How Do You Hold Employees Accountable for Their Position?

Surveys show that workers are happiest when they are productive and are contributing to the success of the group in which they work. To boost morale, efficiency and longevity of workers, one must:

  1. know exactly what one is supposed to produce and a clearly defined final product,
  2. understand the importance of one’s production, and
  3. Explain Reasons Specifically: Don’t say things like “poor attitude” or “insubordination” unless you can cite the specific behaviors. Generalized statements leave too much room for interpretations and argument. You don’t want that now, so have the hard evidence or documentation on hand.
  4. be properly trained to get that product.

Whether you have a staff of 2 or 30, each position in the practice needs to have a clearly defined final product. Both the manager and the employee need to know exactly what the person on the post is expected to produce. For instance, a receptionist’s product is to “swiftly and accurately handle communication in a friendly manner and properly service the customer.” A receptionist who consistently obtains this final product will keep the flow lines and the communication lines of the practice functioning and will be a valuable group member. How many new patients have been lost because a receptionist has failed to answer a phone call swiftly, answer questions correctly and set an appointment?

Determining the final product for each position is a starting point. A statistic needs to be developed, so the final product can be accurately monitored. For example, one of an office manager’s final products is having staff members who are fully trained for their positions. Using a statistic such as “percentage of employees fully trained for their jobs” would show the OM’s performance.

How do you hold employees accountable? The answer is:

  1. name a final product for each position,
  2. figure out a way to quantify that product as a statistic,
  3. monitor the statistic,
  4. evaluate statistical trends, and
  5. apply the correct formula to remedy any downward statistic/improve an upward statistic.

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Turn a 40 Hour Week Into 30 and Stay Profitable

Do you ever get to the end of the day and realize that you didn’t get half of the things done that you intended to get done?

Do you find yourself giving endless streams of orders and then having to spend time following up to make sure everything was really done?

Do you often have to redo work because it was not done correctly the first time by someone else?
Is scheduling a problem?

Managing time in a healthcare practice is an art. Unique problems arise because, as the doctor, your main priority is treating patients. But, how are you supposed to keep your full attention on patients and at the same time stay on top of the crucial administrative work that is paramount to maintaining a thriving practice? The essence of successful time management is the attainment of a level of organization which facilitates the goal of a healthcare practice, a high quantity of well and happy patients.

Simply stated, how well you organize determines how many hours you work and how productive you are during those hours.

If you are having difficulty managing your time, the first action you should take is to keep a time log during a typical work week. While this may be arduous at first glance, you will find it well worth the time and energy you put into it. Carry a small notebook with you throughout the day and log everything you do along with the amount of time you spent doing each. This is best done by logging the events as they happen and avoid trying to reconstruct the information at a later point in time.

At the end of the week, you will be able to look over the information and tabulate how much time was spent on the various activities you engaged in. This exact record will help you isolate areas of the practice that are not being competently handled by your employees and/or are problematic to the point of requiring much of your attention.

The next action you should take is to have each one of your employees keep their own time log, just as you did yours. At the end of the week, you can gather the logs and review the activity of each staff member.

Read part II of this article and find out the key questions you should be asking yourself when you have completed your log. Request “Turn A 40 Hour Week Into 30 and Stay Profitable – Part II” (highly recommended). Scroll to top

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Achieving Better Retention and Patient Satisfaction

Achieving Better Retention and Patient Satisfaction

Thriving successful practices have mastered the challenges of patient and client retention.

A question that needs to be asked, answered and fully understood is “Where does patient or client retention start?”

The truest and most simple answer is the point when the patient is procured!

You could say that patient procurement and patient retention are two sides of the same coin.

Let’s delve into this in a bit more detail.

Let’s delve into this in a bit more detail…

A practice, in essence, has a systematic way of obtaining patients, receiving patients, treating patients and collecting payment for services rendered.

In amongst all of this is the human element or the patient or client themselves. This is where the complexities of patient retention begin and end.

The Key Points That Determine Patient Retention.

How a Clinic addresses the human element is really the crux of succeeding in the challenges of patient retention.

Always keep in mind that underlying retention and patient satisfaction issues are usually issues with service, delivery, and the interaction with the staff.

