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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Where is Your Net Profit?

You’ve worked hard all week; the office atmosphere is rife with discipline and brisk efficiency. The staff have been getting along with one another and you are proud of the team spirit they’ve both individually and collectively demonstrated. In fact, your staff has almost read your mind and anticipated your every need. All of the patients have arrived on time for their appointments, and the majority of them have even heeded your advice and accepted your treatment plans!

Now it’s Friday afternoon; the staff has received their paychecks, which reflect production bonuses that you’ve doled out in appreciation of their contribution to the overall increase in production. But then you look at your bank balance and you’re surprised and sorely disappointed at the lack of funds left over for you. What happened?

Where is your net profit? Did you work hard all week just to earn less money? The bank balance should be going up, not down!

You wonder if it’s worth all the effort. All of that increased production might just have landed you into a “higher office-overhead/higher tax-bracket” situation. It’s that frustrating income vortex — the place where, despite producing and collecting more, you take home the same amount or less. And following a few of these “successful” weeks, you shake your head and realize that if you endure much more of that kind of success, you’ll go broke! So, what should you do?

Let’s start by taking a look at the myriad of possibilities of what might have occurred that resulted in your not having any profit for yourself:

Management Issues:

  • Could you consolidate loans for equipment and/or your practice into just one loan, in order to reduce your monthly loan payment and possibly the interest amount?
  • Can you reduce the amount of inventory the practice maintains?
  • Are you collecting your Accounts Receivables with minimal aging? Do you collect at least 97% of the amounts billed?
  • Do you have any sort of monitoring system that helps you to know at a glance, statistically, who is productive and who isn’t?
  • Do you have written office policies that are known and enforced?
  • Does each position in the office have a fully delineated job description?

To learn the 8 staff-related issues that can plague you and adversely affect your net income read the final half of this article by filling out this form (Highly Recommended).

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Leadership Attributes and Management Qualities

As a practice owner, you should be asking yourself the following questions objectively:

  • Am I a good leader?
  • Do I run from conflict?
  • Am I able to motivate my staff?
  • Is my office harmonious or is it filled with conflict?
  • Does my staff “own” their jobs, or do they just punch in and out?
  • Do I ever feel that my staff is “holding me hostage”?
  • Am I running my practice? …or is my practice running me?

Did you answer any of those questions favorably? If you’re like the average practice owner, the answer is no. That’s because, like most doctors, you were not trained in leadership and executive skills. Consequently, you will often find yourself in management situations in which you lack certainty about what to do. Insufficient leadership could easily result in poor staff performance, unhappy patients, needless stress and lost income.

Maxim: The Morale of the Staff Is Based Upon Their Individual and Office Production.

Believe it or not, most staff members want to do a good job. They want to improve and they like being acknowledged for a job well done. When one produces a good product, it’s a reflection of his competence. Demonstration of competence raises anyone’s morale. As a leader, you have the opportunity to foster an environment that can bring about ever-increasing competence and morale.

So, how does one become a good leader? Is leadership a personality trait with which only a few are blessed? No! Leadership skills are taught and, with practice, can be put successfully into daily use.

The first quality a good leader has to have is the ability to confront situations, i.e., to face up to them. If you are the type of owner who runs and hides from conflict and staff problems, then you need some improvement in this area. First, decide that you are going to face up to the problem. Simply take a moment and make the decision; this is very helpful.

Next, grab someone — a friend, your spouse or a colleague — and roleplay the problem. Have that person play the part of the troublesome individual, hitting you hard with backtalk, new problems, can’t-be-dones, etc. Be sure to do the drill until you find that you are more confident and even feel somewhat excited to try out your new skills and presentation. You will be surprised at how easily the situation will resolve once you do this. Keep in mind that your staff can’t and won’t follow if you don’t lead.

It is very important for you to maintain excellent communication with your staff and to provide demonstrable leadership.

