By John Carruthers, assistant editor, April 02, 2013
An experienced, efficient practice team is at the heart of most successful medical practices. Assembling the right employees, keeping them well-trained and continuously educated, and generating their long-term commitment to the practice is key to maximizing the potential of one’s office.
Setting the tone
When assembling a team of employees who can each spend upward of 2,000 hours in your practice every year, it’s important to find people who fit into a practice’s established culture. Just as no two physicians have exactly the same personality or practice style, no office team is without its unique processes and personalities. For Beverlyjean Jenkin, who has administered four specialty practices and has been in physician office management for over 25 years, finding the right candidate for an office’s culture, preferably one with strong communicative ability, is the foremost concern.
“I’m constantly looking to find people who are team players who can fit in with the unique group of people already in place at the practice I’m hiring for. Dynamics change depending on the practice and the managerial style of the physician and the office managers and administrators,” Jenkin said. “I’m looking for good communicators. It’s very important that you can accept a critique well and you can act as a part of a group.” [pagebreak]
With the Internet-driven sea change in recruitment tactics, generating the right candidates, as well as the right number of candidates, takes strategy on the part of those involved in hiring. While generating a healthy number of candidates for a position is the desired goal, it’s important to not overwhelm oneself — something that can be alarmingly easy, according to American Academy of Dermatology human resources manager Liz Tisch. According to the U.S. Department of Labor Statistics, there were 3.3 unemployed persons per job opening as of November 2012. Between those out of work and those actively looking to switch jobs, hiring managers can find themselves overwhelmed if they don’t tailor their search somewhat.
Referrals from employees, especially those active in professional organizations, can often identify qualified candidates quickly. For those who wish to promote a job opening in a more public fashion, Tisch said, the Internet offers thousands of potential candidates. The sheer volume of candidates is often an obstacle to consider when going this route.
“Online ads work great, but if you’re hiring for general positions, you tend to get a flood of applications. It can become unmanageable. If you’re posting a position on a specific site for coding specialists, you won’t get the volume that you would get from a general job board. You’ll get candidates specifically from that area of the profession,” Tisch said. “If you’re having trouble generating candidates through referrals, colleagues, or specialty sites, job boards are the way to go. Just know that you’ll have to spend a lot of extra time sifting through resumes.” [pagebreak]
Once the interview process has progressed (see sidebar), it’s important to gauge how potential employees will interact with their potential future co-workers. Rae Stapp, practice manager for the Skin Cancer and Dermatology Center of Colorado Springs, brings candidates in for a half-day of work following successful in-person interviews. Since beginning this practice five years ago, she said, both staff and candidates have expressed appreciation for the way it provides a clearer picture to both candidates and existing staff of a potential new hire’s suitability to the practice, and vice versa.
Once a candidate has been approved, Stapp said, the training process is carefully documented. For clinical employees, her practice has skills checks during the process wherein each trained task is demonstrated for and signed off on by a physician. For each candidate, the physician and office manager start with the employee’s education, listed skills, and a documented demonstration of their ability to perform each duty of their job. From there, she said, it’s easy to benchmark performance against expectations and offer additional training or feedback tailored to the employee and practice needs.
Maintaining the balance
Once the right staff is in place and the practice is running smoothly, according to Jenkin, it’s important to recognize the effort necessary on everyone’s part to maintain that efficiency. Continuing education, she said, provides a vital process for keeping professional and interpersonal skills sharp. [pagebreak]
“My thought on continuing education for employees is to have it available constantly to all employees,” Jenkin said. “I’m very big on lunch seminars and continuing education allowances. I’m honestly not interested in having anyone on staff who doesn’t want to be part of a professional association. You need to invest in your employees. They’ll invest in your practice and its success.”
In addition to keeping the option of professional education open to employees, it’s also vital to keep the lines of communication between levels of staff open at all times. For Louise Tillery, practice manager at Blue Skies Center for Women in Colorado Springs, Colo., the time spent following through on a true open-door policy repays itself in fewer misunderstandings or inter-employee conflicts that otherwise might simmer for weeks before causing problems for the practice.
“My office is located where I can see the front office, so I hear the interaction between the patients and front office and when you keep that ear to the ground, you learn a lot. With the back office, we have one lead medical assistant, and I’m constantly talking to her. Listening to these areas helps me decide what to work on or fix in the practice. I always involve the people from the areas involved before I make any decisions. They’re going to be doing the work based on my decision, so I feel that they should have input in it.” [pagebreak]
Stapp, on the other hand, takes a more formalized approach to employee feedback. Each week, every employee is required to schedule and attend what Stapp calls a “five-minute meeting” with her. During these meetings, which she says can actually last anywhere from 30 seconds to half an hour, she’s able to get a feel for current professional, practice, and/or interpersonal concerns. Employees are allowed to talk about whatever’s on their mind, which Stapp feels helps head off any personal or professional resentments lurking under the surface.
“I keep a notebook and track these meetings so nothing ever gets past a week. We did have an interpersonal issue happen last week in one of our departments, and one of the parties said they’d like to come in and sit down with me. We did that last week, I brought in the other party, and they talked it out, basically worked it out themselves. That doesn’t resolve itself so quickly without them knowing that I’m available to hear their concerns and address them.”
