Posts Tagged ‘Employee’

Larry Silver

Making Financial Arrangements

Posted by Larry Silver

Ensuring Your Office Gets Paid
It is the responsibility of the accounts manager to sit down with the patient/client and work out the best financial arrangement within the framework of the policies of your office. Bear in mind that the ideal plan would be one that facilitates the most immediate payment for service rendered. One would not offer a plan that stretched payments out over a long period of time unless there was no other option that the patient could afford. Firm financial arrangements must be made with patients/clients.

It is most advisable to have only one person discussing payment options with your patient/client and this should rarely, if ever, be the doctor. The doctor should present his case recommendation, and if necessary, briefly outline the general payment options, but without getting into the actual financial arrangements (it is always best if the accounts manager is the only person discussing money with patients/clients).

Once the doctor has presented his treatment plan, he should then tell them that his accounts manager will make the actual arrangements. He should then leave the room and quickly acquaint the financial person with the case, including how soon the first appointment (or several appointments) should be; how much time he will need scheduled for the appointment(s); the total fee for the services the patient/client has accepted.

The accounts manager would then meet with them privately to make the financial arrangements. They should begin by seeing to it that the first appointment is scheduled, and then introduce the topic of finances. A good approach is, “How do you want to pay for this today?”

The accounts manager would strive to secure payment in full, but if necessary, would go over the other options that are available, illustrating with dates and amounts.

Don’t force a person into a hasty decision. If he/she needs time to review his/her finances, then simply write down the total fee and the methods of payment available. Schedule another conference to complete the financial arrangements.

Once the accounts manager and the patient/client have decided on a method of payment, the “agreement” should be summarized in writing, with dates and amounts and have the patient/client sign it. Give a copy to the patient/client.

It is advisable to then send a letter to the patient/client after the meeting, congratulating them for going ahead with your services and outlining the financial agreement again, offering assistance if they have any questions.

Always discuss fees and payment options in a very clear manner with the patient/client before providing any services. It is important to work with them so they have financial arrangements that they feel they can abide by. They will feel better about being your patient/client when they know that you have really worked with them, and that together you have made an agreement which is workable.

Publicize any new payment plans that you institute. You can put a sign in your reception area that says “Ask About Our Payment Policies”. You could also mail statement stuffers which include payment information for your patients/clients. Put together a practice brochure that explains your payment policies. Instruct your front office staff to discuss new payment plans with every person at his/her next appointment (only if appropriate).

The accounts manager’s job does not need to be difficult, time-consuming and frustrating if it is done in an organized and efficient fashion. Two of the most important factors are:

  1. Having firm financial policies
  2. Making sure that the patient/client understands and agrees to his/her obligation


Larry Silver

From the Editor: Hiring, Orientation and Firing: A Constant Struggle

Posted by Larry Silver

It’s amazing how prevalent issues involving hiring and firing personnel can be across a spectrum of vocations. As probably the only practice management publication that conducts ongoing surveys of doctors in various healthcare professions, our surveys continue to document the immense stress involved with personnel issues in private practice.

Every day our surveyors find doctors who know they could have more efficient and productive practices were it not for the various personnel problems that they have to deal with. Unfortunately, one or two bad apples in a practice can undermine the constant efforts on the part of doctors to expand their practices. Decent employees suffer for it. Our surveys show this over and over.

Such situations often come down to lack of any know-how on how to properly hire. How do you get that dream employee? How do you offload the employee who spends his/her days surfing the Internet, daydreaming or being generally non-productive?

In this issue, we provide some successful practice management solutions for the screening and hiring process when looking for productive employees. We also provide information on how to terminate the bad apples. You’ll also learn about how to best orient a new employee to your practice with the least amount of downtime.

As usual we also provide news articles from a range of sources that we hope you find interesting and useful. Additionally, our profiles of three different doctors will provide a cross-section on how practice management consulting can help with staff issues and be a real boon to one’s success.

I’m also putting out a call for any of our readers who are interested in sharing their experiences. We’ve had, in past issues, great contributions from some readers. We would like more! Please let me know if you are interested in contributing any articles about your practice and/or health care management issues for inclusion in Practice Solution.