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How to Properly Correct Employees

It would be wonderful if employees never make mistakes and always do a perfect job. But we’re all human; on-the-job errors are part and parcel of working in a practice. That begs this question: What do you do when a staff member messes up and how do you correct him?

Here are some suggestions on how to properly correct your staff:

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

For starters, if you need to correct a staff member, make sure you review any specific disciplinary policies that you have issued, so that your actions are consistent with them. For example, if your policy states that proven theft results in an automatic discharge, you would not utilize a gradient approach to termination by merely reprimanding someone guilty of stealing.

Typically, the first step in correcting a staff member is to direct his attention to the specific item he violated, as delineated in his job description or in your written policies, indicating the appropriate action that he failed to take or the inappropriate action that he did take. Direct the staff member to reread the policy and/or job description. Ensure that he understands it and clear up any confusions or misunderstandings. This corrective action is usually sufficient to handle the first offense.

If the staff member commits a second offense involving the same issue, the office manager or practice owner should review the situation with the staff member and have him sign a copy of the policy or procedure that covers what was violated, as an attestation that he understands it and agrees to abide by it. We then recommend that you put a copy of the signed document in the staff member’s personnel file and give him a copy to put in his staff binder. One may consider that this constitutes a warning.

To learn how to apply these policies in specific situations, such as;  How many warnings should be issued? What if the employee is an excellent producer? Read the final half of this article by filling out this form.

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Resolving Negativity in the Office

Since dealing with staff bickering and personality conflicts can be a major source of stress in an office, knowing how to deal with it can be extremely useful. When you let employee situations linger too long, bad things happen, and you can end up losing not only the problem employee but other good employees as well. So, when you encounter two or more employees feuding, our recommendation for you is to find out as quickly as possible who seems to be instigating the problem, as well as determine which of the two employees is the most productive, and to quickly nip it in the bud.

Normally, when a feud is going on, other staff members have either been involved or have observed it in one form or another. It usually bothers them as well, even if they are not directly involved. What we recommended to practice owners is to interview these peripheral staff and get a more neutral opinion of what’s going on and who is really causing the problem. Also, interview the staff involved and get their respective sides of the story. From this you should be able to find out who the real problem employee is.

ACT FAST! The longer you let something like this linger, the greater the odds that you will lose not only the problem employee, but the good employee and possibly other staff members who are sick of being involved in that type of work environment. If you act swiftly on such matters, you will keep your employees happy.

There’s another very important point: the longer this kind of thing is allowed to continue in your office, the more likely it is that other staff members will start to feel that their workplace is not safe. They will also feel that the owner is not in control of the office and that they may want to find a better environment to work in. You could end up losing a really good employee because you didn’t confront the problem and act swiftly and appropriately.

Having the right office policy and job descriptions in place to govern acceptable and unacceptable behavior in the workplace will give you an important foundation to stand on when handling this kind of situation. Lack of such policy can make the workplace less than harmonious. And don’t forget to document, document, document the non-optimum issues in writing and what was done to handle the people involved. Without documentation, you can open yourself up to potential legal issues.

The “staff infection” is a term that I came up with long ago to discuss the effects that a negative employee can have on a team and how fast it can spread. Similar to how the “Staphylococcus Infection” is dangerous to the body.

The “staff infection” starts in various ways, such as with a staff member that often rolls his or her eyes at staff meetings. This staff member engages in rumormongering and can be counted on to “stir the pot” in the office. This can be the idle staff member or the person who always seems to be busy but gets nothing done. You get the idea. This is the employee that you are “just not sure about.”

What would you think of a doctor that did not practice good sepsis control and permitted Staphylococcus germs to fester in or on his or her equipment? It simply does not make sense, does it? Nobody would do that. Preventing any sort of infection in a patient is more than second nature to any doctor. What would your opinion be of a doctor that was aware that his or her patient had an obvious staph infection but did nothing about it? Enough said.

How do you handle the “Staff Infection”? Read the final half of this article by filling out this form.

