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!

What is one of the biggest hindrances to expansion in any practice?

Cancellations and Broken Appointments.

Broken appointments or cancellations are symptoms of other problems. This may be a way that the client is telling you that they are not satisfied with their service received or they have some financial concerns.

What can be done to reduce no-shows, cancellations and reschedules?

Your receptionist should fully understand that the appointment book has been placed in their hands and they are fully responsible for its handling.

Your “General Policy” statement should be used to educate clients on needing to keep their appointments.

You must have the honest and genuine attitude that you really care about your clients and your receptionist knows why it is important for your clients to set and keep their appointments.

Always call right away, any client, who does not show within 15 minutes of the scheduled appointment. Find out from the client if something went wrong, that might have caused them to miss their appointment. A caring “time is valuable” attitude is important and letting them know that you want to work with them to ensure that they can make it in.

When a client calls to cancel, find out, diplomatically, the real reason why they are canceling. Many times you’ll find it is a financial concern or a lack of understanding about why they need the recommended care.

Ultimately, when you find out why clients do not keep their appointments, you will find an area of your practice that needs more work. Better financial arrangements, better explanation of your treatment plans, et al.

In summary, its extremely important to make sure your clients and their pets receive the best care you can give them, that they accept your treatment recommendations and also show up to receive that treatment.

The key to really expanding in 2014 is making sure your clients make an appointment and keep it. Your receptionist is the key and often mystery ingredient to your clients showing up or not showing up.


David Tregurtha

CEO, Clear Advantage Profit Solutions

Join me on LinkedIn

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
626-583-6605 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

Independent Contractors

Our readership, for the most part, is made up of privately owned health care practices in the dental, veterinary and optometric fields. It is not uncommon for them to occasionally hire outside vendors to do sporadic work here and there. Therefore we want to help you be aware of the various rules and regulations surrounding independent contractors.

For starters, what is an independent contractor?

There is no pat answer to that question as each state has its own rules regarding this. But there are some national (IRS) guidelines that any employer should be aware of when determining whether someone qualifies as an independent contractor or not.

The most basic concept to understand in this area is that individuals who are independent contractors have their own business, profession or trade. They are in business for themselves. They earn their money and receive their income from their own independent business. They do not depend upon one employer for their livelihood.

Some simple and more obvious examples would be: hiring a painter to paint your office; your attorney or accountant; hiring a bookkeeper to do your books who also does this for other businesses. None of these people depend upon you for their sole source of income, and you do not control their work hours, work location, etc.

Here are some specific points to look at when attempting to determine if a person you hired is an independent contractor (IC) or not. Review the following points in order to become familiar with what an IC is.

• Can the person earn a profit or loss from the work they are doing? If so, they could be an IC.

• Is the person told where to work, when to work, what he/she can or cannot do as part of the work? If so, they likely wouldn’t be an IC.

• Does the person offer their services to others in general? If so, they could be an IC.

• Does the person furnish their own materials, tools, etc. needed for them to do the work? If so, they could be an IC.

• Does the person work for more than one company or firm at one time? If so, they could qualify as an IC.

• Does the person invest in equipment and facilities? If so, they could be an IC.

• Does the person pay his/her own business and traveling expenses? If so, they could be an IC.

• Is the person told how to work, when to work, where to work by the hiring firm? If so, they would likely not be an IC.

• Does the person hire and pay his own assistants? If so, they could be ICs.

• Does the person set his or her own working hours? If so, they could be ICs.

• Does the person provide services that are an integral part of the hiring firm’s day-to-day operations? If so, they might not qualify as an IC.

• Does the person receive training from the hiring firm? If so, they might not qualify as an IC.

As mentioned above, the most basic thing to understand about whether a person is an independent contractor or not is: do they have their own business, profession or trade, and earn their income from their own independent business rather than one employer? If so, and most of the points we’ve gone over are present, they would likely qualify as an IC.

If you have any uncertainty on this subject, please consult your accountant or attorney before making any final decision regarding anyone’s qualifications as an independent contractor.

Ken DeRouchie

Hiring Techniques

The Application

One of the areas we are regularly asked about is how to best read and evaluate an employment application. Here are some things you can look for on an application that will give you an initial “feel” for the applicant.

• Neatness
• Completeness
• Does everything look accurate and honest? For example, are the dates of past employment consistent?
• Past work experience – what have they done that would qualify them to work for you – look for past responsibilities held and descriptions of what they did and the salary they earned.
• Past work stability – how long did they work at previous jobs or did they hop from one job to the next?
• Reasons why they left their past jobs – are their statements positive or negative about this?
• Gaps in time between jobs. What did they do?
• Comments they may write about themselves.
• Level of education achieved.
• Date available to start work.
• Yes or no questions – are they all filled out? Are there any questions raised from their answers?

The Applicant Interview

Once you have decided to schedule an interview with a potential employee, make sure you are fully prepared with the questions you want to ask. Since the purpose of the interview is to gather information to make an informed decision, it’s important that the questions you ask elicit as much information as possible.

There are basically two types of questions: open ended which allow a person to think and speak, and closed ended, which give basically “yes” or “no” answers. You want to ask open ended questions as they are more revealing. Here are some examples of open ended and close ended questions, each concerning the same subject. Look them over and you should easily be able to see how they will elicit different responses and how the open ended question will give you much more data for your hiring evaluation.

