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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Forming Office Policy

Forming Office Policy

All doctors are extremely well trained in their profession. Unfortunately, very few doctors are trained in business or employee handbook policy creation and their appropriate implementation.

Every healthcare practice is a business that provides a beneficial service to its patients and clients. The less the practice owner knows about business management, the less service he or she will be able to deliver. The more he or she knows about practice management, the more successful their practice will be.

Forming office policy is one of the most basic and important practice management tools that any owner can implement to make a more successful practice.

Why is policy so important? Why do we consider it a fundamental practice management tool? The answer is simple but important.

Policy is important because it sets up the group agreements, the rules of the game, the procedures to follow. It is usually based on what has worked and what legal guidelines are important to know and follow. Without good office policy, you get a chaotic environment because people end up making up their own policies. This results in inefficiencies and lack of teamwork.

Policy that is understood, agreed upon and adhered to will strengthen the office and provide the best means to achieve practice goals. Even those policies that are unspoken and assumed to be known should be put in writing. By putting all policies in writing, problems and confusions that could otherwise surface will be curtailed and even eliminated. Additionally, in this litigious world, having written office policies that are attested to as read and understood provides a layer of protection from potential disgruntled employees who have violated the policies.

Policy is vital to achieving teamwork, cooperation and efficient coordination in any group activity. If everyone knows the rules of the game, the game is much more easily played. These rules and procedures are outlined in office policies.

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Leadership Attributes and Management Qualities – Part II

If you need to refer back to the first part of this article, click here. Otherwise, continue reading below.

Active Leadership

It is very important for the owner of a practice to maintain excellent communication with his/her staff and to provide active and visible leadership. The following are some key points for the executive.

Communication of Goals

Determine what the purpose, the mission statement, of your practice is and communicate it to your staff. Let them know what the goals for the office are and keep them informed of the programs that you intend to implement to achieve those goals. A well-informed staff will have greater understanding and will be likely to join you in mutual motion.

Communication Tools

The implementation and use of basic communication devices is key. These tools can be kept in place by your office manager but must also be reinforced by you as the senior executive. These tools include: written requests or proposals, written office dispatches, written policies, and the use of an effective communication relay system.

It is important that written communication is responded to swiftly. When people do not hear back regarding their communication within a reasonable period of time, they become less willing to communicate. As a result, the business can have more problems on its hands.

Staff Meetings

It is vital that you ensure that the practice holds a staff meeting once per week. This is one of the most valuable opportunities available to you for educating staff, setting goals and targets, and handling problem areas. The staff as a whole can address such matters. The communication lines within the business will strengthen considerably as well.

The owner and the office manager should continuously strive to establish strong coordination and leadership for the staff. Any problems or disagreements between the owner and office manager should always be sorted out outside of the staff meeting and should never be addressed in the presence of any staff.

Staff meetings are run most effectively if the owner and office manager meet prior to the staff meeting to plan and coordinate the issues to be addressed with the staff.

Setting Goals and Targets

When targeting your weekly and monthly quotas, it is advisable to plan in advance of your staff meeting. You should really confront how much production you did the week/month prior and how much can realistically be produced within the upcoming week/month with expansion in mind. Realistically look at what CAN be done. Then go over it with the rest of your staff at the staff meeting.

Each week you should bring your graphs to the meeting and keep the staff informed as to how the group is doing in approaching their goals.

Group Member Responsibility

The more each staff member takes responsibility for the office as a whole, the better your office will perform. It is very helpful to have each staff member come to the staff meeting prepared to contribute. The owner should support the efforts of the office manager to show the staff the importance of this format and to gain staff compliance. The goal of the executive should be to show the staff how to take on more responsibility and how to contribute to the creativity, growth and expansion of the practice.

Policy

To create stability for the practice and to keep the lines straight, it is very important that you continue to implement written policies. There should be a written policy to govern each and every activity in the practice.

When you write a policy, place the original in a Master Policy Manual. The office manager would then distribute a copy to each applicable staff member indicating that the policy is to be read and verification is to be sent to the office manager confirming that this has been done. A copy of the policy would be placed in the Staff Job Description Manual under the General Staff Section.

The office manager can be very helpful in policy development but needs to know exactly what your policies are. Policies can be written and submitted to a lawyer for final approval. The office manager can and should suggest areas where policy is needed. Staff should also be encouraged to propose policy via the office manager.