Sincerely,

Larry Silver

Managing Editor

The Practice Solution Magazine


Larry Silver

Applicant Screening

Posted by Larry Silver

The Group Interview
Finding a new employee is a very time consuming process. To consolidate efforts and streamline the initial stage of the interview / selection process, have all the applicants who meet the basic criteria come into the office for a “group interview” session. The purpose for this is that it consolidates the office manager’s efforts, giving you an opportunity to get a look at the applicants and screen out those whom you do not care to invest any more time in. The finalists from this segment will then be invited back for an in-depth individual interview.
Once you have collected all of the resumes from your advertising, go through them and screen out those that do not have the qualifications you are looking for. Take into consideration whether or not the applicant included a cover letter, and whether that letter really communicates something about the applicant. Look at the experience, background and talents being conveyed in the resume and letter.

THE FIRST INTERVIEW
Phone those applicants that appear to be the very best and schedule them to come into your office to fill out an application. During this phone call you can “rate” their phone voice and composure and get a bit of a feel for their willingness. Make notations on the resume. Schedule all of the applicants for the same time (i.e., an evening after work or a Saturday morning).
Make preparations ahead of time. Have packets of paperwork ready for each of your applicants. Their packets will contain an application, a questionnaire, a sheet they will fill in with their employment goals and what their understanding of a practice is. They will also be asked to write a brief collections letter and sign an Authorization for Release of Information form.
When the applicants arrive, welcome them and deliver a brief statement (10 minutes or less) about the practice and the position. Then direct them to the pre-printed packets handed out. Have them:

  1. Fill out their Job Application Essays.
  2. Fill out their Hiring Questionnaire.
  3. Write a brief letter to a client who has an overdue account (which gives you a good indication of how the person deals with others on sensitive matters).
  4. Sign and date the Authorization for Release of Information form.

As the applicants complete their forms, rate them on their appearance (1-5) and take them individually into a private office to conduct a brief interview (about 5 minutes for this first interview). This will give you a feel for the person.
Before your applicants leave, give them each a card for a complimentary exam at your office. (This is optional, but could garner a new patient even if not hired.) Thank them all for coming in and let them know that they will be hearing from you within the next couple of days.

EVALUATING YOUR APPLICANTS
After your applicants leave, you can go over what you know about them so far by rating them each in the following categories:
The Application:

  • Is it neat and legible?
  • Is it thorough?
  • Does this person “job hop”?
  • Are there unexplained lapses in employment history?

The Employment Goals:

  • Check the spelling, punctuation, grammar and composition.
  • What do this person’s goals tell you about him/her?
  • Do his/her goals indicate that he/she is looking for a long-term position?

The Collections Letter:

  • Check the spelling, punctuation, articulation, content and professionalism.
  • Is this letter friendly yet firm?
  • Does this letter actually “communicate”?

Their written version of the purpose of a medical practice:

  • Look for the person’s basic understanding of the purpose.
  • Check the person’s ability to articulate and communicate effectively.
  • Does the statement convey the attitude you are looking for in the position you are filling?

AFTER THE INTERVIEW
Based on what you know at this point, you will be able to determine whom you wish to have back for a second interview.

  • Phone those applicants and schedule them for their second interview, which you will schedule separately (since it will take longer than the first interview).
  • Send reference letter request forms to former employers of your final applicants.

Send rejection letters to those applicants who did not qualify for the second interview.


Larry Silver

Interviewing and Selecting Employment Applicants

Posted by Larry Silver

The personal interview represents the basic process to use for selecting the best available person for a job. Relying on the interview process for finding the right person demands that the interviewer possesses the necessary expertise for planning and conducting an effective interview.

Great attention must be paid to the selection / interviewing process. By doing so, you will minimize staff problems such as troublesome employees or dissatisfied employees who seek employment elsewhere. While other factors in the working environment have a great influence on the employee’s performance and satisfaction, fewer problems will arise when the selection interview is regarded as the first critical step in hiring and keeping a qualified worker.

