechanism for relieving stress?
34. Have you ever collected money from people as a part of a job?
35. What do you wish you could learn to do if you had the chance?
36. What do you think your current/last boss would say about your job performance?
37. What’s your favorite outdoor activity?
38. Describe a failure that taught you something.
39. What is your response to someone who is verbally threatening you?
40. Who (outside of a family member) has taught you the most?
41. Have there been tasks at previous jobs that you enjoyed that others didn’t? What were they?
42. What’s the best team you’ve been on and why?
43. What would you do about a close co-worker who isn’t pulling her weight and is making you work harder?
44. Based on your work experiences, what is one thing most employers could do better?
45. What do you hope to gain from this job?
46. What in your life are you passionate about?
47. What is offensive to you in the workplace?
48. What do you think “being to work on time” means?
49. Tell me about a special pet you’ve had or have now.
50. Why do you/do you want to work in healthcare?
51. What have you heard about us as a company?
52. Name 5 things you could do with a cantaloupe besides eat it.
53. What is the best employment benefit you’ve ever received at a job?
54. What’s the hardest thing you’ve ever been asked to do at work?
55. What makes you laugh?
56. What accomplishment are you proudest of?
57. What do you think the expression “rolling with the punches” means?
58. Describe a situation (work or non-work) when you were the team leader.
59. What would you do in a situation where a problem occurs over and over again without anyone taking steps to fix it?
60. Describe your current boss/last boss using three words.
61. What do you think it means to give someone “the benefits of the doubt”?
62. What is the best conference or seminar you’ve ever attended, either for work or outside of work?
63. How would you handle a co-worker who uses language that you feel is inappropriate in the workplace?
64. Do you consider yourself a detail person? If so, give an example of your attention to detail.
65. What motivates you to go the extra mile in the workplace?
66. When was the last time that you felt you really made a difference at your job? Please describe.
67. What’s your favorite sports team?
68. What do you think the expression “It is what it is” means?
69. What kind of music do you like?
70. Do you play any musical instruments?
71. What would you do if your boss had really horrible bad breath?
72. How do you define professionalism?
73. Do you think you are good with money? if so, why?
74. How do you know when it’s time to schedule a mental health day?
75. If you were asked to choose between writing a report by yourself, giving a report at a staff meeting or being part of a team writing a report, which would you prefer to do?
76. What’s your favorite soft drink and why?
77. If you were in charge of collecting money for an office function and one person never paid up, how would resolve this?
78. Do you consider yourself good with technology?
79. Describe the last time you had to ask your supervisor for help.
80. What do you think irritates others about you?
81. Do you have any problems remembering to clock in and out daily?
82. Do you any trips or time off already scheduled going forward?
83. What’s the favorite city or house you’ve ever lived in?
84. Would you be available to work overtime if needed?
85. What type of co-worker is the hardest for you to deal with?
86. What do think are the signs of a well-run office?
87. Have you ever made a suggestion at work that you thought was “out of the box”?
88. Are you a good speller?
89. What is the dress code at your current/former employer?  What do or don’t you like about it?
90. What do you think “casual day or dress down day” means?
91. What questions do you have for me?

Questions for Supervisors:

1. What do you find hardest about supervising people?
2. Give me an example of a situation where you made an exception to an office policy and why.
3. What is the best way to handle a face-to-face patient complaint?
4. What do you think should be the first priority for the person in this position?
5. How do you stop people from gossiping in the office?
6. What is your personal philosophy on customer service?
7. What do you do when you find your stress level increasing?
8. What’s your favorite trick for staying organized?
9. Is there ever any situation when you think it is appropriate to share something an employee said to you in confidence?
10. What’s your favorite technique for achieving a win/win outcome to a problem?

Let me know about any great questions you think should be added to the list!

I think so.

But I know I’m probably in the minority.  Many managers do not approve of employees using their phones for social media (Twitter, Facebook, etc.) at work, but I am actually okay with it when used with discretion. Unlike computers, with smart phones you do not need to worry about viruses infecting the office network.

Most managers accept and allow employees who smoke to step outside at least twice a day to smoke a cigarette.  Doesn’t it seem fair to allow everyone else to take a phone break to check messages, make calls and text a few people?

Here are some objections I’ve heard to allowing staff to use their phones at work, and my answers.

“They’ll never get any work done if you let them play on their phones all day.”

My Answer: I only hire adults.  I expect adults to have a reasonably well-formed work ethic that is demonstrated by doing work first, and doing non-work on breaks and briefly other times.  If the practice can’t run without me peeking over their shoulders every hour or so to see if they’re working, then I am not a very good manager.

Performance measures are a great way to set guidelines for what work must be done.  If the employee is meeting their performance goals appropriately, why shouldn’t they be able to take a micro-break to catch up on life?

“Employees should do work at work and save their home life for home.”

My Answer: Employees are people with busy lives, lots of commitments and lots of responsibilities outside of work.  Every single one of us needs to attend to our personal lives for some part of the day.  Most of it can be dealt with at lunch or during breaks, but sometimes people need to attend to their lives at work.  I want them to be able do that, within reason, because it is a realistic response to life in 2010.

“What if staff using the Internet on their phones puts the practice at risk?”

My Answer: If you have done a good job of educating your staff about confidentiality and HIPAA, you should have no worries.  In short, staff should not reveal any patient information (via spoken, written or digital communication) to any third party for any reason besides those dictated in your Notice of Privacy Practices (NPP).  Your HIPAA education plan should be reviewed and updated annually to include any policy changes due to the use of social media for personal and practice purposes.

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