There are several key points in any practice that determine the outcome of patient retention. This applies to new patients as well as existing patients. These are as follows:

  • Overall Clinic Environment and General Staff Interaction with the Patients
  • Front Desk – Patient Arrival
  • Patient Prep
  • Physician Interaction
  • The Front Desk – Patient Departure
  • Interim Period – The Time After the Patient Leaves Until the Time They Return.
  • Dealing with Patient Upsets

Each of these elements, when properly set up and organized, will lead to a higher degree of patient satisfaction and will result in better retention and better reviews.

In the next article, there will be some tips and strategies to help improve patient retention and treatment satisfaction.

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Getting Your Staff on the Same Page

 

This article is a continuation of Critical Practice Foundations. If you haven’t done so yet, we recommend reading the first article to get a better context.

The Staff Meeting

One very important activity you, as the owner, should implement is a regular staff meeting with all of your personnel. This provides regular communication with all of the staff and enables any questions to be addressed in a forum that allows for coordination.

Highlighted below are basic policies for conducting a staff meeting and what the purpose of having a staff meeting is.

Purpose: To provide a predictable time for the entire staff to come together to communicate, focus, plan and coordinate as a team. Staff meetings should be quick, upbeat and productive.

Staff Meeting Policies:

  1. Staff meetings are mandatory. They are the only time during the week when the entire staff can get together as a team to coordinate on important matters.
  2. Designate a specific day and time that staff meetings will be held. The end of the week that just ended or the first part of the new week are the best times.
  3. The office manager (or owner) would run the staff meeting.
  4. Staff meetings will run for about a half hour unless stated otherwise, in which case the staff will be notified in advance.
  5. If the staff meeting is going to be during lunch, make sure that the staff bring their lunch or has arranged for their lunch to be there on time. If the practice is going to pay for lunch, keep the cost low and the choices simple. Appoint someone to be in charge of getting the lunches there on time.
  6. All staff should come to the meeting prepared to report on their area.
  7. Topics of a serious (personal or individual) nature will not be taken up at the staff meeting. Rather, it will be addressed in a private conference with the appropriate staff members.
  8. All staff are expected to participate in the meeting, even if that simply means to politely listen whenever anyone else is talking or presenting material.
  9. Someone will be assigned to keep notes of the meeting and will submit those notes to the office manager each week.

Preparation for the Meeting:

  1. To plan the format ahead of time, the office manager will meet with the owner to determine any special topics that he/she, as the CEO, would like the office manager to cover.
  2. The office manager will have the graphs posted for the major practice areas (production, collections, new patients) and ready to present to the staff.
  3. The office manager will prepare any handouts, e.g., new policies, educational materials, etc. that are intended for staff distribution.
  4. The office manager will look over the notes from the last week’s staff meeting to determine if there is anything that needs to be followed up on from that meeting.
  5. Delegate someone to turn on the answering machine (or service), indicating the time frame that your office will be closed.
  6. The office manager should ensure that the receptionist has gotten the last of the patients checked out and give her a hand if need be (or delegate another staff member to assist her).
  7. Lunch should be ready to go.

Basic Format

  1. Referring to notes from the previous last week’s meeting, the office manager will address anything that is appropriate.
  2. The office manager will go over the graphs, stats and the plan of action based upon the stats, using this time as an opportunity to train the staff a bit more on what the graphs are all about.
    1. When going over the stats, the office manager should get the staff to participate, eliciting their input on how they think things can be improved and strengthened.
    2. Determine if the graphs that are being discussed met the goals that had been set and determine what the new goals will be.
  3. Have the staff members show their personal graphs and discuss what the appropriate actions, based upon those graphs, would be for the upcoming week.
  4. Discuss any future plans that the practice may have. Keep it brief.
  5. Go over any promotional activities that are active or in the planning stages.
  6. Make any announcements that are appropriate for all staff to be notified of.
  7. If it appears that more time will be needed to go over any particular issues, let the staff know that you will plan a longer staff meeting within the next week or two and that you will notify them of that schedule change in advance.
  8. Allow time for the doctor (both as doctor and as owner) to address the staff on any issues he/she deems pertinent for the weekly staff meeting.