Interviewing and selecting employees can become a time-consuming responsibility for the office manager. However, if this process is regarded with high importance, the likelihood of hiring the right person who will enhance the practice increases greatly.

THE INTERVIEWER’S PURPOSE
The office manager must be careful not to enter the interview with any preconceived ideas about the applicant that can compromise an intelligent hiring decision. If, before or during the interview, the interviewer thinks in evaluative terms or reacts to statements from the candidate from a judgmental attitude, several results could negatively affect the hiring decision:

  • First, an evaluative attitude runs the risk of premature evaluation. If the interviewer reacts negatively to any particular applicant response and thereby decides that the applicant is not suitable, an otherwise valuable employee might be lost.
  • Second, an evaluative attitude increases the likelihood that important questions might not be asked because the interviewer’s mind is already made up.

While the office manager must maintain judgment concerning the applicant’s “fit” into the organization, the basic purpose guiding the interview must be to get in communication with the applicant and to collect information (facts, explanations, character traits, etc.). That will provide a basis for predicting an applicant’s potential success on the job. The office manager is a data gatherer.

The office manager must use his/her time wisely. Many interviewers tend to waste much and create negative impressions by asking questions about information already explained in a resume or application form. Oftentimes, the interviewer tends to talk too much. The interview should invite the applicant to do the majority of the talking; that is going to be far more revealing to the office manager as to who the applicant really is. The office manager is looking for things that otherwise could not be found on an application or resume such as:

  • How the applicant feels about past positions
  • How the applicant feels about types of management
  • Is the applicant interested in further training and professional growth
  • How does the applicant work as part of a team
  • How does the applicant appear to handle pressure

The interviewer is not only looking for the qualifications of the applicant, but also:

  • their communication abilities
  • depth regarding goals and motivation
  • the ability to think on their feet
  • the willingness of the applicant
  • the trainability of the applicant

Look for answers and attitudes that demonstrate a sincere interest in contributing, rather than simply what the applicant hopes to get from the business.

Be alert to comments and questions that indicate the applicant’s willingness to learn, to contribute, to be flexible, to take on new duties, and to help out when needed.

COMMON APPLICANT SELECTION CRITERIA

  1. Communication Skills: Messages are clear, easily understood; candidate listens well, is articulate and concise.
  2. Self-confidence: Seems poised and relaxed; attitude is not defensive or hostile; demonstrates ability to accept responsibility; seems to understand personal feelings and ideas.
  3. Sociability: Demonstrates ability to work with others; has pleasant and supportive interpersonal style, able to relate to others with empathy, openness, non-defensive.
  4. Ambition and Motivation: Shows understanding of personal goals and priorities; understands attraction of profession or job; capable of acting/working with minimal supervision or guidance.
  5. Perseverance and Responsibility: Shows evidence of ability to start and follow through; can be counted on to produce and get results even under adverse conditions or stress.
  6. Leadership: Demonstrates ability to influence others toward desired goals and provide appropriate direction and support along the way.
  7. Adaptability: Demonstrates an ability to interact or communicate with a variety of different personality styles.
  8. Appearance: Personal grooming and dress habits are adequate to the demands of the position.
  9. Cooperativeness: Does not appear excessively competitive; possesses give and take attitude.

PLANNING AND PREPARATION
The essence of the hiring decision is to match an applicant’s qualifications with the requirements of the practice as a whole and the requirements of the job. The interviewer must have a thorough knowledge of the job. To evaluate the fit between the job, the practice, and the applicant, the job must be represented in all of its dimensions.

I. Have a thorough knowledge of the job, involving the following:

  1. Duties and responsibilities
  2. Competency requirements: What knowledge is needed to perform satisfactorily? What skills are required?
  3. Enhancement skills: What job-related skills might increase the likelihood of above-average performance?
  4. Performance standards: How is competency to be measured?
  5. Selection criteria: What qualities would an acceptable applicant possess?

II. Prepare for the Interview:

  1. Thoroughly read the resume, cover letter, application and references.
  2. Prepare the questions you plan to ask, avoiding repetitious questions already answered on the paperwork; ask open-ended questions to get the applicant talking.
  3. Confirm that none of your questions are illegal or discriminatory.
  4. Plan the interview so as to avoid wasting valuable time. Failure to plan results in an unstructured interview which is less productive and could appear unprofessional.

