Great staffing habits for a healthy practice
It is important to focus on both short-term and long-term issues involving practice staff.
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“I can’t expect loyalty from the Army if I do not give it.”
– George C. Marshall
“I’ll take 50% efficiency to get 100% loyalty.”
– Samuel Goldwyn
A client asked this week, “How can we do a better job with staffing? It seems we’re missing the boat with low performance, high turnover and so-so loyalty to us doctors.”
This great question is like a patient asking, “What’s the best way to preserve good health?” It is never one thing. It is a combination of things, altogether, end to end. Marathon-running vegan meditators who smoke still get cancer.
At root, you need a financially successful practice, so that the right number of top-flight staff can be affordably hired, ably managed and rewarded. Too many practices get into a vicious circle: Profits are low, so training, wages and nonmonetary forms of motivation are allowed to stagnate, leading to even lower business performance.
You get the picture. It is like the patient who is stressed about their poor health, so they drink to excess and then are too depressed to exercise. Here are 10 staff-focused “healthy practice” guidelines you can apply (hopefully as a bundle) for greater control over the destiny of your company.
Ten guidelines
1. Clear policies and values: Do you want to take the “infantry” approach and pay below market rates and align your HR practices accordingly? You can succeed by hiring a few extra staff, providing excellent training, applying tighter supervisory oversight and living with higher turnover, but saving overall staffing costs. Alternately, you can take the “Navy Seals” approach: pay premium wages, hire only superior staff and aim for a small, elite cohort of long-tenured professionals. Both approaches work, and both can be cost-effective, but they have to be applied consistently.
2. Professional management staff: Companies are built from the top down. The best technical assistants in the world will not do their best work unless they are led by an effective senior technician-manager. Your mid-level management staff should receive at least 4 hours a month of formal leadership and management training. Your administrator — no matter their level of seniority — should be formally mentored and receive 10+ days of continuing education annually, which can include site visits to well-run peer offices.
3. Consistent HR good hygiene: Before posting a help wanted notice, get the basics right. Write a clear position description and make sure your internal stakeholders (docs, managers, line staff) agree with its content. Take a formal search committee approach to important hires (department heads and above). Develop the largest possible candidate pool, and do not hire the first person interviewed. Test the top candidates for job-related skills. Learn all you can from references, especially comments about the most important skill of every service worker (including doctors): being nice.
4. Proper onboarding: Do not throw new staff into the deep end of the pool. Bond them with at least one peer beyond their direct supervisor. Connect your new staffer to the company emotionally. How? Have them watch surgery, observe postop day 1 and learn about the miracles we old hands too often forget.
5. Apply tough but fair supervision: Nothing I am writing here should be taken as a recommendation that you go easy on staff. Think personally about your favorite professors and bosses: Were they the easy ones or the ones who (fairly) held you to high standards?
6. A balance of easy and hard jobs: Give every worker, at every stage of their tenure in your practice, the right mix of tasks. The majority should align with each person’s individual competence and mastery — people love doing jobs they are good at. But everyone also likes an achievable challenge. Even for your most junior staff, build in opportunities for “just a job” to become a career.
7. Written standards: This includes training and operations documentation, your practice’s personnel manual, checklists and related accountability documents. All of these should be kept up to date and used as live documents — not just sitting at the back of a drawer.
8. Market-based compensation and benefits: It is a changing world. More health systems are launching eye departments and luring away private practice staff. Not too many years ago, $15 per hour was a pretty competitive wage for a receptionist. In some cities, that is the new minimum wage. Scan your community for trends and stay ahead of them. Make sure that your benefits are aligned with the age and career stage of your staff. If most of your workers are young, they will be focused mostly on dollars per hour. Older workers will be more motivated by pension benefits. Working parents (especially single moms) will value flexibility.
9. Monitor and constantly improve morale: People do not work just for money. They work for the feelings that only a great job with a great employer can give. This starts at the top, with something you can personally control as a physician: You should be uniformly positive in your interaction with support staff. The best how-to starting point is the now-classic Whale Done! by Ken Blanchard.
10. Staff subtraction when indicated: Only about half of all lay staff hires result in long-term employment. You should feel comfortable removing any staffer who does not fit your enterprise model, your tempo, your expectations.
Good practice health
Here is another way that the “good health” analogy applies. As a practice owner, you can do everything possible to increase retention and performance but still have an acute HR crisis, just like an acute disease puts a patient in the hospital. Despite your best efforts at great HR hygiene and following every guideline above, there can be several overlapping adverse drivers all operating against you and your administrator at once; all you can do is push through them:
- Today’s low unemployment rates, which now make staff more comfortable with the risks of changing jobs.
- Loss of a key staffer or provider who has been single-handedly elevating morale.
- Stagnant wages imposed by stagnant practice profits.
- A provider or manager’s inappropriate behavior (demeaning, bullying, harassing, etc).
- The formation of staff “cliques,” leaving outsiders unhappy.
Just like the patient whose health is going downhill, one HR problem in your practice can compound and turn into others:
- A long-term administrator retires and is replaced by an inexperienced one.
- This causes the head tech to join a competing practice and then start recruiting your best techs away.
- With fewer staff on the floor, the remaining techs are stressed, and the doctors are growling; practice morale declines in every department.
Just like a course of antibiotics can quickly put down an acute infection, in some practices, an acute HR crisis can be put down with a single action: Revising compensation. Restoring benefits. Hiring a better administrator. Dismissing one disruptive worker.
But more commonly, staff retention is not an acute problem. It is chronic. Just like the patient with diabetes who needs daily medicine along with proper eating and exercise to stay healthy, practices need to adopt a number of disciplined habits like those above to keep staff retention and performance high.
And finally, to complete the analogy with a patient’s health, some practices try to get by with the bare minimum of staff. The loss of a single worker leads to a crisis. (Like the super-lean elderly patient who succumbs because they have insufficient fat reserves to fight off an infection.) It is better to be slightly overstaffed and be able to get through the peaks than to be chronically understaffed and suffer through every challenging valley.
- For more information:
- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams, Simple: The Inner Game of Ophthalmic Practice Success and a new book, UP: Taking Ophthalmic Administrators and Management Teams to the Next Level of Skill, Performance and Career Satisfaction. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.