 

Questions? Ask the Editor

If you have any questions or suggestions about this article, please feel free to submit them below. Our editors speak with professional doctors like yourself every day. They would be delighted to hear from you.

Critical Practice Foundations

Critical Practice Foundations

The Basics

Most doctors, when starting their practices, miss some of the basic actions that should be established prior to opening.

An owner of a healthcare practice should always, as a first step, work out the following basics: their purpose as a practice owner, the actual product of the practice, and the statistics that will measure the success of the practice.

Below are examples that you can modify and use for your own practice.

Purpose of the Practice Owner

The owner’s purpose is to establish an efficient health care practice that delivers quality service to its patients and/or clients and to have a very solvent and viable practice that provides an enjoyable place for the staff to work and a high quality-of-life for the doctor/owner.

Once the purpose has been established, it is the owner’s responsibility to set the direction and the pace for the business and to demand that the valuable final products of the organization be achieved. To do that, she/he must work out what the product of the practices are. Here are some examples of products:

  • A solvent, viable, expanding practice that delivers high quality care and service
  • Satisfied patients and clients who have received high quality care and service
  • Statistics
  • Number of active patients/clients
  • Production
  • Collections
  • Net Income
  • Solvency (the amount of cash versus the amount of bills owed)

Putting the purpose, product and statistics in place will help create a strong foundation for the expansion of your practice.

Getting your staff on board with you is another part of this process.

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The Truth About Collections

The Truth About Collections

Accounts receivable and collection percentages are a subject that we hear about frequently. Every doctor has a different idea about what a good collection percentage is as well as how to collect money for services rendered.

For example, I have talked to many doctors that feel obligated to let patients/clients go without paying. They feel guilty about trying to collect from a patient/client if they feel that that person is in a financial hardship.

While this is quite altruistic, what these doctors must also understand is that they can’t continue to provide help to their patients/clients if they can’t afford to keep the doors of their practice open. If you provide a service, you should be compensated for it. Period. Unless you go into a situation knowing in advance that it is going to be a charity case – and there is certainly room for that in any practice, as long as it is planned for – you should insist on being paid for rendering that service.

Of course, this is great in theory, but being able to actually collect all monies owed is another story and requires good group coordination and effort. If you and your staff are trained on how to do this from initial contact through patient discharge, including having the proper policies in place with your staff and patients/clients, your chances of collecting at the time of treatment go up exponentially. We believe that you should be collecting 98% or better of what you are producing, minus insurance adjustments. If you are collecting less than 98%, you are losing net income out of your own pocket.

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Staff Management Distress Solutions

Staff Management Distress Solutions

I’m sure many of our readers are very familiar with The Practice Solution Magazine’s phone surveys. Our team of surveyors speak with doctors all over the country, 8 hours a day, 5 days a week. Given the busyness of your schedules, we definitely appreciate it when you take the time to speak with our team. The information that you provide enables us to more closely concentrate on articles of interest to you and your staff.

With that in mind, we have found from our recent surveys that one of the most distressing areas for most doctors is the managing, hiring and controlling of staff. Every person is different, and human interaction within small practices oftentimes can be nerve-racking, volatile and frustrating. You have probably found that not everyone thinks like you do, cares as much about your practice as you do, or is as willing to work extra hours as you do.

We definitely recognize the frustration that can occur with losing an employee whom you have just invested thousands of dollars and hundreds of hours training. One of the most important things that you can do to bolster your practice is to ensure that all of your staff are fully trained and operating on the same page. The optimum team is one that knows what their specific duties are; how to do those functions without any difficulty or emotional issues in other words, strictly professional; and what the other staff are should be doing.

When staff are competent, work is more efficient, morale is higher and the doctor can just be the doctor instead of the referee or babysitter.

In this issue of The Practice Solution Magazine, we provide articles addressing employee issues like staff meetings, setting production targets, and what your responsibility is as the leader for your staff. If you implement the suggestions within these articles, you may find some of your frustrations disappearing, and you may get even more support from your front desk because they will have a better understanding of what you need as the practice owner, which will enable them to become more competent and more professional.

