Issues And Answers In Staff Management

Lynn Homisak, PRT

Managing staff members can add to the challenges that already exist in a busy podiatric practice. This author draws upon her experience to help resolve common issues such as conflicts over staff responsibilities and salary issues.

   Managing staff can be challenging. There is no doubt about it. Well, there are various reasons why it can be challenging but there are a couple of common factors when it comes to staff issues.

   First, doctors were never really trained to be managers. Without the necessary management training concepts and tools, DPMs may have difficulty facing the variety of potential stressful situations that can (and do) arise on a daily, sometimes minute-to-minute basis. As a result, doctors may avoid things. Doing so only exacerbates the situation and the associated stress.

   Second, for any one problematic circumstance that can arise, there can be several viable solutions. The prize goes to the individual who has the time, energy, patience and knowledge to find which solutions work and which ones do not. Again, because this position is many times by default filled by the doctor whose time is extremely limited, we can usually expect more stress.

   Third, staff members are a widely diverse group of individuals. They have different values, personalities, needs, genders, expectations, goals, motivations, opinions, attitudes, backgrounds, skills, etc. Staff members are successfully and unsuccessfully thrown together to work in close quarters every day, five days a week, and expected to produce on equal levels and without causing any additional stress.

   Since there is a possibility you may have encountered similar situations, I thought it best to address some common scenarios I have encountered.

When Resentment Over Duties Leads To A Staff Infection

   I spoke to one person who noticed that staff members are more and more intolerant of each other. There is constant friction between the front and back office, work is slipping, patients are noticing and the doctor is pulling her hair out. The doctor has no office manager and no time to deal with this. How can the doctor put this team back together and move on?

   Conflict between front and back office workers is a common dilemma and the uncooperative behavior can lead to various repercussions. Experience tells me there is a lack of awareness between these two groups that has never been addressed. That is where I would focus my initial attention.

   All too often I have seen what happens and how this conflict develops. The front desk, for example, has instructions to schedule patients every 10 minutes. However, because 10 minutes is not always a proper amount of time, the back office cannot efficiently handle the patient flow. Instead of communicating with their front office colleagues to question the scheduling logic or, better yet, help them understand that not every patient takes 10 minutes, the knee-jerk reaction from the back office staff is to criticize their actions.

   The front office staff take it personally and the next thing you know, things get out of hand. Cliques start developing. Rather than co-workers finding a solution, an all-out battle ensues based on nothing more than accusations, limited evidence and the emotional tension of whose job is more important or who’s right and who’s wrong. Clearly, each side feels it has a legitimate point. Without someone to take control of the situation, little happens to diffuse the anger and everyone around them, including the doctor and patients, suffer.

   If you see this “we work harder than they do” attitude develop, it is probably because people are only seeing things from their own perspective. My solution is to try letting them step into the other person’s shoes and experience for themselves the reality of the “other side.”

   I visited an office once that had unexpectedly lost two clinical staff. Purely out of necessity, the front receptionist stepped into an unfamiliar role to fill the void temporarily. She did so willingly, thinking this would be “a piece of cake.”

   After one week “on the floor,” she was amazed at all the clinical staff did. The firsthand realization of what the clinical staff needed to do to manage patient flow was eye-opening. She knew her own work could be stressful at times but immediately experienced a different kind of tension. She learned that trying to keep up with the schedule while assisting the doctor in providing patients with the best care possible was not as easy as it appeared.

   When things were back to normal and she resumed her front desk tasks, she had an entirely new mindset for scheduling. She recommended that everyone sit down together to strategize on how the front office staff and back office staff could work together to make things more efficient.

   This brings us back to the broken process. Obviously, not every podiatry patient takes 10 minutes and it is unrealistic to expect that a predetermined block of time can efficiently accommodate each and every patient. No wonder the back office staff is struggling.

   Receptionists should learn to triage and schedule appointments according to the complexity of the visit. That includes understanding the condition, the treatment plan, the patient and whether there is physician extender (staff) assistance and adequate equipment available. It should not be based on how many slots are in the scheduler or how many rooms you have that can be filled in an hour. It does not matter whether the patient waits in your reception room or goes back to wait in a treatment chair. The fact that he or she is left waiting depicts poor patient management.

   Remember, if you cannot measure it, you cannot manage it. Perform a time and motion study, find your areas of weakness and make the necessary adjustments in your system.

   A house divided cannot stand. Your staff should know upfront that you will not tolerate continuous infighting. Consider hiring a trained office manager to deal with these and other critical issues. Going to work each day should be a fun experience, not a stressful one. Strive for a better understanding of each other’s efforts, a better handle on your processes and having a person at the top who can effectively manage these types of situations. By adequately addressing these issues, you can spend your valuable time doing what you do best: treating patients.