In addition, Stapp said, regular meetings with staff also allow managers to provide job-based feedback with immediacy. [pagebreak]
“Before I started this policy, when you would sit down with someone every three months, every six months, or yearly, it wouldn’t be as appropriate to bring up something that happened months ago,” Stapp said. “It makes my job a lot easier to deal with any issues on a weekly basis, before they develop into problems for the practice.”
Keeping essential employees
Hiring, training, and maintaining open communication with employees are all vital factors in building the right practice team, but truly successful practices also focus on retention of their best and brightest employees. While tactics differ, managers across the board agree that positive reinforcement and the ability of managers and owners to listen to employees provide the best foundation for employee retention.
“Keeping your best employees happy is all about communication. It’s my job to give the pats on the back and to commend people and talk to them regularly to make sure they’re happy,” Tillery said. “I do it by acknowledging the work that my staff does, by being open and honest with them on changes, by telling them as soon as I know something big is coming down the road, like our coming EHR upgrade. It’s only fair. Being as up front as I possibly can helps their morale.” [pagebreak]
Employees who have proven indispensable over the long term, Stapp said, can sometimes be trained to offer new benefits to the practice outside of their original job description. Adding additional responsibilities, she said, can uncover hidden potential in some employees. One employee in particular, she said, had been a dependable receptionist for over a decade when she and the practice’s physicians decided to offer her the training and opportunity to become a certified coder. She now runs the practice’s insurance department and patient accounts, confirming management’s decision to give her the opportunity to grow beyond her proscribed role.
“We’ve had employees who just didn’t fit in, like any other practice. They felt like it was too busy, or that there was too much work for them to catch on to,” Stapp said. “But we’re also very good at paying attention to what our people are good at and giving them opportunities to excel.”
In the end, Stapp said, it’s the intangibles that come with a well-run office where colleagues respect each other that go the longest way toward retaining a practice’s most valuable employees. [pagebreak]
“I worked at an ophthalmology practice before my current position for 12 years, and I told myself when I left there I wasn’t going to stay at another practice long-term like that,” she said. “Of course I came here and have stayed 18 years. If your staff feel proud of where they work and take pride in the kind of care provided by the physicians, it makes them want to stay.”
Efficiently recruiting, identifying, and interviewing suitable candidates for openings, especially in smaller practices, is of paramount importance in keeping a practice running smoothly. Liz Tisch, the American Academy of Dermatology’s human resources manager, advises hiring managers to focus entirely on job duties and concrete experience when evaluating candidates. She provided a number of tips followed by experienced human resources professionals and recruiters that can help physicians and office managers post a position and successfully interview for it.
- Creating an accurate job description reflective of the position, she said, comes down to a formula that identifies necessary skills, education, and experience while avoiding information overload.
“You want to first think about the duties and responsibilities that the person will be doing on a day-to-day basis. Once you have a good sense of that, I would recommend having no more than seven to nine of the essential duties listed on the job description — if the duty is listed, it should make up at least 5 to 10 percent of what the person will be doing,” she said.Once the minimum qualifications are set, it’s important to set a baseline for the knowledge and abilities required of the candidate.
- “Do they need to have good communications skills? Previous practice experience? Database or specific software abilities? This is where you want to set the minimum levels of education and professional experience.”
- In evaluating resumes, Tisch said, look for concrete experience. A resume that reads “expert coder” tells the hiring manager far less than “reduced coding errors by 10 percent at previous position.” People who can point to concrete examples, she said, should be considered for a face-to-face interview.
- During the interview process, Tisch said, the most vital part of evaluation is stepping away from personal biases and focusing on the attributes of the practice and the candidate.
- Likewise, Tisch said that keeping the discussion job-related, instead of looking for commonalities between interviewer and interviewee, will ensure that a clearer picture of the best candidate will emerge from interviews.
- “People naturally want to find common ground. And that’s fine, but at the same time, you don’t want to look more favorably on someone because they’re like you in certain ways — young kids, animal lover, etc. That doesn’t help the interview in any meaningful way.”
- Assumptions about candidates should be avoided, she said. Even just looking at the name on a resume and making assumptions about age is biasing and potentially discriminatory. Likewise, avoiding older candidates for a perceived lack of computer skills runs afoul of equal employment law. A good general rule, Tisch said, is “don’t assume anyone can or cannot do something without asking them first.”
- Solicit feedback on the hiring and training process from the candidates, both immediately following their hiring and further into their employment. It’s important to look at both good and bad hires and identify the factors that affected their recruitment, training, and integration into the practice.
“We’ve all going to have great hires and we’re going to have hires that don’t go very well. You’re going to have to take a step back after the really great hires to ask what we did correctly and what made the hire successful. Ask the employee about their experience,” Tisch said. “It’s never simply the case that the candidate didn’t work out; it’s always a two-way street. When you have a bad hire, ask yourself, were you realistic with the job responsibilities and tasks? Did they have a clear understanding of the position? Communication is the most important part of improving the hiring process.”
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