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Did You Hire the Wrong Person?

A recent survey conducted with practice owners across the US revealed that the number-one management problem they have is personnel issues. Among the problems mentioned by hundreds of owners surveyed were:

  • Procuring qualified personnel,
  • Getting employees to perform competently once hired,
  • An inability to hold staff members accountable for their work,
  • Turnover and handling disputes among employees.

Correctly isolating and debugging non-optimum practice situations is a skill that every doctor finds he needs. Oftentimes, a manager who is seeking solutions overlooks some administrative fundamentals which, left undetected, cause a problem to appear larger or more complex than it really is. Moreover, failing to discover the real source of a problem leads to poor decision-making. In the case of managing employees, this type of failure is not only frustrating, it’s expensive.

The real work begins after the hiring process ends, for each employee must be well trained for his/her position in the practice. Lacking thorough training, an employee will not perform to the expected standard. That will inevitably lead to either the employee quitting or the doctor firing him/her.

There is an exact technology for finding and hiring good staff members. Assuming the hiring techniques are sound, the most devastating managerial mistakes are made during the training period. During that time, an unskilled manager might make assumptions that lead to incorrect reasons for poor performance, and those conclusions, in turn, lead to bad decisions regarding personnel. All too often, a suitable person who is both willing and trainable fails to receive the information needed to do the job. As a result, turnover occurs and doctors and office managers spend their time dealing with personnel problems rather than treating or servicing patients.

Written job descriptions are a must for each position in a practice. More importantly, those descriptions need to include fundamental data that are often omitted because the manager assumes that the employee already knows what is needed from him. Common sense, or common knowledge, to one person may not be so to another. Verbal instructions are much less effective than thoroughly written job manuals.

Every job description in an office should include the seven following sections:

  1. The responsibilities that the person holding the job position has to the patients,
  2. A general description of the position, which includes its purpose,
  3. A statistic that quantifies, and thus objectively measures, the production of the position,
  4. A list of specific duties that one in the position is expected to perform,

What are the final three sections that a job description should contain and the four things to examine when employee problems arise? Read the final half of this article by filling out this form.

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A Functioning Office Manager

Your Key to Success

The primary function of the office manager is to accomplish the goals and purposes of the practice as determined by the owner of the practice. The OM should assist the owner in developing policies that forward the purpose of the business as a whole. It is the OM’s job to see to it that all members of the group are fully contributing to the expansion of the practice, and that a high level of communication exists between the group and the owner.

The OM should run the day to day activities of the office and keep the daily distractions off of the owner/doctor’s plate. This would be accomplished by ensuring that the OM, first of all, was trained in the handling of staff and felt comfortable with the hiring, training and correction of all staff members.

The OM should be a person who understands the importance of communication and the power that open communication can generate within any group. The OM should energetically lead the group toward accomplishment of the established goals. The OM should be someone with good communication abilities and someone who can really care for the staff.

The OM would ensure that all internal communication systems are strongly in place and operational, and that the staff is taking responsibility for keeping all unnecessary “traffic” from and within their own posts to a minimum.

To affect the above, the OM should have a strong working understanding of the management tools such as statistical management, the establishment of a communication system that really works for the office, written communications, job descriptions for each position, written policies for the practice, and personnel management.

The OM is in charge of seeing to it that all areas in the practice are running smoothly and producing the desired products of each respective area. This would require her/him to have an understanding of organizational structure and function. They would ensure that all functions in the organization were being firmly held by someone and that they were trained in the skilled handling of their assigned posts.

The OM should have a very strong working knowledge of statistics and their use in strengthening the practice. The OM would be in charge of posting statistics and going over those statistics with the staff in the staff meeting to determine the appropriate steps to take in order to improve, maintain, or increase practice production statistics.

It is the OM’s responsibility to obtain compliance from all staff in regard to the owner/doctor’s wishes and any program or project steps that are being worked on.