Request Part II Instantly: Suggestions on Staff Correction

Suggestions on Staff Correction

It would be nice if employees never made any mistakes and always did a perfect job. But, we are all human, and mistakes and on-the-job errors are part and parcel of running a practice. That raises the question, what do you do when your staff err and how do you correct them? Here are some suggestions on staff correction.

As part of this overall process you must have written job descriptions and office policies that clearly delineate what tasks a person is responsible for on their job and the overall working guidelines for the office. The reason these are so important is that you use them as part of your correction procedure. Unfortunately, very few practice owners have proper job descriptions and office policies in place.

For starters, if you are in need of correcting a staff member, make sure you know of any specific disciplinary policies that you have issued so that your actions are consistent with these. For example, if your policy states that theft is an automatic discharge, you would not work up the disciplinary gradients and only reprimand someone caught stealing.

The first level of addressing correction is normally directing the staff member’s attention to whatever policy he/she violated, what was not done or what should have been done, all of which is delineated in their job description or in your written policies. Have the staff member reread the policy and/or job description. Ensure that they understand it and clear up any confusions or misunderstandings. This is usually enough to handle the first offense.

On the second offense the office manager or practice owner should review the situation with the staff member and have them sign a copy of the policy or procedure that covers what was violated as an attestation that he/she understands and agrees to the policy and/or job description. We then recommend for you to put a copy of the signed document in the personnel folder of the staff member and give a copy to the staff member to put in their staff binder. One can consider that this constitutes a warning.

On the third offense, we recommend that you do the following: give the employee a written warning, a copy of which goes in their personnel file. Sit down and discuss this situation with them; go over the fact that they’ve been corrected on this twice before; and tell them that, per office policy, continual violations could result in a suspension or dismissal.

Practice owners normally find that this type of action on a third offense either puts a stop to the problem or points out clearly that they have a real problem staff member on their hands and that proper actions, including excellent documentation, will need to be taken in order to suspend or dismiss the staff member for future violations.

What do you do with a staff member that you have corrected three times and who messes up again? You’ve already given them a written warning, discussed that continued violations could result in suspension or dismissal, but you still find them doing it again.

At this point you should check their production record (although you should have done that already as part of correcting earlier violations). Hopefully you have a simple statistical method to keep track of key production metrics for each staff member and the office as a whole so that you can monitor their productivity. If the person is an excellent producer (which is unlikely given that they keep messing up), you might consider the next step to be a suspension without pay for a certain number of days. If the person has a poor production record, dismissal may be in order.

Again, the importance of having proper office policies and job descriptions in place in order to properly deal with staff cannot be overemphasized. You can easily put yourself in a legal quagmire if you attempt to discipline staff without these in place.

We also strongly recommend that you check with a good employment attorney when you are looking at dismissing any problem employee to insure that all of your legal bases are covered.

Real Office Policy Examples and Checklist

Below is a list of items that should be included in any basic office policy or policies:

  • Patient Relations
  • Sexual Harassment
  • Orientation and Training
  • Work Hours
  • Fringe Benefits
  • Solicitation
  • Equal Opportunity Statement
  • Terms of At-Will Employment
  • Definitions of Full Time and Part Time
  • Pay Periods
  • Vacations
  • Sick Leave
  • Maternity Leave
  • Tardiness
  • Personal Time Off
  • Absenteeism
  • Staff Meetings
  • Breaks and Lunchtime
  • Unemployment Insurance
  • Problem Resolution
  • Wage and Salary Guidelines
  • Retirement Plans (if any)
  • Holidays
  • Funeral Leave
  • Leave of Absence
  • Jury Duty
  • Disciplinary Measures
  • Continuing Education
  • Workers’ Compensation Insurance
  • Health and Safety Rules
  • Appearance
  • Office Security
  • Telephone Use
  • Where to Park
  • Voting
  • Job Performance Reviews
  • Uniforms
  • Dating of Patients
  • Confidentiality of Records and Information
  • Cleanliness and Maintenance
  • Reimbursement of Expenses
  • Outside Employment


Policy is very important to establish so that the entire group understands the rules and agreements upon which the office operates. When you have good policies known and understood by all staff, you get an effective and efficient team that coordinates and cooperates at a high level.

