How to create a top workplace in a bottoming economy

Creating a safe, nurturing and upbeat work environment ensures staff loyalty and job satisfaction.

Corinne Wohl

Like many practices responding to stalled reimbursements, increased expenses and worries about the financial future of our practice, we recently implemented a wage freeze and tough employee benefit changes. These policies could have made us a less desirable place to work. But they didn’t. Instead, our 13-doctor, 68-staff-member practice was recently named a “Top Workplace” by our hometown paper, the Delaware News Journal.

You might not expect a cost-cutting organization in our challenged position to earn such a distinction, but that is what happened. Here is how I think we did it, along with 15 take-home lessons you can apply with ease in your own practice.

How it all started

Our doctors and senior management crossed their fingers and elected to participate in a survey offered each year by the Delaware News Journal. Twenty-five questions and a comment section were sent via confidential e-mail to each employee by a third party. Staff participants were given 2 weeks to complete the survey. There was a notification e-mail letter sent to each employee the day before the survey was distributed explaining the process and its confidential nature.

The rules were clear. The practice managers and doctors were not allowed to promote the survey in any way that could be interpreted as pressure to write a good review or disqualification would occur. Some of our managers expressed concerns since numerous questions focused on management support and performance. Some employees expressed concern that their comments and answers would be seen by the practice. To allay these fears, we sent out a letter emphasizing that the survey was being conducted by a third party and that the practice would never see the raw scores, just the final, anonymous results.

Once the results were independently tallied, the practice was notified that we had a 65% participation rate — considered high — and that we would be listed as one of the top workplaces in the state.

Although we were not aiming to win any awards, looking back on the past few years, we have identified as a team at least 15 important actions and behaviors adopted by management and providers alike that garnered this recognition.

Show respect and empathy

Doctors must respect staff and show empathy while making the difficult financial decisions necessary to keep the organization financially healthy and strong for the long term. Rather than share our thinking behind closed doors, we asked around widely for staff feedback and buy-in.

Have doctors set the tone

Doctors obviously set the tone for patient care, but they also establish the business philosophy of the group. Prioritizing patient care as our first goal creates goalposts for the staff to run and ultimately promotes job satisfaction. This is endlessly reinforcing. Happy patients lead to happy employees, which makes patients even happier, and so on.

Teach and encourage

Your own doctors, like ours, should be willing to patiently teach and encourage each employee to learn as widely as possible about not just their specific job but the full range of services we provide. Informed staff present themselves more confidently to patients, and constant learning makes the work interesting, not just a chore for a paycheck.

Have management staff set an example

Our strong commitment to enforcing policies and rules in a fair and consistent manner is critical to our success as a practice — and, perhaps surprisingly, to employee morale as well. Senior management operates with a proactive, positive, trusting perspective while setting high standards and stiff guidelines. We certainly did not win an award for being the easiest company to work for.

Listen and guide

Supportive midlevel managers listen and guide employees to see the whole picture, not just their portion of the patient pie. The emphasis here is on active listening. This takes time but wins in the long run.

Solve problems as a team

Teamwork in health care takes a lot of meeting time. Our management team is encouraged to solve their problems together at weekly meetings. Rather than having a collection of bright individuals, team problem solving is the norm. I am delighted when a manager without any direct involvement with an issue supplies an excellent solution. Sometimes being less involved allows for clearer analysis and creativity. So let your optical manager propose solutions for the front desk, and vice versa.

Work together as an organization

We like to blur the lines that normally exist between departments. This has to start with the individual managers; left on their own, they might instead build autonomous empires. Drive this concept through to the managers and expect them to work it down to line staff. Turf wars are highly detrimental to patient care and to team spirit. When everyone is working as a total team, make sure that the doctors and administrators show their appreciation to the entire organization, not just to one department.

Offer accessible management

Leaders must be personally accessible. Have an open-door policy. If you have provided clear policies, procedures and guidelines in general, an open-door policy should not equate to constant interruptions and distractions. Walk regular “rounds” throughout the office.

Build confidence with employees

Prove to your employees that their confidential comments will always be kept confidential. When the only way to improve a situation is to utilize the information they are providing, be up front and explain why. Whenever possible, interview many staff on the most sensitive issues, so it is plausible that any one of several people could have disclosed the uncomfortable truth. The best way to understand what is happening under the surface is to have employees bring you the information. They only do this if they feel safe and secure that the information will not be used against them or others.

Complete performance appraisals

Performance appraisals are provided annually in our practice. They are designed for discussion opportunities with future goals and expectations prioritized. Nothing in them should come as a surprise. Indeed, semi-annual appraisals are indicated in many settings, especially those with newer staff or quickly changing roles.

Empower the employees

The environment you create as a leader should empower employees to make the right decisions and do the right thing for better patient care. If something isn’t done exactly right the first time, it can be used to teach them for the next time. No matter how frustrated you may be with an employee whose recent performance disappoints, you will go nowhere belittling or taking their responsibility away. Build on performance from whatever their current level.

Create a nurturing culture

Do not be afraid to show that you care about the staff. Volunteer to walk them out to their car when it is dark. Ask about the status of a child who has been ill. If a slammed clinic kills the lunch break, bring in a mid-afternoon snack or hand out movie passes.

Conduct productive meetings

Weekly management meetings, monthly department meetings, quarterly all-staff meetings, task force meetings, doctor meetings … The complexity and zero-defects environment of health care necessitate a lot of meeting time. These should not just be dry sessions, and they are critical for team spirit. Long before I arrived at this practice, the quarterly staff meetings involved as much laughing as information sharing. This laughter bonds us together.

Encourage personal growth

Access to education and avenues for self-improvement should be strongly developed in your practice. Training and subsequent certification is a tangible measure of performance and self-worth, whether or not the practice can accompany these hallmarks with a pay raise. If your practice has to limit conference travel, provide local equivalents by teaming up with compatible colleagues in the area and bringing in trainers at a shared cost.

Be an inspiration

Inspire your workforce to exceed goals. The best bosses I ever had were the ones that inspired me to work hard for them every day — because I wanted to, not because I was fearful of any adverse consequences. They encouraged me in ways that made me want to be successful and effective for myself, not just for them and the company.

The bottom line is as simple as this: Your practice’s culture is an extremely important key to both patient care and business success. Doctors and managers who prioritize an upbeat, safe and nurturing staff culture create successful companies.

Remember that you have so many more tools for this than just salaries and benefits. Realizing this has always been important, of course, but will be increasingly so in the next decade. As the financial resources to pay escalating wages taper, non-financial tools are becoming a critical adjunct to practice management.

• Corinne Wohl, MHSA, COE, is the administrator of Delaware Ophthalmology Consultants and has extensive physician practice and hospital administration experience. She can be reached at 302-477-2646; e-mail: cwohl@delawareeyes.com.