This article was helpful, but now I need to implement what I learned into my practice.
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When the Doctor is Away

How you keep the office running

If you as the doctor/owner are planning to be away from the office – even for a day or two – the staff has some free time, too. The doctor/owner or office manager can make lists of things that need to be done.

Make sure that if your absence was somewhat unforeseen, provisions for referring emergency cases to other doctors have been arranged for, and that patients/clients have been rescheduled.

The doctor’s absence provides an opportunity to take care of matters that could not be conveniently handled on days when patients/clients are in the office. For example, this may be the time to have the walls repainted or to have equipment repaired. Of course, the owner should be consulted before this is organized.

The staff should take care of as many tasks as possible on their own, so that an insurmountable pile of unfinished business will not be waiting for your return. Mail should be opened, sorted, and placed in priority order. If any mail comes into the office that needs to be acknowledged, the office manager should send a letter informing the writer that the doctor is away, when he/she will be returning, and that the doctor will answer the letter when he/she returns. If the doctor is going to be away for a long time, a brief summary of the mail and phone calls can be mailed or emailed to him or her, or communicated over the phone.

This is a good opportunity to perform chart purges, contact patients/clients regarding their recall appointments, activate inactive patients/clients and get them scheduled, send out letters, and work on promotional projects.

The owner and the office manager should meet prior to the scheduled absence and form a plan for what the staff should work on during that period. As unexpected absence of the doctor can occasionally occur, the owner and the office manager should determine the policy to govern such an instance which would define what the staff is to do during that time.

Making Financial Arrangements

Ensuring Your Office Gets Paid 
It is the responsibility of the accounts manager to sit down with the patient/client and work out the best financial arrangement within the framework of the policies of your office. Bear in mind that the ideal plan would be one that facilitates the most immediate payment for service rendered. One would not offer a plan that stretched payments out over a long period of time unless there was no other option that the patient could afford. Firm financial arrangements must be made with patients/clients.

It is most advisable to have only one person discussing payment options with your patient/client and this should rarely, if ever, be the doctor. The doctor should present his case recommendation, and if necessary, briefly outline the general payment options, but without getting into the actual financial arrangements (it is always best if the accounts manager is the only person discussing money with patients/clients).

Once the doctor has presented his treatment plan, he should then tell them that his accounts manager will make the actual arrangements. He should then leave the room and quickly acquaint the financial person with the case, including how soon the first appointment (or several appointments) should be; how much time he will need scheduled for the appointment(s); the total fee for the services the patient/client has accepted.

The accounts manager would then meet with them privately to make the financial arrangements. They should begin by seeing to it that the first appointment is scheduled, and then introduce the topic of finances. A good approach is, “How do you want to pay for this today?”

The accounts manager would strive to secure payment in full, but if necessary, would go over the other options that are available, illustrating with dates and amounts.

Don’t force a person into a hasty decision. If he/she needs time to review his/her finances, then simply write down the total fee and the methods of payment available. Schedule another conference to complete the financial arrangements.

Once the accounts manager and the patient/client have decided on a method of payment, the “agreement” should be summarized in writing, with dates and amounts and have the patient/client sign it. Give a copy to the patient/client.

It is advisable to then send a letter to the patient/client after the meeting, congratulating them for going ahead with your services and outlining the financial agreement again, offering assistance if they have any questions.

Always discuss fees and payment options in a very clear manner with the patient/client before providing any services. It is important to work with them so they have financial arrangements that they feel they can abide by. They will feel better about being your patient/client when they know that you have really worked with them, and that together you have made an agreement which is workable.

Publicize any new payment plans that you institute. You can put a sign in your reception area that says “Ask About Our Payment Policies”. You could also mail statement stuffers which include payment information for your patients/clients. Put together a practice brochure that explains your payment policies. Instruct your front office staff to discuss new payment plans with every person at his/her next appointment (only if appropriate).

The accounts manager’s job does not need to be difficult, time-consuming and frustrating if it is done in an organized and efficient fashion. Two of the most important factors are:

  1. Having firm financial policies
  2. Making sure that the patient/client understands and agrees to his/her obligation

3 Easy steps to reducing stress in your practice.

How can you expand if your staff are stressed out?

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.

