How Do You Hold Employees Accountable for Their Positions?

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. understand the importance of one’s production,
  2. know exactly what one is supposed to produce and have a clearly defined final product,
  3. be properly trained to get that product, and
  4. be specific. Generalized statements leave too much room for interpretations and argument.

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 “communications handled swiftly, accurately and in a friendly manner.” 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/or 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 monitored accurately. For example, one of an office manager’s final products is “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

apply the correct formula to remedy any downward statistic or improve an upward statistic.

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The First Step to a Successful Marketing Campaign: Research

To craft a successful marketing campaign for your practice, you must first conduct some basic research that will start to identify what your marketing plan and promotional pieces will look like and the message they should deliver. The first step in your research is to work out the general mindset and styles that dominate your particular geographic area. Every state, city, town or area has its own mindset and styles that are unique to that place. If you have lived in the area where you practice, chances are you know them well. Additionally, it is smart to check with others from the area to ensure that your opinion agrees with the general consensus. If you are new to the area, ask locals, as they generally have a good idea.

Some examples are provided below to give you an idea of what one might list as the mindset and styles for his/her area.

Example #1:

Mindset: “Slow and steady pace”, “Friendly”, “Easy going”

Style: Earthy. Lots of greens and whites used in colors.

Old fashioned.

Example #2:

Mindset: “Efficient and Professional”, “Friendly”, “Straight to the point”

Style: Modern and Edgy. Lots of blues used in colors.


Next, identify the top three practices in your area and find out how they market themselves. Doing this will enable you to see which marketing approaches have been successful for your area. Looking at your three competitors’ websites is a good start, as well as looking in the Yellow Pages, local newspapers, Valpak/ADVO, etc., to see how they are marketing. Look for which words they are using to sell their services to people, which offers they are advancing and what their designs look like.

The next step is to identify the successful campaigns or promotional pieces you have created and used thus far. You need to look for any promotional pieces, slogans, brochures, ads, internal marketing campaigns, discounts and word-of-mouth success that resulted in notable increases in delivery. Again, pay attention to the words that were used, the offers that were put forward and the visual impact of the design. It is also good to consider the general demographics of your area. A good website that provides this information for free is: Gathering this data should enable you to get a good idea of both what worked for you and what works for other similar professionals in your area. It also provides you with a general impression of what people in your area like and will respond to.

This basic homework will provide you with a foundation of information that can be used as you work out new marketing campaigns, whether internal or external.

Fill out the form on this page to read the rest of this article and find out the second step in crafting a successful marketing campaign. (highly recommended). Click to scroll to the top of the page.


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Your Responsibility to Your Staff

Just as your staff has responsibilities to you and your practice, you likewise have several responsibilities to your practice and staff.

The complexity of active leadership can be best understood by breaking it down into its essential and integral parts:

1. Communication: It is vital for the owner of a practice to maintain excellent communication with his/her staff and to provide active and visible leadership. The following are key elements involving communication that you, as an executive, should implement:

a. Communication of Goals.
Determine the purpose of your practice (most often presented in the form of a mission statement) and communicate that to your staff. Impart the goals of the practice to the staff and keep them informed of the projects that you intend to implement to achieve those goals. The better informed your staff is and the greater understanding they have of such matters, the more likely they will be working in tandem with you.
b. Communication Tools.
There are some fundamental communication tools to implement in the practice; see to it that your staff uses them. These tools can be established and maintained by your office manager; but, as the senior executive and leader of the practice, you must reinforce them. Examples of those tools are: written requests or proposals, written office communications, written office policies and the use of an effective communication relay system.
c. Responding to Communication.
It is vital that you and your staff respond swiftly to written communication. When people do not receive a reply to their memos or emails within an appropriate and reasonable period of time, thereafter they become less willing to communicate. As a result, the business can have more problems on its hands. (Keep that in mind when reading the second part of this article.

2. Staff Meetings: It is also vital that you ensure that the practice holds staff meetings 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 that should be addressed by the staff as a whole. The communication lines within the business will strengthen considerably too.

You, as the owner and leader, in addition to your office manager, should continually strive to establish strong coordination and leadership for your 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 run most effectively if the owner and office manager meet prior to the staff meeting to plan and coordinate those matters to be addressed with the staff.