The OM would be responsible for the hiring and firing of personnel and for conducting performance evaluations on a regular basis with all staff.

The OM is responsible for the preparing and implementation of programs that would take the group through the needed steps toward the accomplishment of company plans.

Fill out the form to read the rest of this article which includes: 5 key objectives of an OM, the results the OM must obtain for the practice and how to select an OM (highly recommended). Scroll to top

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Putting New Employees on the Job

Practice owners bring on new employees for a variety of reasons. Often, when practices are undergoing expansion of production and income, they require increased staffing. Or, due to poor past hiring procedures practice owners find that they have to replace some employees who are poor performers. There is a natural attrition rate as well when a staff member moves out of town, gets a higher paying job, etc.

Many past Practice Solution articles have been written on numerous aspects of our successful hiring procedures, including testing, how to conduct proper interviews, how to weed out non-qualified candidates, legally acceptable and unacceptable questions to ask, etc. You’ll find some of those articles in this issue of Hot Tip.This article will go over some of the best actions to implement when putting new employees on the job.

Once you’ve decided to hire a new staff member, the first thing to do is have them complete all appropriate paperwork. This would include signing whatever employment contract you use as well as having them read all of the appropriate office policies and attesting to having read them.

Personnel File

A personnel file is vital for maintaining proper documentation on every employee. You can set yourself up for legal problems in the future if you don’t have this properly in place. Therefore, creating a personnel file for the new employee is one of the first things you should do after hiring the person.

The office manager should create a personnel file for the new employee which contains:

  • The full job application and the resume turned in during the hiring process.
  • Any other forms used in the hiring process.
  • Any tests taken.
  • Any interview notes, write ups, etc.
  • Employment contract.
  • A copy of the policies the new employee read and signed.
  • A checklist of everything the office manager will be doing with the new employee to bring them onto the job. Make sure the checklist is filled out as each item is done.

As the new employee becomes a regular employee, the personnel file should be constantly updated with job reviews, disciplinary warnings, commendations, etc. The personnel file is your key management tool for documenting everything having to do with that employee, from the time they are hired until the time they leave, for whatever reason.

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Dealing with a Problem Employee

Private Practice Owner Reading EmailI received an email recently from a doctor having a staff problem. I replied to her and thought this might benefit some other people out there. Please see our discussion below:
Hi Ken,

As an employer, how can you tell your employee to stop his/her: gum smacking, not to laugh at the end of each sentence, to stop blowing her nose as everybody can hear it, to stop asserting herself on someone else’s conversation?

I have such a hard time saying something to my assistant about these issues. Everybody in the office is being affected, and I am not happy at all with her. I try my best to tell her what I would prefer from her as an employee, but it hasn’t worked.

Please help me.

Dr. S

My Reply

Dear Dr. S,

There are several things that can help you in this current situation and help prevent this from happening in the future. This is a bit of a lengthy reply due to the nature of your problem. Please take the time to read through this as I believe it will give you some insight into the problem and how to handle it.

The first, and probably the most important thing is to make sure that you have very detailed job descriptions and office policies in place. In your office policy manual, there needs to be written policies about acceptable and unacceptable employee behavior. When new employees are hired, they are given a copy of this policy manual, and they are to read and sign off on them. This lets them know what is and isn’t permitted in your office. They agree to this, and you now have legal recourse for disciplinary action and/or termination for non-compliance.

As new policies are written, a copy is handed out to all employees for them to read and sign off on. These signed agreements are added to their personnel files. These can then be referenced in regular employee evaluations, disciplinary actions, and if needed, termination situations.

If, however, you only deliver your requests verbally, you leave these requests open to interpretation. It is imperative to have everything in writing so that there is no room for interpretation.