Key Pointers On Ensuring Proper Phone Etiquette

   Another doctor was shocked when he heard his receptionist speaking on the phone the other day with a patient. The receptionist not only gave the patient wrong information but argued with her about her bill. This DPM cannot be at the front desk to monitor every call that comes in. How can one be sure the staff is properly handling phone calls?

   Customer service takes on a lot of different forms in our practices and the telephone is one factor with the most impact. If you are “all about customer service,” you are familiar with the theory which states that one dissatisfied person will likely tell nine or 10 other people about their poor experience. Those are numbers you do not want to see multiply.

   Knowing your staff possesses the power either to draw your patients in or chase them away, putting the right person in that seat becomes all that much more critical to your practice building efforts. Your receptionist is responsible for delivering that first impression. For a new patient who may not yet be exposed to your skills as a physician or your charming personality, that is a tall order. Greeting every caller as a welcomed guest requires a constant, conscious effort on the receptionist’s part, not just when the receptionist feels like it.

   It amazes me that even though doctors willingly hand over such a significant task to their staff, they do so without making proper phone etiquette training a mandatory requirement for the job. Sure, everyone is familiar with answering the phone but that does not mean they are qualified to do so.

   If the aforementioned receptionist had been given proper training (or a refresher course), she would know that arguing with a patient over a bill is inappropriate. It is true that many times patients drive us to our limits. Instead of reacting in a defensive or angry way, trained personnel would know exactly how to communicate with this individual and follow proper protocol toward a successful outcome. Going head to head with the patient is clearly not the right path to take. It only tends to irritate the patient further.

   As a rule, a patient calling to complain about a bill is not meant as a personal attack. He or she wants information. If staff members know enough to remain calm, control the conversation (with open and closed questions) and provide them with answers instead of a runaround, they can easily take the phone call in a more constructive direction.

   If you are suspicious that your staff is mishandling your phone calls, try disguising your voice and call the office yourself. Hear what your patients hear. What should you be trying to discern?

   • Is the receptionist answering your phone in a friendly, helpful, polite way?
   • Is your practice name clearly identified?
   • Does the receptionist put you on hold (without your okay) and then leave you there for an eternity? Worse yet, are you disconnected?
   • Do you get wrong information to a question?
   • Do you get medical advice from the receptionist?
   • Does the receptionist make you feel that your call is not important or that speaking to you is an inconvenience?
   • In the end, did you feel the call was worth your while?
   • Finally, would you call again?

   If you think this tactic is sneaky, go ahead and warn your staff that you will be calling anonymously. They are either going to know their stuff or not. If they cannot appropriately handle the call, then they should not be in that seat or they should receive better training. On the other hand, if they can handle it, it is yet another reason to praise and congratulate them for a job well done.

   In addition to training, if you are going to put someone in that “hot seat,” please give him or her the proper tools to succeed. One of those tools is scripting. Having a pre-rehearsed response (practiced enough so it can be delivered naturally) ensures the following:

   • your patients are getting accurate and proper information;
   • responses are consistent among all staff;
   • the staff can handle a majority of the calls without interrupting you; and
   • there is better flow and efficiency with the elimination of repeat patient calls at the front desk.

   We do not want to see you lose your patience or your patients. Making appropriate changes now can help put your practice in the “customer service spotlight.”

How To Resolve Conflicts Over Salary

   Another DPM notes that even though there is a solid policy in place that disallows staff from sharing wage information with each other, several staff members have been comparing salaries.

   After confronting two staff members about their sudden obvious decline in productivity, the podiatrist learned they were not happy with the fact that they are making less than their co-workers even though they felt they were working as hard. This is exactly why the DPM developed a “no-tell” policy but what good is it if no one follows the rules?

   Salary should be a private topic in and outside the workplace regardless of the context. Even though you claim to have a “solid policy” against your staff discussing wages with each other, I can assure you sure that nothing is 100 percent foolproof. My advice to employers is to take an honest and fair approach when determining compensation and if the time ever comes when you are challenged, you will have nothing to hide. Let me expound on that a little more by asking a few questions.

   • On what criteria do you structure your compensation?
   • Do you have a process for increasing salaries?
   • Do you offset base wages with additional perks/bonuses?
   • Do you make the time to help your staff understand their total compensation?

   Doctors need to create their own reasonable wage structure based on the specifics of their practice. However, more often than not, weak alternatives (guesswork and inappropriate colleague recommendations) end up establishing compensation. The idea that you can pull a dollar amount from thin air certainly does not hold water when you are asked to explain to Joan why she is getting $5 an hour more than Mary, when they both started at the same time and have comparable job descriptions.