Below are some sample policies about the subjects suggested previously. Always consult with a good employment attorney before implementing your policies to make sure that they conform with the laws of your area.

Example General Policy Introduction

Welcome to our practice. The following policies are designed to provide working guidelines for all of us. Written office policies help to:

prevent misunderstanding and lack of communication;
eliminate hasty, unrefined decisions in personnel matters;
ensure uniformity and fairness throughout the practice; and
establish the basic agreements that everyone in the office operates on.

Our practice is open to change. Changes happen as a result of internal growth, legal requirements, competitive forces or general economic conditions that affect our profession. To meet these challenges the practice reserves the right, with or without notice, to change, amend or delete any of the policies, terms, conditions and language presented in this manual. Changes in personnel policies are made after considering the mutual advantages and responsibilities of both the owner and staff. All of us need to stay aware of current policy and, as revisions are made, new pages will be given to the personnel to place in staff manuals.

Remember, your suggestions are welcome. Just notify the office manager whenever problems are encountered and wherever you think improvements can be made.

Example Harassment Policy

This practice is committed to providing a work environment free of discrimination. This policy prohibits harassment in any form, including verbal, physical, religious and sexual harassment. Any employee who believes he or she has been harassed by a co-worker, manager or agent of the practice is to immediately report any such incident to the office manager or next highest authority. We will investigate and take appropriate action.

[As harassment is a big legal issue in today’s world, we also suggest to all practice owners that a more extensive policy be written that further defines the types of harassment and the exact steps to follow should it occur. We also suggest that you check with your attorney on proper policy in this area.]

Below is a sample policy on employee classification. These classifications are important for any employer to know because they affect the type of working hours, pay, benefits and bonuses that various employees are eligible for. Some of these classifications and their accompanying benefits or restrictions can vary from state to state. Therefore, it is important that you consult with an attorney who is familiar with the employment laws in your state before implementing this type of information.

Example Employee Classification Policy

  • New Employees: this category would include those employed for less than a specified number of days, during which they are on probation.
  • Regular Full-Time Employees: this could include staff who work a minimum of 32 hours a week.
  • Regular Part-Time Employees: this would include staff who work less than the minimum required.
  • Temporary Full-Time Employees: this would cover staff who work full time but are hired for a limited specific duration.
  • Temporary Part-Time Employees: this would include staff who are hired for a limited duration and work part-time.
  • Exempt Employees: this covers staff who qualify under the Fair labor Standards Act as being exempt from overtime because they qualify as executive or professional employees. Make sure you know the exact rules and regulations on this before you exempt anyone from overtime.
  • Non-Exempt Employees: such employees are required to be paid at least minimum wage and overtime.

Example Overtime Pay Policy

Overtime pay is paid according to the Federal Fair Labor Standards Act and our state’s wage, hours and labor laws.

Exempt Employees: employees exempt from the minimum wage, overtime and time card overtime provision of the Fair Labor Standards Act do not receive overtime pay.

Non-Exempt Employees: employees not exempt from minimum wage, overtime and time card provisions of the Fair Labor Standards Act do receive overtime pay.

Overtime hours must be authorized by the office manager or owner in advance of extra hours worked or as soon as possible thereafter. Time not worked but paid for, such as vacation, holidays and sick leave will not rate or count for overtime calculation purposes.

Example Time Tracking Policy

Each staff member is individually responsible for recording work time on the attendance sheet and/or time card when reporting for work, leaving for lunch, returning from lunch and leaving at the end of the day.

The attendance sheet and/or time card is a legal document and must not be destroyed, defaced or removed from the premises. Never allow another employee to enter your time for you and vice versa.

Overtime must be authorized in advance of extra time worked or as soon as possible thereafter. Overtime, changes or omissions on the attendance card must be authorized by the office manager and initialed.

When you leave the premises, let us know. If you have to go out of the office or the building on personal business during your scheduled work hours, first, get permission from your supervisor. Then, check in and out on your attendance sheet or time card.

Whether you use the above examples or not, having written office policy is vital to the smooth operation of any practice. It is the foundation of education, training and correction in your office and can make the difference between a well oiled machine and a machine that is constantly having problems and is in need of repairs.


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