The other underlying issue that I see here is hiring the right people to begin with. There are three steps here:

  • Attracting the right kind of employees,
  • Determining who to hire, and
  • Training them to do their job properly after you’ve hired them.
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When you are looking to fill a new position, the wording of your ad/listing is key. Where you are advertising is also a big factor. Utilizing employment agencies that pre-screen applicants to your qualifications can greatly increase the quality of candidates that you see, weeding out the lower quality people ahead of time.Determining who to hire is a shot in the dark for most doctors. They read a resume, conduct an interview and take a shot. No one writes on their resume that they are chronically late, don’t take directions well and can’t get along with others. What you see on a resume is only what the applicant wants you to see. Similarly, all you hear in an interview is what they want you to hear. They say the right things or at the very least what they think that you want to hear in order to get the job.

After they are hired they stay on their best behavior until they get comfortable; then, they become themselves. Only then do you know who you’ve really hired.

You need a more objective way to screen and hire people so that you have a better idea of who they are, what kind of personality they have, their responsibility level, their aptitude and their work ethic. Corporations have been hiring people this way for years. Small businesses suffer through much higher turnover rates due to their lack of successful hiring techniques.

Personality tests, IQ tests, Aptitude tests are all implemented to get a feel for who a person really is and how they will fit into your practice and interact with the staff, more importantly your patients.

Once you have hired the right person, you need to make sure that you train them properly. This is where detailed and up-to-date job descriptions and office policies come into play. It is vital that you equip your new employee with the proper tools to do their job rather than throw them to the wolves and hoping they pick up the proper way to do things as they go.

Here is a policy regarding employee performance evaluations. Take a look at this as I think it will give you an idea of the kinds of policies that should have a place in your office policy manual.

—————

Performance Evaluations Policy

Private Practice Employee ManagementWe have established a procedure for evaluating job performance on a regular basis. These performance evaluations are vital for future planning and provide fair, timely and objective measurement of the performance of job requirements.

We conduct at least two evaluations of a new employee during the first year. The first after approximately 90 days of employment, and a second evaluation is completed after 9 to 12 months of employment.

Thereafter, each staff member receives a performance evaluation at least twice per year.

We will notify you of the time scheduled for your review at least seven days in advance. This gives both of us an opportunity to prepare so that areas of mutual concern can be addressed.

The performance appraisal is designed to:

  • maintain and improve job satisfaction by letting staff members know that we are interested in their job progress and personal development,
  • serve as a systematic guide to recognize the need of further training and progress planning,
  • ensure a factual, objective analysis of an employee’s performance as compared with job requirements,
  • help place employees in a position within the practice that best utilize their talents and capabilities,
  • provide an opportunity to discuss job problems or other job-related interests,
  • serve as an aid in salary administration,
  • provide a basis for coordinating goals and objectives (those of the employee and of the practice), and
  • give recognition for superior performance.

The performance evaluations will address job factors and behaviors that are observable, measurable and specifically related to job performance. The factors we consider are:

  • quality of work,
  • employee relations,
  • patient relations, and
  • job knowledge.

Salary adjustments are not necessarily made at the time of the performance evaluation.

——————–

Your current situation is a volatile one. This person is causing you stress, is making the other staff uncomfortable, and is bringing the overall morale of the practice down. Patients can and will pick up on this, and it will negatively affect their experience at your practice. Doctors that are uncomfortable with leadership and necessary confrontation and communication will often let these situations go until they fester and burst into a hostile situation. Good employees can leave a practice when a bad employee is not confronted and handled. If you don’t implement better hiring techniques followed by detailed job descriptions and office policies, you open yourself up to the possibility of lower quality employees who don’t get trained well and further diminishing your current staff. Ultimately this will cause stress for you and conflicts with your staff. However, if you hire higher quality employees and equip them with all of the tools needed to perform their job, you will find that they are more inclined and able to deliver what is needed and wanted by you, and they will strive to achieve it.

Please feel free to call me if you need any further clarifications or help: (800) 695-0257.

Sincerely,
Ken Derouchie

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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.

If you are a practice owner and are in the middle of or have questions about a particular employment concern, please schedule a 1 hour complimentary call with one of our experts now!


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