Fill out the form on this page to read the rest of this article and find out why writing and implementing Policy in your practice, as well as setting Goals and Targets successfully, is so vital to achieving expansion. (highly recommended). Click to scroll to the top of the page.


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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.

To learn Six Key Actions That You, As An Executive, Should Take fill out this form.


Fill out the form to read the rest of this article (Highly Recommended).

Termination Series:

Making the Decision. Should I Fire My Employee?

This series will go over how a termination decision should be made, how the organization handles problems before making a termination and how to convey the news for a constructive face-to-face termination. There are specific guidelines when terminating because all of these factors will impact strongly on the employee’s perceptions, their consequent motivation to act on their emotion negatively and the way your current employees will view how you handle these and following situations. It’s up to you to make a termination something that is going to aid you and your practice or something that could collapse it.

Of the many responsibilities of managing staff, having to terminate an employee is one of the most troublesome and difficult. Termination is the final step of investment protection, one in which the return on investment is wholly inadequate, justifying the ending of the investment. However difficult, it is part of the job and must be done in as timely and humane a manner as possible.

Making the Decision to Terminate

Deciding to terminate an employee is serious business for all that are involved. Considering the increase in litigation over terminations and the losses incurred by employers who have made unwise decisions, the termination must be based on a reasonably thorough assessment of the employment relationship. After all, that is what is being terminated, not merely the employee or the position.

Work is an investment relationship. However different or lopsided, the employee has invested something in the job and practice, and the practice has invested in the employee. Termination ends that investment. People don’t abandon investments unless the return is unfavorable. Remember, the employee’s investment is more risky (bills to pay; life to support), so he/she will have a hard time understanding why the company’s “investment” is being withdrawn, and this will present a greater challenge to the office manager to communicate.

Basic Guidelines to Be Aware of in Making the Decision to Terminate:

  1. Protected Group: If the employee belongs to a protected group (minority), the likelihood of legal action is increased. Have all your documentation and facts clearly prepared.
  2. Defensible Paper Trail: Make sure that the decision to terminate is backed in writing by specific, detailed documentation.
  3. Risk Potential: Is the law clear or fuzzy regarding the facts of your case? Second opinions from labor lawyers are advised.
  4. Public Image: Can your practice withstand any adverse public exposure through the spreading of the bad news in the community?
  5. Organizational Culpability: A “failed relationship” usually has plenty of blame to spread around. To what extent has the practice “failed” the employee? Does the practice have a clear definition of its responsibilities to marginal or unsatisfactory employees?
  6. Continued Damage Potential: Assuming the employee is not terminated and situation doesn’t improve, can you stand continued “repeat performances?” What is at stake if improvement is not forthcoming?
    1. Remaining Morale: Management credibility is really on the line in termination cases:
      What impact would failing to terminate have on morale?
    2. What impact would terminating have on morale?
  7. Twelve Strangers: How would 12 people completely unfamiliar with you, your practice and the employee judge the termination? With the record you have, would they conclude the action was reasonable?
  8. Consistency: How have similar situations involving other employees been handled? If differently, what differences justified such treatment?
  9. Shooting from the Hip: Are you just trying to get rid of someone that you don’t like or does the evidence justify a dismissal?
  10. Procedural Consistency: Have published guidelines for company disciplinary procedures been followed to the letter up to this point?
  11. Skeletons and Pretext: Sometimes companies try to cover up the “real” reason for termination and offer something that sounds plausible. Cover-ups usually unravel at very inopportune times, like with investigators and judges.
  12. Motivation to Organize: Terminations can impact on seeking representation for employees. Do all the factors guiding your decision and your company’s termination policies provide adequate “protection” against the perception of unfairness?
  13. Receptivity to Help: To what extent has assistance been offered and how has the employee responded? Has he demonstrated willingness to cooperate and improve? Is there evidence?
  14. Influence of Personal/External Difficulties: Are there any off-job problems which, in not being resolved, create or add to on-job performance?
  15. Track Record: Why consider termination now? Does the employee have a history or track record of problems or is this something new?
  16. Undeveloped Potential: Does the employee have potential for success in another job or part of the company? Working for a different supervisor?
  17. Pre-termination Conference: Having followed the pre-termination warning and gotten nowhere, have you talked with the employee and given full hearing to his/her side of the situation? Assuming the stories differ significantly, have you accounted for why the differences exist?

