Expert Insights On Mastering Staff Training

By John V. Guiliana, DPM, MS

   Well-trained and efficient employees are crucial to the success of any business. Often a shortcoming, staff development is something that podiatric practitioners need to take seriously, building an integrated training process into their business plan. Without an adequate plan to train employees, doctors often feel as though the practice is inefficient and that they are constantly taking corrective measures.    In many medical practices, staff training is often inadequate. What often winds up happening is having a new employee simply observe and work side by side with a seasoned staff member. The training period, as well as its goal, is often ill defined and unstructured. The training then becomes “retrofitted” as the new employee makes mistakes. The result of this type of training not only has an adverse effect on morale but also contributes to increasing costs.    Many organizations realize that errors in any part of their business are extremely expensive. In his book, Quality Is Free, Phillip Crosby estimated that the cost of quality is 25 percent of revenue. Following the publication of this book, many businesses set a goal of “zero defects” but they soon realized this was rather unrealistic. However, by instituting and emphasizing proper training techniques, podiatrists will likely see increased staff productivity and satisfaction, and corresponding decreases in costly mistakes and errors. Training is not simply a transfer of skills. It also has the following goals and benefits.    • Training ensures clear and noticeable results in job performance.    • Training offers employees the opportunity to develop and expand their skills.    • Training helps facilitate increased productivity.    • Training decreases the amount of time spent with poor performers.    • Training improves the understanding of priorities.    • Training increases morale and job satisfaction.    For training to be successful, it requires commitment at all levels of one’s practice. The core principles of training must be inextricably linked to the practice’s objectives and performance. Responsibility and accountability are built into the training structure. Both the office manager and employee must accept that training is required, implemented, monitored and assessed. The training period only ends when there is mutual agreement that it has been effective.

Making The Commitment To A Training Program

   Part of making the commitment to a regular training program requires establishing a mentor for new administrative employees and one for clinical employees. One should charge this mentor with developing and managing the training program, researching training options and techniques, and preparing specific programs. (See “Developing An Action Plan For Training” below.) The mentors should be qualified by their skills and experience as well as their ability to teach others.    Develop a training plan and schedule. This plan should include the type of training programs one plans to use and the establishment of training priorities and goals. One should also establish a training budget as part of the annual budgeting process conducted by the practice. It is important to view training as an investment. Accordingly, it will impact the budget when it comes to attendance at practice management seminars, coding and billing seminars, and scientific programs. Inform the staff of the various training options available and for which items the practice will pay.    One should require those attending outside educational programs to disseminate their information to other staff members. For example, if one of the staffers attends a seminar, he or she could give a short presentation at a lunch meeting or write up a summary report for office distribution.    It is important to vary the types of training programs one uses. Many options are available. For example, in-house lectures and seminars are programs that last from one hour to one day and may be conducted by outside management consultants. For courses like those for X-ray certification, tuition may be covered in part or in full for selected staff members to expand present capabilities or develop new ones.    Outside seminars are another option. Keep abreast of the numerous single-day or multi-day courses and seminars such as American Podiatric Medical Association (APMA) programs, the American Academy of Podiatric Practice Management (AAPPM), the Professional Association of Health Care Office Managers (PAHCOM) and state society-sponsored programs. Although one will have to reconcile the cost of these programs within the practice’s budget, these programs do give staff the opportunity to exchange information and ideas with individuals from other practices throughout the country.    Finally, one should review the success of the training program when it is complete.

Developing An Action Plan For Training

   When one wants to initiate and/or develop staff training, it is important to develop an action plan. It should document which skills employees should have in order to perform their job duties and how they will obtain these skills. A training action plan should establish goals for performance levels and when employees should reach these levels. The plan should also note the structure and frequency of the training received. Lastly, the training plan should establish when the final performance assessment is expected to occur.    A training manual should serve as the foundation for new employee training. It should contain information about the practice, the training period, job description, training goals, available resources and the date of the employee performance review or assessment.    One should plan to conduct formal coaching sessions on a periodic basis to reinforce the skills taught during the training program. These sessions will also prepare employees for their performance assessment.    The performance assessment will determine if the employee has achieved the skill levels set forth in the training agreement. When the podiatrist and the employee are satisfied that the expected performance levels have been achieved, the training agreement is complete.

