By Cinda Cannon,  May 01, 2013

Your front desk staff are pivotal, critical, and of the utmost importance. They are the voice and face of your practice. They make that indelible first impression on patients walking through your office door. Your front-desk staff can make or break your practice. That’s right — this crucial role is held by your receptionist, an employee you’re most likely not paying very well and perhaps don’t even talk to very much. You may want to change your ways.

Key points to consider

The front desk person has the single greatest influence on patient satisfaction, even more so than those who actually provide the patient care. If the patient has been well received at the front desk and made to feel that you’re glad they’re here, by the time they get to the examining room, half of the work of satisfying them is done. Patients who have been treated poorly before seeing their physician don’t rate their office/clinical experience very highly, no matter how well their physician has treated them. Unsatisfied patients are less likely to comply with treatment plans, so this has a clinical impact as well.

What key points should you be conscious of? Here are a few to consider:

• What is the attitude of your staff when your patients are greeted at the check-in?
• What is the response time of your staff regarding a simple request or patient report?
• What is the response of your staff to a patient when a bill is due or overdue?
• How satisfied are outside physicians and patients with your specialty or office? [pagebreak]

Know the answers to these key points. This will help you assess your cultural strength. The point is simple: Culture determines brand. The manner in which your office treats team members or employees indicates how they may treat patients and physicians. Setting the right tone, creating the right incentives, and leading by example will help reinforce your desired brand in the marketplace. Let’s face it — you are competing for that new patient to come through your door and not the door of another provider down the hall or street.

What to consider when hiring for these positions

The first thing to remember is that experience tells us that candidates who look great on paper can turn out to be a disastrous hire. Why is that? The answer is simple. It comes down to cultural fit, the ability of an employee not merely to be able to do the job, but also to have the attitude and personality needed to work with others and further the goals of the practice. Landing the right person who has all the elements that you need is a difficult process to get right even for the more tangible measures that you can verify and/or test. The intangibles, such as cultural fit, are even more difficult. I challenge any manager with any degree of experience to tell you that they have gotten it right 100 percent of the time. (For elaboration on this point, see last month’s feature, “Team players.”) A key point to consider when seeking the right individual: Look beyond technical skills and find candidates who fit the practice’s culture and goals. Physician groups need to assess their own cultures, determine their needs, and identify the employee characteristics that are most important. Getting a cultural fit right is difficult, but it’s not impossible. [pagebreak]

Keep in mind that cultural fit is not about filling a workplace with employees of one ethnicity, race, religion, gender, sexual orientation, political affiliation, or age. Looking at cultural fit that way would get a medical practice into legal hot water! Cultural fit is about identifying possible negative traits, such as who is most likely to irritate co-workers and patients, and positive traits, such as who will make the practice more efficient. Most employees will work well in at least some settings, but will they work well in yours? What is meant by hiring for cultural fit is hiring for the intangibles. It’s everything that doesn’t fall into a resume or job application. You must look outside the box. Keep in mind, if it’s not a fit, they’re not going to last. If you are not happy, then your patients are not going to be happy.

Identifying a practice culture

The second step for those hiring is to take a look at the practice’s culture. The assessment should include identifying your vision, mission, and values. What is it really like to work here? Most practices will say they have a compassionate team atmosphere, but what does that really mean? Not every practice has thought through this, but the really successful practices have core values. They’re very clear about what their own culture is, what they are trying to accomplish, and how they do things.

Does teamwork mean that employees pitch in when appropriate? Or is it more that they work individually toward a common goal? Do employees compete or collaborate with one another? Is it a tough competition or jovial? Is it a casual or formal atmosphere? None of these scenarios is necessarily wrong, but depending on the potential employee, it may not be a good fit. [pagebreak]

Some practices are very corporate, with very strong policies and procedures. They’re very structured. Then there are other practices where it is very family-oriented. People know each other’s families. That doesn’t mean it’s not a well-run practice. It’s just a lot more social.

Other aspects that translate to workplace culture: Is it a small practice where everyone is required to juggle multiple tasks? Or is it a large one, where employees are expected to innovate but not push much beyond the limits of the job description? Is it a high-stress workplace, or does it have a slower pace? What kind of decisions will employees be expected to make on their own, and when should they seek approval? Do employees hang out together outside of work? Is the work/home balance a priority? Do people clock in and out at set times, or are hours more flexible? Does the practice promote from within? How is achievement rewarded? Is this done at the group or individual level? How do you hold employees accountable? What are the lines of communication? Is it face-to-face or electronic?

Communication is always something that every practice wants to say they do well, but people all communicate differently. Practices also need to consider that the culture will vary depending on how separate various departments are from one another. The physician’s personality usually sets the culture for his or her staff, although that influence may differ depending on practice structure. Some physicians may give a lot of direction and want to control as much as possible. Others will give their staff more autonomy. I caution you on too much of the latter. [pagebreak]

Then there are some physicians who are very strong micromanagers. If the employee doesn’t like to be micromanaged and doesn’t need a lot of direct supervision, they are going to be driven to seeking other employment. The same is true for those who need a lot of direction but are working for a hands-off manager. This usually comes from the physicians themselves. They need to know what their culture is or at least what they want it to be and communicate that to all employees.

Meeting the practice needs

The third step is to consider your office needs. A good cultural fit does not mean that all employees working in a particular setting are the same. Rather, they work together. An example of this would be a practice that was performing poorly until it identified a new employee who could fit in with the compassionate atmosphere but, unlike other employees, had no hesitation about asking patients to pay their bills. This new employee loved the patients, and loved asking them for money in a very polite and professional way. She was able to coach the others at the front desk to do the same.

The practice might want to go in a certain direction but can’t without the correct mix of staff. Does the practice need more employees who work steadily to counter those who work more intensely but take more breaks? Maybe the practice needs more innovators to balance out those who follow orders well.

Selecting the right candidates

The last step, after a potential candidate has been identified, is to ask him or her open-ended questions during interviews that may indicate fit. If a new hire is not the right fit, then the right questions were probably not asked in the beginning. [pagebreak]

If compassion is a priority at the practice, have the candidates give examples of times they have been compassionate inside or outside the workplace. Ask, for example, how they worked as a team. How did they deal with challenging situations? How much experience do they have with a particular type of practice? Experience at only larger practices should not disqualify someone applying at a smaller one, but it may be worth asking how he or she will adapt to the change. Always find out what their strengths are regardless of what they have done in the past.

Applicants should have a minimum of two interviews, although more may be needed for higher-level positions. Additional interviews should include questions about handling potential stress and how applicants view autonomy. Are they looking for a position that will lead to promotion and more responsibility? Can the practice offer that? Or are applicants looking for a more stable job with less advancement? Does the practice’s policy on rewarding employees for good work match the applicant’s expectations? How do employees manage their time and hold themselves accountable? How do they communicate?

The good news is that cultural fit does not have to be handled perfectly. A particularly bad match can increase turnover and reduce productivity and morale, but a slight mismatch may be addressed through additional training. The new hire does not always need to be let go. The key is to get as close of a fit as possible. Invest the time and the outcome will reward your practice. People can be brought around with the right coaching and training when it is not an extreme mismatch.

Want more guidance on this topic? The AAD offers two manuals:

• The Dermatology Employment Manual: A Guide to Personnel Policies and Procedures, and
• The Office Policy and Procedure Manual: A Guide for Dermatology Practices.

You can learn more about both at www.aad.org/store. Additional reading, and one of my favorites, is The Complete Idiot’s Guide to HR Management by Arthur R. Pell, PhD.