The Responsibilities of Managers and Staff

Dealing with staff can often be a confusing and complex subject.  Certainly if a staff member was overtly unwilling, refusing to do what was expected, gossiping, constantly complaining and so on, this is a staff member you wouldn’t tolerate.

On the other hand, what a pleasant job it is to work with someone that does exemplary work, follows policies, requires little supervision and consistently pitches in to help.  Clearly this is a staff member to treasure.

However, the vast majority of the staff seem to lay somewhere between these two extremes.  The quality of the work might be acceptable most of the time but then on occasion, not.  They don’t always follow policy.  Maybe there is friction between them and other staff.  Or perhaps they don’t readily accept corrections or direction without making it a big deal.  

The challenge for executives is how to transform a staff member from this mediocre condition into a prized employee.  Perhaps you’ve tried correcting them or disciplining them but it never results in enough change and so your attention eventually comes back to them.  They aren’t so bad as to necessitate firing them, but they just aren’t where you want them to be.

Unsuccessful in improving these people, the executive tends to give up and start tolerating their mistakes or allow them to continue uncorrected. This creates three rather serious problems:

First, the mistakes obviously create problems in the practice.  Maybe this leads to patients not being scheduled correctly with an appointment book that vacillates between being empty and other times where the people are scheduled on top of each other.   Or maybe the treatment areas aren’t clean or the rooms or instruments aren’t correctly set up – all of which creates appointments that last longer than they should, which in turn creates a log jam throughout the rest of the day.  Whatever the mistakes are that created these problems, left uncorrected they will again create the problem tomorrow.

Secondly, the good staff have to then scramble to compensate for the mistakes made by the marginal staff member.  This in turn forces the good staff to work twice as hard as they still have their own work to do.  This can create a toxic work environment wherein staff are always upset at other staff.  Further, the good staff will lose respect for the executive who fails to ever fully resolve this issue.  

Third, these mistakes, happening again and again over time, tend to increase the frustration of the executive.  The result is that one day the executive comes down overly hard on the person making the mistake.  The staff member then feels the executive is overreacting to a simple error and thus loses further respect for the executive.  

So, how does one deal with all of this?

To sort this out, let’s start with the basic responsibilities of the executive and that of the staff member.  The executive’s responsibilities are:

  1.  For any specific position, determine what the functions need to be.  For example, the receptionist would be in charge of scheduling, checking people in and out, and answering the phones among other tasks.


  2. Once the specific functions are figured out, then the executive must decide exactly how the task is supposed to be done.  For instance, there are different ways a phone could be answered.   The executive needs to decide how they want it answered in their practice.  These descriptions of how a function is supposed to be done, are often called a protocol. 
  3. Once all the protocols have been developed, they now need to be written up in great detail so there is no ambiguity or confusion as to what is expected.  There is a vast difference between verbally walking someone through how to schedule, and having that protocol written out.  Without these protocols in writing, but instead relying on verbal explanations, confusions inevitably arise.  A staff member will swear that they heard the explanation one way, while the executive is equally certain they explained it differently.  This is often why staff get defensive when they are being corrected.  In their minds, the executive is correcting them differently than how they were initially trained.    These written out protocols are commonly called job descriptions.   What can get underestimated is the amount of hours it takes to create job descriptions detailed enough to really make a difference.  The truth is the executive probably doesn’t have time to compile these job descriptions.  In such an instance, the practice is better off buying them.  Beware though, even a lot of the job descriptions you can purchase aren’t detailed enough.  There are a few companies like ourselves that have put in the hundreds of hours needed to put this kind of manual together.  To give you an idea of what is needed, our job description manual is 450 pages long.


  4. Fourth, the executive is expected to train the staff member on the functions of the job.  Typical mistakes done at this point by most executives are again, verbally explaining things rather than referring the staff member to written materials, or not role playing or drilling with the staff member and not doing it thoroughly enough to ensure that the staff member is competent when they perform the task live.


  5. And lastly, the executive is supposed to develop metrics that objectively verifies whether the staff member is doing the job well or not.  Without those statistics, correction becomes too subjective.  Staff are being told that they aren’t doing their job well, and yet they feel they are.  Lacking objective ways to measure the staff member’s productivity can lead to disagreements between the executive and the staff member as to how well the staff member is doing the job.  These disagreements tend to fester over time.