Close Ended: Are you highly motivated?
Open Ended: What career objectives have you set for yourself?

Close Ended: Are you qualified for this position?
Open ended: In what ways have your previous jobs prepared you for this position?

Close Ended: Can you accept criticism?
Open Ended: Give me some examples of times you’ve been criticized. How did you respond?

These are just a few examples of how to properly ask questions in a hiring interview. You can see that the open ended question will provide you with much more useful data to evaluate the applicant.

Applying the proper screening techniques when hiring, which would include proper use of the application, interviewing with information eliciting questions as well as testing can help you identify both the good and potentially dangerous applicant which will allow you to make a more informed decision.

Happy hunting!

Ken DeRouchie

Vacation Policy

One of the key areas that we’ve helped practice owners with is office policy. In this article we’ll present some ideas on what you can include in an office policy having to do with vacations.

The importance of having and using office policies that cover the rules, regulations and agreements for how a health care practice is to be run cannot be overstated. Without policy known and agreed upon, you end up with confusion, inefficiency and overwork in any practice. With proper policy in place that covers all aspects of a practice including such things as discrimination, paid holidays, vacations, retirement plans, etc., staff will know what to do and the result will be a smooth running office. Below is a sample vacation policy that can be adapted to any office.



Regular full-time staff and specified regular part-time staff get an annual paid vacation. The length of your vacation is based on the length of your continuous service with the office.


Length of Continuous Service

Less than 90 Days: 0 vacation days
After 1 year: 5 vacation days
After 2 years: 10 vacation days

Vacation pay for full and specified part-time staff members is at the regular pay rate.

Vacation benefits accrue on a monthly basis. However, since vacation time is earned in 12 month increments, staff members are not eligible to take vacation time off for time worked in less than a 12 month period.

New employees begin to earn vacation pay at the end of the orientation and training period. Upon completion of this phase, eligible new employees will receive vacation benefits retroactive to the date of employment. If employment is terminated for any reason after completing the orientation and training period, the employee is entitled to payment of prorated vacation benefits earned and accrued, retroactive to the date of employment.

Staff members may be required to take their vacation while the doctor is on vacation. If the entire staff goes on vacation when the doctors does, staff members not eligible for vacation benefits may be required to cover the office during the vacation period. All vacations will be approved at the convenience of the office so that continuous patient care is assured. Conflicting requests will be decided in favor of the person with the most seniority.

Any earned and unused vacation time must be taken prior to the beginning of a leave of absence. No vacation time is earned while on a leave of absence.

If a paid holiday falls during your scheduled vacation period, you will be given an additional day off with pay or paid for the day at regular wages. No allowance will be made for sickness or other types of absence occurring during the vacation unless the staff member is hospitalized.

Staff members are required to take their earned vacation time in the year after which it has been earned. If there are extenuating circumstances (for example when the absence may severely affect office operations during a critical period), you may be requested to carry all or part of your vacation forward to the next year.

Failure to return from vacation on the scheduled date is considered job abandonment and treated as a voluntary termination.

Regular full time staff members will receive holiday pay equivalent to the straight time pay received if the holiday falls on a regular working day. New employees do not receive holiday benefits until they complete the orientation and training period.

To be eligible for holiday pay the staff member must be at work, or on an excused absence, the day immediately before the holiday and the day immediately after unless approved, in writing, by management.

Holidays that occur during a leave of absence are unpaid.

If a holiday falls on a weekend, the office may close the day before or the day after the holiday and take this as a paid holiday day.

When a designated holiday occurs during an eligible staff member’s scheduled paid vacation period, the individual will receive an extra day off (the date to be approved and paid at the regular rate for the day).

Staff members who terminate employment will receive compensation for any past earned, but unused holidays such as one that occurs during a scheduled vacation period that hasn’t yet been used.

New Years Day
Memorial Day
Independence Day (July 4)

What Goes in a Job Description

I can’t stress enough the importance of implementing proper, well written job descriptions and office policies into your practices. As few doctors are trained in practice management or management and executive skills while in professional school, most doctors have to fly by the seat of their pants when it comes to running the business side of a practice. That’s why we often write about how and why to implement office policies and job descriptions in order to make the office run more smoothly.

This begs the question: what should be included in a job description?

Here are the key points that we include in a job description:

• The purpose of that position. For example, what is the purpose of the receptionist of a practice? It might be: “to keep the appointment book full, rescheduled appointments to a minimum and the patient flow smooth and efficient”.

• The product or outcome of that position – i.e. what are they suppose to produce? For a receptionist it could be, “A full appointment book with maximum productivity for the doctor and a correctly routed flow of patients and communication within the office”.

• Statistics for the position. You need some sort of metrics to accurately measure the productivity of any job. For a receptionist it might be “percent of patients kept to schedule” or “percent of schedule book filled”, etc.

• The various job duties the position is to perform. You can simply list them out, making sure you have the most important duties covered.

• Write-ups of how to do the various job duties you’ve listed. These write-ups should be written by people who have successfully performed the duties of the job and should be continually updated.

These are the key points that we find make a good job description that will help anyone put a new employee on the job and make any transition from one employee to another much easier.