The above are guidelines intended to help you in this area. It is not intended to be, nor is it, legal advice. You should consult an attorney on any specific legal problems that might come up with employee discharge.

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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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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

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: or call me at 800-695-0257.

Ken DeRouchie

You can’t control the economy…

You can’t control the economy, but you can control your practice.

By: Ken DeRouchie

I have recently been interviewing doctors around the country regarding how the economy has been affecting their practice and what they have been doing to keep their practice financially viable. I have found that many of the doctors I’ve spoken to have simply shrugged their shoulders and accepted the down-turn in the economy. Many say there’s nothing they can do about the economy and, because of that, are producing less and making much less money. At the same time, most of them who feel this way have done little to nothing in terms of making any changes in the management of their practice to combat the exterior forces that are impeding the growth and solvency of their business.

This brings to mind an old saying: “If you always do what you’ve always done, you’ll always get what you’ve always gotten”. Simply put, if everything is changing around you and you don’t change and adapt with it, you will be unable to combat the external forces – very real forces – that are slowing or stopping your practice growth. It is imperative that if you want to continue growing in the economic environment that we are all experiencing, you must be able to adapt the management of your practice to the current state of your area, your local economy, the changing demographics of your area, etc. Most practice owners can grow in a booming economy. We’ve seen that during good economic times. But only those who have sound management skills, either inherently or through training, can adapt successfully to difficult times.

In August of 2007 I conducted a user poll on The Practice Solution Magazine’s web site in which 169 practice owners participated. The survey question was “The economy of the past 6 years has negatively affected my practice?”. 51% of the doctors answered :yes”.

I decided to follow this up with another user poll in November of 2007. 171 practice owners participated.

The topic of this was “When there are slow periods of the year, I …”.

46% of the doctors replied that [they] “live with it until it picks up again”

24% of the doctors replied that [they] “do extra marketing/promotion to make sure we don’t lose money”

16% of the doctors replied that [they] “schedule vacations at that time”

4% of the doctors replied that [they] “have a hard time making payroll”

11% of the doctors replied that [they] “wish there was something I could do to counter this”

You can see that only 24% of the doctors surveyed were actually doing something proactive to handle the slow periods! Obviously, you aren’t in a position to change the country’s economy, but you can , if you know how, make effective changes in your practice to combat slow periods.

Realize that the above surveys’ were conducted prior to the recent economic collapse. I therefore conducted a third survey in the last few months in which 71 practice owners took part. Since effective marketing of a practice is essential during poor economic periods, I decided to ask the question “On your new patient/client forms, when you ask the question “How did you find out about our practice”, what do you do with the answers?”

65% said [they] “Do Nothing”
1% said [they] “Enter it into a data base then nothing”
20% said [they] “Send a thank you card”
2% said [they] “Too busy to do anything with it.”
11% said [they] “Use this info for future marketing campaigns”

As you can see, only 11% were doing something useful with this vital data!

From these 3 surveys I conclude that:

  1. Many practices across the country are hurting from the effects of the economy.
  2. Most of them aren’t doing anything about it.
  3. When they are getting new patients in they don’t even bother to strengthen or further the actions that got those new patients in.
  4. The ultimate result of all of this is most practice owners that are completely the effect of the economic environment and not in control of their practice.

If this in any way sounds somewhat or a lot like what you are going through, read on. .

Things that you CAN control:

The following list includes links to articles written about specific areas in your practice that YOU DO have control over. If you are feeling a negative impact from the economy, I highly recommend that you hunker down and dig in. There’s a lot of ground to cover here but you will find this time well spent.. You do NOT just have to shrug your shoulders and “live with it”, you CAN take back control of your practice! These articles and others in this issue of Solutions can help you.

– Your appointment schedule – Cancellations/No-shows-rescheduled appointments

– Giving Great Service

– Marketing (internal and external)

– Staff efficiency

– Collections and Receivables

– Staff salaries and production bonuses

If you get in control over each of these areas in your practice you can very effectively “out create” the external forces that are negatively impacting your practice. If, however, you simply keep doing what you have always done and don’t change your operating basis, you will find yourself on a slippery slide with a crash at the end of the ride.