Speaker: Go beyond raises to retain your practice’s good employees
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LOUISVILLE, Ky. — Incentives and communication are essential for staff retention and practice success in today’s economy, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“It doesn’t matter if you’re employed. It doesn’t matter if you own your own business. HR matters,” Priya Bansal, MD, FAAAAI, allergist and immunologist at the Asthma and Wellness Center in Saint Charles, Illinois, and a Healio Allergy/Asthma Peer Perspective Board Member, said during her presentation.
Retention challenges
Practices will not prosper unless the right people are in place, Bansal said, a truth laid bare by staffing issues caused by the COVID-19 pandemic.
“A lot of us had experienced a lot of turn-over, right? We didn’t have staffing,” Bansal said, noting that gaps left in the practice roster when people leave can impact production — a problem exacerbated when remaining staff who test positive for COVID-19 would be out for 10 days as well.
Finding replacements was challenging too, even though online tools made recruitment look easy as candidates expressed interest in open positions. Scheduling job interviews is a requirement to stay on unemployment, according to Bansal.
“They had to show interest in the job, but they would not show up for the interview. I would wonder why they would apply and not just answer my call,” Bansal said.
Payrolls have increased in order to stay competitive. Bansal noted that her medical assistants used to start at approximately $13 to $15 an hour, but these rates have crept up by about $5 an hour more. Bansal recalled one new hire who said she wanted an additional $2.50 an hour for her to stay on the job during her 90-day review.
“I need the people. I gave her the raise,” Bansal said. “Less than 30 days later, she said she was leaving because she got an offer down the street for $26.”
Small and solo practices face particular difficulties in competing against major hospital systems that pay higher base rates and award signing bonuses, not to mention industries outside of medicine.
“About 350,000 health care workers have left medicine. This also has been really difficult,” Bansal said.
The role of incentives
Bansal acknowledged that practices simply cannot throw more money at salaries to keep employees on the job, especially with inflation and reduced reimbursements from private and public insurance.
“We’re not making any more money, right? We’re making less money,” she said.
Yet hospitals now offer a range of benefits. Bansal cited a survey indicating how in the previous 3 months, hospitals have used wage increases (31%), recruitment increases (30%) and one-time bonuses (16%) to retain their nursing personnel.
Hospitals also have been cross-skilling or upskilling their nurses (10%), implementing flexible scheduling (4%), offering nonmonetary incentives (4%) and cross-skilling or upskilling their support staff (2%).
When practices have truly valuable employees who want more money to stay, sometimes they simply have to pay them what they want, Bansal said.
“I’m going to have to make a decision. Is this too much money for me? Or am I just going to have to cut ties with this person? But it’s really hard when that person is really good at their job,” Bansal said.
When raises are impossible, bonuses may be an alternative, Bansal said. They could be offered quarterly, for example, or based on performance metrics. And unlike raises, which impact the entire year, bonuses can be scheduled for when the money will be available.
Also, bonuses do not need to be cash. Bansal offers gift cards.
“If you’re making 95% of your collections for everybody that walks in that door, and all the accounts are on there, you get the gift card,” she said.
To compete with hospitals, small and solo practices also can cross-skill and upskill their nurses and other personnel, Bansal said. When there are coverage gaps because employees are out sick or have left the practice, personnel in the office then can more easily step into their roles.
Flexible scheduling is valuable as well, Bansal said, as it gives employees a voice.
“Let’s say you have an employee and you ask them, ‘What are your ideal hours?’ You get together and you look at the calendar. ‘Do you want to float? Do you want to work part time when you’re free to come on in?’” Bansal said.
A happy staff
It is not just about the money either, Bansal said. Burnout is another major issue, and clinicians need to see it wherever it is happening in their office.
“You have to recognize your staff is also very burned out. Your front desk staff. Your mid-levels. Your nurses. Going back to the office manager. Everybody is burned out,” Bansal said. “Every day, there’s somebody testy. Every day.”
More people are negative, Bansal said, including patients, who are much more frustrated about how much they pay for treatment.
“We saw our first $100 copay in the past couple of years. A hundred dollars as a copay to come see their physician. So, they’re testy. They don’t want to have a bill. They don’t want to hear it,” Bansal said. “You’re seeing a lot of this negativity increasing, and you need to recognize that it’s not just you. It’s your staff.”
Solutions begin with a system of checks and balances, Bansal said.
“Somebody needs to be able to talk to you,” she explained.
Practices need people who can recognize when tension is getting thick and then speak to those involved in a gentle and calming way, including the bosses, acknowledging their stress and providing constructive criticism.
“Who is that whisperer in your ear?” Bansal said. “Have them whisper to you when you’re being a little bit difficult. And vice versa. You need to know who’s the one who is the magic whisperer for your staff.”
Leaders need to make sure that these communicators can connect with others on the staff who need them, Bansal said.
“And don’t get them out of that place, because it is very hard,” she continued. “It is a time investment, because it’s hard to train and keep these good employees.”
Similarly, Bansal said practices need to get rid of the bad employees — the ones who generate friction and negativity.
“I learned this lesson the hard way. I lost quite a few people because there were a couple of negative people. And you don’t realize the impact of that negative person usually until it’s too late. So, cut them out,” Bansal said.
“My whole office changed the moment I cut out that one person,” Bansal continued. “After that person left, we started getting compliments online.”
Negativity breeds negativity, whereas positivity breeds positivity, Bansal said. The staff fed off each other’s new, positive attitudes, and the patients responded to the change in the environment.
“You started seeing that their leaving the office improved each other’s positivity. And what is that in turn doing? It’s creating that team culture. It’s really where you want to stay. That’s what you want to make your own. It’s that team culture,” Bansal said.
Practices can even use apps to track patient compliments and use them to reward the team, Bansal suggested, although a bedazzled jar on the front desk would work as well. When members of the staff get a compliment, it goes in the jar.
“When you get a certain number of them, then they get a reward,” Bansal said.
There are many nonmonetary things that practices can do to recognize their personnel and acknowledge their contributions, Bansal said, which makes employees feel valuable and encourages them to stay with your practice.
“Maybe you’re making them the team leader, or practice champion of the month,” Bansal said. “You can feature different employees and make them your champions.”
Solutions can come from the pocketbook or from personalities, Bansal said. But whatever the approach, she continued, employees need to feel like they are valued before the practice can truly succeed.
“The people you work with, that is your group,” she said. “This is what matters.”
Reference:
- Increased workforce turnover and pressures straining provider operations. https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/increased-workforce-turnover-and-pressures-straining-provider-operations. Published Aug. 19, 2021. Accessed Dec. 29, 2022.