If you let employee situations go on for too long, bad things happen and you can end up losing not only the problem employee, but other good employees as well. When you encounter two or more employees feuding;

Find out as quickly as possible who seems to be instigating the problem
Determine which of the two is the most productive employee,
Nip it in the bud, fast.

Normally other staff have either been involved or observed a staff conflict in one form or another. Interview these staff and get a more neutral opinion on what is going on and who is really causing the problem. Interview the staff involved and get their side of the story. From this you should be able to find out who the real problem employee is.

Make sure, above all else, execute the above steps QUICKLY.

The longer this is allowed to continue, the more likely it is that other staff will start to feel that their work place is not safe. You could end up losing a really good employee because you didn’t handle the problem and act swiftly.

One easy way to keep your work place stress free:

Having office policy and job descriptions in place to govern acceptable and unacceptable behavior in the practice will give you an important foundation to stand on when handling staff conflicts.

Document, document, document in writing the issues and what was done to handle the people involved. Without this documentation you can open yourself up to potential legal issues.

With your practice stress reduced, your staff, Office Manager and you, can work quickly, efficiently and everyone will win!

Watching Out for Harassment in Your Practice

These days most business owners are aware of sexual harassment and the need for having policies and employee training on this type of conduct. But sexual harassment is only one form of workplace conduct that any practice must do everything possible to prevent. There are other forms of harassment that any business owner should know about and have appropriate policies on. You should always be watching out for harassment in your practice. Here are a few others you should be aware of:

• Visual harassment: This might include things like pictures, posters, screensavers of an offending or demeaning nature. Someone having a poster of the latest Playboy Bunny or some hot semi-dressed male model would not be smart as would an offensive screensaver that others in the office could see.

• Physical harassment: This could include threatening some sort of unwanted or harmful contact, blocking someone’s movement, unwanted touching of a person, etc.

• Verbal harassment (or written): This could include making unwanted statements about a person’s appearance, clothing, body, behavior, religion, sexual orientation and/or creating rumors about a person.

• Nonverbal harassment: Examples of this could be staring at a person and making them feel uncomfortable, looking up and down their body, nasty or derogatory gestures towards a person, following a person without their permission (i.e. stalking).

You should have office policy that covers these matters. The policy should explain what harassment is and the exact steps an employee should take if they experience any form of harassment. If you don’t have an office policy manual that covers these things, consult your attorney and get one done. A law office that is very good with these matters, one that we’ve referred many practice owners to and where this data comes from is:
The Law Offices of Timothy Bowles, P.C.
One South Fair Oaks Ave. Suite 301
Pasadena, CA 91105
626-583-6600
626-583-6605 Fax

Ken DeRouchie

The Cost of Employee Turnover

All of the information we’ve written about on proper hiring and training procedures in this and past issues of The Practice Solution are based upon several key issues: a) to have the most productive office possible you have to have a team of good staff, working well together to accomplish the mission of the practice, and b) the cost of employee turnover can be very high, therefore hiring the right people who remain with you long-term can save a tremendous amount of money.

The facts are that employee turnover can be very costly. Studies indicate that such a cost can equal 6 to 9 months of the salary of the position. This is based on the costs involved in finding, interviewing, testing, selecting, training and getting a new employee fully functioning on the job. There is also the cost of lost income that can occur during the period of employee development, especially if the position is empty for a period of time.

If the position pays $3000 per month, your costs could be between $18,000 and $27,000 every time the position turns over. That may seem high, but because much of that is a “hidden” cost, you may not see it. But you will experience it in the long run. It’s therefore extremely important to test and screen applicants properly and carefully in order to hire the best possible individuals for your practice.

Your goal is to find employees who will work well within the procedural framework of your office and stay, contribute to and grow with your practice. In order to find those people you need successful hiring practices including tests, applications, reference checks, interview questions and more that can help with the hiring process. Only looking at a resume and conducting an interview is no way to determine the quality of an applicant. Hiring someone off of a resume/interview alone is a crap shoot and can be disastrous in the long run. If you are interested in learning more about successful hiring procedures, including what tests to use, what to look for in an application, what screening procedures are best to filter out the best applicants, who should you interview and how do you conduct a productive interview, contact me at: kderouchie@silkinanalysis.com or call me at 800-695-0257.

Ken DeRouchie