So these are the responsibilities of the executive.  What then are the responsibilities of the staff member?  Simply put, to follow the protocols as laid out in the job descriptions and to perform them to the expected level as measured by the statistics.  

So with this in mind, let’s go back to the original problem, how to take a less than stellar staff member and turn them into a good one. The first thing to do is to see if you have fulfilled your responsibilities as the executive.  So, have you:

  1.  Put in writing what the job tasks are?  I have seen practices wherein the staff weren’t even sure who was supposed to do what function.


  2. Determined how you want the task performed?  As mentioned above, there are a lot of ways to do any task, so you need to figure out how you want it done in your practice.


  3. Written up how the task is to be performed?  And is this write up detailed enough or does there have to be a lot of verbal explanation?  Many problems with staff stem from this confusion.  Ie, the staff member thinks they are doing it correctly but they had simply misunderstood the verbal explanation.


  4. Have you trained the staff member on the function?  There is training and then there is training.  Are you using job descriptions and role playing and drilling to allow the staff member the opportunity to really master the skill?


  5. Do you have some objective way to monitor how well the person is performing their job?  As discussed above, having statistics eliminates the subjectivity from supervision.

If you’ve done the above and you still are having trouble getting quality work from the staff member, there are most likely three issues in play:  

  1.  The staff member is disorganized to the point they can’t get to everything.  This can particularly occur during expansion.  At a certain level of production, the staff member has organized his job so they can get everything done.  When the production increases there is more work to be done and there are times the area needs to be reorganized to be more efficient to accommodate the increased workload.  As an executive, it may be necessary to get into various areas and find ways the staff member can be more efficient.  And of course with continued expansion, there will ultimately be a time where the area is as efficient as it can be, it just simply needs additional personnel.  But you need to be good at streamlining areas otherwise you will bring on staff prematurely thus hurting the bottom line.  There are ways of analyzing overloaded areas to determine whether they can be more efficient or need personnel.  If you don’t know how to do that sort of analysis, then you need to learn this skill.


  2.  Assuming there isn’t a problem with disorganization, then the next problem may be the staff member is confused about how to perform the function.  In other words, the training wasn’t sufficient.  So now you need to correct the staff member.  There are a lot of tools one can use to correct staff.  Here are two:

    a) Use the written job descriptions to see if the confusion lies there (for example, have them read it and check to see if there was anything they didn’t understand).

    b)If you discover any area they intellectually know how to do but have trouble actually performing it, have them practice this repetitively until they are more comfortable.  An example of this would be using a certain script to answer the phone.  They may agree with the general approach but  have trouble with the actual phrasing.  Having them role play this over and over again until they have created verbiage they can easily say can be very productive.

  3. If you have eliminated the problems of disorganization or confusion, what you probably have left is an unwilling staff member.  Don’t give up on them yet though, apply the tools of discipline.  Discipline is basically a system of consequences.   For people who aren’t willing to follow protocols or policy, you need to let them know you are serious.  You can and should develop a gradient level of consequences, starting with something as simple as letting them know it is not acceptable to violate policy (or protocol) and working through written warnings and suspensions before you finally are forced to terminate.  The idea is that if the staff member knows you are really willing to let them go if they won’t abide by the rules, then they may change their behavior.  The more ethical the staff member, the lighter the consequences need be to get that sort of change.

As a last point on all of this, here are a few things to consider:

  1.  If you don’t do your job as an executive in establishing what you want done (through job descriptions and protocols, etc) it will be very difficult to discern whether the troubled staff member is a problem due to something you are not doing or because of their attitude.


  2. You have to be able to analyze overloaded areas (or areas that appear to be overloaded), otherwise you won’t be able to solve the issues in that area.


  3. If you are reluctant to let someone go because you have trouble hiring good people or training is too time consuming, then you’ll never be able to discipline someone.  Discipline only works if you are willing to go all the way.  So, if you have concerns over training or hiring, you must get educated to do these functions, otherwise you will never be able to apply the tool of discipline.

The basic truth on all of this is if you have hired a person with a good attitude who is reasonably intelligent, putting the above in place will allow you to proactively create the ideal staff member.

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