   Since the tasks delegated to staff are too wide-ranging from office to office, it is equally illogical for doctors to adopt the same salary ranges as their colleagues. While they indeed can be influential, there are far too many factors that would need to match up perfectly to make that a reasonable solo determinant.

Six Criteria For Establishing Policy On Employee Compensation

   To avoid all the pitfalls associated with an inequitable system, I recommend using the following criteria when it comes to setting policy for employee compensation at your practice.

   Your personal salary philosophy. Is it your intention to attract a more qualified individual or do you lean toward paying little and expecting little in return?

   Do you think of your staff wages as a “cost” or an “investment”? If you are unwilling to offer staff a fair compensation or feel like wages are sucking all the profit out of your practice, it is unlikely that your practice will attract high quality staff. If you do have quality staff, retaining them may be a challenge.

   The performance of the practice. Is the practice prosperous or are you just surviving? If it is the latter, are you satisfied with these conditions? Some say if you want to grow, you need to invest in your employees.

   What the specific (podiatry/ healthcare) market bears. With this criteria, you can consider your colleagues’ advice (not take it as gospel) but certainly do your own research as well. In the last salary survey I took in 2007, based on approximately 500 podiatric professionals, the average salary for a staff person working in a solo podiatric practice between one and five years in a middle-income, suburban location was $12.52 per hour.

   I cannot emphasize enough that the position of podiatric medical assistant, for the most part, remains uniformly undefined and has a number of diverse job descriptions nationwide. This average salary remains a static figure and does not apply to everyone.

   Still, to my knowledge, it is the only “market figure” reference available to our profession. If your base wage compensation for staff is already set, it would be unfair to reduce it to match this number. If you have good staff, do what you can to keep them. Pay them what they are worth, not what statistics dictate.The current economic crisis. How is it affecting you or the neighborhood in which you practice?

   Internal assessment of job analysis and employee performance. How much work do you delegate to your staff? How much responsibility do they bear? What specifically have they contributed to the practice in terms of productivity?

Pertinent Insights About Giving Raises To Staff

   That last point is a lead-in to our next comment on wage increases. While there is a lot to be said for employee commitment, it should not be the sole reason for a wage increase. Often, though, it is the sole reason.

   After a while, the employer may feel “stuck” giving the employee an obligatory annual raise and eventually the generous, repetitious increase turns into resentment. Wage increases should be based on performance using examples, facts and accomplishments, not opinions, feelings or emotions. In particular, do not use your personal hardships as an excuse. Your staff can easily argue against that with their own financial responsibilities.

   A well-rounded review utilizing a valid point system will allow you to objectively determine if they have reached the standards of productivity to warrant a base wage increase. Be sure to use their written job description as a guideline.

   Many employers, in an effort to not “lock” themselves in to annual cash raises, offer their employees alternate pay options such as profit sharing, bonuses or days off. These options, depending on the employees’ personal situation, may actually be a more attractive offer. A profit sharing plan that ties employee productivity to the practice’s profitability gives staffers the opportunity to take “ownership” in the success of the business. This kind of incentive can translate into success for both the practice and the employee.

   It is important to understand that what motivates one individual may not necessarily motivate another. Accordingly, it is worthwhile to openly discuss potential options with your staff and ask for their input by prioritizing their wishes.

   Annual employee reviews will also help you align your wage increases with performance. If you feel avoiding these reviews will avoid opening up a can of salary increase worms, you are not properly managing your staff. Do not be afraid to have that discussion. Staff members deserve (and want) to know how they are doing. They also deserve to know exactly how much you invest in them.

   One can convey this by outlining and making visible an annual compensation worksheet. This will explain how every perk (days off, insurance benefits, taxes, bonuses, seminars, uniforms, paid meals, gas allowance, parking, etc.) offered comes with a price tag and contributes to the value of that employee.

   In other words, it is not just the dollar/hour or salary amount they take home every pay period. It is the whole package. By paying your employees fairly and taking wage concerns off the table, they get an opportunity to redirect that potential negative energy into positive work performance.

In Conclusion

   Many doctors have confessed to me that managing staff is not all that easy and I believe that is true. As I have discussed, there are many variables that all need to work together. Add to that the diverse personalities and attitudes, and it is no wonder that doctors sometimes feel a loss of control. That said, if half as much time, effort and resources went into staff management as goes into patient management, it would not be all that hard either.

Ms. Homisak is the principal owner, consultant and coach of SOS Healthcare Management Solutions, LLC. She has a certificate in Human Resource Studies from the Cornell University School of Industry and Labor Relation. She is a Fellow and Past Vice President of the American Academy of Podiatric Practice Management, and frequently lectures on practice management issues.

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