Staffing Best Practices

Bottom line: Good staff management means hiring smart people and treating them with respect. Ideally, you can just get out of their way and focus on patient care.

If it's not working out like that, here are some things you might want to try.

• Match skill and skill level. It is a waste of money to hire well-trained, expensive staff-such as nurses-to do simple tasks, such as pull charts. Hire less expensive staff to do less complicated work in your practice. According to The Health Care Group, registered nurses with at least 5 years of experience made about $18.89 an hour in 2000; file clerks with similar experience earned only $9.79 an hour. If a file clerk pulled charts 20 hours a week instead of a nurse, that’s a savings of $182 a week, $9464 a year.

Keep in mind that thanks to poorly planned processes, staff sometimes end up doing tasks not included in their job description. For example, your nurses might be spending time pulling charts because the file clerks are also expected to answer phone calls and are so overwhelmed they don’t have time to pull the charts themselves. Look carefully at who is doing what-in real life, not just on paper.

• Hire a good manager. You can’t do it all yourself, and a physician’s time is best spent seeing patients-the activity for which you are best trained and the only activity you do that brings in money. Find a manager to handle staff matters on your behalf. A good manager is one who empowers staff and encourages high productivity, yet is disciplined enough to hold employees accountable for results. Look for managers credentialed through the American College of Medical Practice Executives or other organizations or who have experience in a medical practice.

• Prioritize quality improvement. Continually ask employees for suggestions on how to improve-then listen and act. Your practice will benefit by the improvement, and the employee will be proud of his or her contribution.

• Encourage regular social interaction to establish camaraderie. For example, set up a break room where employees can interact. Physicians can use the same break room-in too many practices, physicians don’t know the names of staff and barely acknowledge them. No wonder turnover rates are high.

• Establish policies for conflict resolution among employees. Don’t sweep it under the carpet-everyone will be affected by it.

• Don’t underpay. Keep on top of market rates in your community, and pay appropriately.

• Invest in training. A poorly trained staff will cost you money in the future. On the other hand, a certified coder can help you as much as it can help the employee who gets the certification.

• Establish lines of authority and accountability. Every employee should know for whom he or she works, and exactly what they’re accountable for. Clearly written job descriptions can help. If you’ve been using job descriptions, review them. If you haven’t, find out what each staff member is doing and, with their help, write a job description that makes it clear who should be doing what. It’s OK if some the job descriptions cross-that is, if several employees work on the same tasks. But make sure only one person is ultimately responsible for making sure a task is finished. Otherwise, if a problem arises, it’s too easy to blame one another. One person must be accountable.

• Conduct personnel evaluations on an annual basis-but first make sure personnel know what they are going to be evaluated on and what it means to their salary. Using job descriptions and annual or monthly goals specific to each position, detail for staff what you expect and how they can improve.

You might base some specific performance expectations on industry benchmarks or on performance in prior years. Annual reviews should be based strictly on these established expectations-not on a sudden mood or some new project. The reviews can be completed by one superior or a by superiors and anonymous coworkers and subordinates. Employees should have full access to all evaluations about them-these are meant to help them improve, not to be secret threats. Employees also should have an opportunity to respond to evaluations and the goals on which they are based.

Use the evaluation as an opportunity to find better processes, not necessarily to place blame.

Many better-performing practices now tie financial incentives to an annual evaluation-sometimes looking for strong performance by a team of players, sometimes for the individual, sometimes both. Be especially sure, if you choose this path, to define expectations clearly. There is no better way to make someone angry than to not pay them what they are expecting.

• Establish a standard, new employee orientation for every new staff member. Give them a nametag when they arrive; prepare a small, but written agenda that includes a tour of the facility, greeting fellow employees, and training; hand them a pamphlet outlining employee policies and procedures; and make sure they know how to use the phone, fax, and other equipment. Consider setting up an informal mentorship program; ask one staff member to always be available for answering a new staff member’s questions and for meeting with her away from work-say, for lunch once every 2 weeks-to find out how she is feeling about the job. Make new staff feel welcome, and they may stay around longer.

• Prioritize communication. For example, hold staff meetings each month. Don’t just talk in sweet generalities or focus on small stuff; let everyone know how the practice is performing, what’s going wrong, and seek advice from those in trenches on how to fix it.

• Celebrate accomplishments. Health care is an incredibly stressful arena, and we all spend a lot of time arguing and complaining. Stop to smell the roses; recognize what the practice-or individuals in it-have accomplished. Reward and recognize staff who earn a new degree or complete an important course. Post letters from happy patients or referring physicians. Show some interest in personal successes too-a triathalon completed or a son married.

• Establish work volume ranges. For billing employees, say how many total accounts receivable they are expected to manage. Nurses might have similar ranges for number of patients seen; for telephone operators, calls answered. With measurement, you can make sure all employees bear the work burden equally. One slacker can ruin the morale of many.

• Be strict about hours worked. Don’t turn your back to employees who consistently come in late or leave early; it’s demoralizing for the rest of the staff.

• Manage your overtime. Never allow employees to work overtime without compensating them-that’s illegal. On the other hand, you don’t want an end-of-the-year revelation that you’ve spent 50% of your total salary costs on overtime. You’ll have exhausted, resentful employees. Instead, you could have hired more help. Track overtime monthly so you know where you stand.

• Don’t play favorites. “Protected” employees can cost you a lot of money through a demoralized staff.

• Empower employees. When employees present you with a problematic situation, ask them what they would do before you respond with a solution. They will begin to think through the solutions themselves next time.

• Maintain written-and consistently applied-personnel policies.

• If you offer benefits to your staff, review the value of it to them. For example, often employees won’t recognize the value of retirement benefits.

• Consider putting staff incentives in place. Think incentives through very carefully; you get what you plan for. So, for example, don’t incentivize accounts receivable staff to process as many claims as possible, forgetting that they have to be accurate. You’ll just end up with lots and lots of denied claims. Ponder the consequences.

Also, try basing incentives on meeting or exceeding industry benchmarks-or at least internal goals-rather than on arbitrary numbers. That makes it harder for employees to say it's impossible.

Set tangible goals that are understandable. Don't give a goal that each employee doesn't understand. That's why you'll see a lot of successful plans have one goal: for example, collect $10 million this year.

Ask for input from staff for more buy-in. Often, management will consider a certain level of reward, and employees may decide on something lower. That is, you'll decide to set the incentive at $100 per month, and without telling them that you are budgeting for that, they'll say $500 per year is the number.

Consider team-based incentives-front and back office, across all clinics-to encourage teamwork and cooperation.

Money-based incentives work great, but so do pizza parties and movie tickets. Simple things often work better, and cause less angst than money.

Communicate the incentive plan plainly and in advance of its implementation-especially if you're talking about salary/cash incentives.

Don't monkey with you staff's income lightheartedly. Let them know what they need to do to meet the goal. Help them find solutions. And never, never, never change the goal at the end of the road. You'll never regain their trust.