Why Understanding The Learning Process Facilitates More Effective Training

   The trainer cannot make assumptions about the beliefs and capabilities of the trainees or their existing knowledge. Such assumptions can have a negative impact on an individual. It is important to remember that all people need to feel accepted, responsible, understood, important, proud and part of a winning team.    Prior to implementing a training program, it is important to understand the adult learning process, what good learners have in common and some common barriers to learning.    Good learners like to be able to evaluate, challenge and question. They need to integrate new ideas with “old” ones if they are going to keep and use the new information. Along the same lines, they may find it more difficult to relate to, remember and recall skills that are completely new to them. Good learners consider themselves independent and often enter learning situations with their own goals, motivations and needs. They are concerned with immediate problems. Finally, good learners learn by doing and therefore prefer “how-to” and “hands on” instruction.    It is also vital to understand some common barriers to learning. Adults generally approach new ideas with set expectations and beliefs. While one may be showing someone a new skill that seems to fall squarely within that person’s capabilities, the person’s existing values, beliefs, attitudes and inherent fears can cause learning barriers.    Other potential barriers to learning include: a trainee's educational background, previous training and experience; the nature of the information being taught; the instructional methods and techniques one employs; and the capability and attitude of the trainee and trainer.    Employees learn better if they are involved and have opportunities to apply and practice what they have learned. They learn better in informal but organized workspaces, and when not they are not pressured or tested. They should be given time for reflection and short breaks between instructional periods and the achievement of small accomplishments.

Five Steps To A Strong Training Program

   Prepare. The first step in this process is to prepare the learner. The trainer should put the employee at ease and explain why the skill is important. Explain any challenges that may be involved and how to deal with them. Answer any questions that the employee may have about the task.    Tell. Explain the task thoroughly. Break it down into key parts or steps. Most employees will find that learning several smaller tasks and putting those together is easier than trying to learn one large process at once.    Show. Demonstrate exactly how to perform the task or skill. Involve the employee by asking questions and getting feedback. Have the employee explain the process or skill back to the trainer.    Do. The employee now has the opportunity to perform the task. The trainer needs to help employees develop confidence by first carefully monitoring them and then allowing them to work without supervision.    Review. Provide honest feedback to the employee in terms of encouragement, constructive criticism and additional comments. This is a great opportunity to praise the employee or correct his or her progress. During the training steps, it is also important to encourage the employee to write down important aspects of his or her new experience. One may use these notes to add to or further develop the training manual for future use.

Reinforce Training Lessons With Staff

   Consistent feedback is critical if one wants to maintain a standard of high-quality work, efficiency and staff morale. Unfortunately, feedback is often synonymous with negative reinforcement. There is a tendency to demand improvement and to discipline and “chew people out” when they make an error. Contrary to common belief, negative reinforcement is the slow and costly way to get improvement. This type of negative reinforcement gives managers the “illusion of control,” but not real control.    There is also the notion of positive reinforcement, doing things that cause employees to be excited about making improvements in how well they perform their job duties or tasks.    A manager should identify the behaviors that create high-quality or error-free outputs, develop a way to measure and monitor them, and then provide positive reinforcement for improvement. While it is important to stay on top of consistent or patterns of errors, one should also track desirable behavior, such as 100 percent collection of co-pays for a day.    After determining the behaviors and the results that one desires, develop a plan to positively reinforce the behaviors when one sees them and celebrate small incremental sub-goals along the way. Set small goals in the beginning so improvement is easy. This will allow people to receive the positive reinforcement that will create energy and excitement about improvement. Remember, the more positive reinforcement, the faster the improvement. Think of positive reinforcement in this case as any interaction with your employees that communicates that one likes, appreciates or values what they are doing.

Why One Should Emphasize Cross Training

   Cross training involves training an employee to do a different part of the organization’s work. Training worker A to do the task that worker B does and vice versa is cross training. Cross training is good for managers because it provides more flexibility in managing the workforce to get the job done. During times of absenteeism, it becomes the catalyst for continued efficiency. Cross training is good for the employees as well. It allows them to learn new skills, makes them more valuable and can reduce worker boredom.

Final Words

   Unstructured “on-the-job learning” is costly and frustrating. Developing and monitoring the results of a comprehensive training program, emphasizing positive reinforcement techniques and utilizing cross training will ultimately lead to enhanced efficiency, productivity, employee relations and patient satisfaction. Dr. Guiliana is a nationally recognized speaker and author on practice management topics. He is a Fellow and Trustee of the American Academy of Podiatric Practice Management and holds a Master’s degree in Healthcare Management. He practices in Hackettstown, N.J. and may be reached at (866) TEA-MSOS or (866) 832-6767.

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