FUNCTIONAL OPENING OF THE INTERVIEW:
Opening an interview is functional when it achieves several important purposes:

  1. Explains what is going to happen.
  2. Establishes rapport with the applicant in order to facilitate the flow of information during the next stage.
  3. Actually begins the information-gathering process.

Although it is important to set your applicant at ease when welcoming them to the interview, it is not really necessary to engage in a lot of trivial, “rapport-building” techniques or ice-breakers such as chatting about sports, hobbies, the weather, etc. This can tend to waste valuable time and may even actually create more tension for the applicant who is eager to delve into how they are qualified for the opening.

Remember that this is a professional business meeting, and the beginning of this meeting is more than just to start talking. What is discussed demonstrates how well the interview will proceed later on.

  1. Greet the applicant cordially and introduce yourself, along with your title, indicating (if appropriate) how you would like to be addressed.
  2. Explain the purpose of the interview and how it will proceed.
  3. Indicate why notes will be taken and ensure that the applicant understands that note taking is not indicative of negative impressions.
  4. If appropriate, ask the applicant how they would prefer to be addressed.
  5. Begin the “rapport-building” and the data-gathering itself by asking questions that are positive and that provide the applicant with an opportunity to begin letting you know who they are.

    Example:

    “What are some of your most significant accomplishments to date?”

    “What personal qualities are represented in those accomplishments?”

QUESTIONING SKILLS
The questions that you ask and the manner in which you ask them determine the extent to which otherwise unavailable information about the candidate will be obtained.

There are some underlying categories that will guide the interviewer in planning specific questions to ask during the interview:

  1. Competency: Is the candidate technically competent to perform the required duties and fulfill the required responsibilities?
  2. Motivation and Willingness: Given that the candidate is competent, does the person demonstrate the motivation to contribute and the willingness your practice is looking for?
  3. Adaptability or “Fit”: How well will the candidate interact in the practice’s interpersonal network? Depending on the specific requirements of a job, the fact that a person possesses a high degree of competency does not ensure that he/she will be able to work with others.
  4. Personal Fulfillment: How well will the company satisfy the needs, goals and ambitions of the candidate? The apparent desirability of the applicant for the company does not insure a constructive fit. Both must be right for each other.

KEY QUESTIONS: DEVELOPING A QUESTIONING STRATEGY
One helpful way to prepare for an interview is the format listed below. For each of the key question areas, develop more specific questions you would ask. List two or three questions you would ask. Try to list two or three questions for each area. While these questions below are themselves not asked, they constitute the background from which the interviewer’s game plan or systematic questioning strategy is constructed.

  1. Competency: What would you ask to determine the extent to which the applicant is technically qualified to perform the job?
  2. Motivation: What questions would you ask to determine if the applicant is highly motivated, willing to utilize those skills that are technical in nature?
  3. Adaptability / Chemistry: How will you determine the extent to which the applicant’s work style, ability to work and cooperate with team members, might justify hiring?
  4. Satisfaction Potential: Regardless of qualifications, the job must be satisfying to the applicant or you will have a potential problem employee. What will you ask to determine if you are the right organization for the applicant?

Do not ask questions to simply fill time and avoid the discomfort of prolonged silence. To ask the right questions, one must know why the question is being asked and how it relates to hiring criteria. Prior to the interview, make two columns on a piece of paper:

  1. On the left, list the qualities or criteria needed in a qualified applicant.
  2. In the column on the right, list those questions which you believe will elicit responses from the applicant or which will provide insight about the candidate’s fit with the respective criteria.

OPEN-ENDED QUESTIONS
When developing your questions, use those that elicit information – open-ended questions rather than closed “yes” and “no” form of questioning. Open-ended questions minimize the possibility of an interviewer talking too much and dominating the interview. They also provide a basis for observing the applicant’s communication skills and ability to organize thoughts. They also give the applicant a chance to provide a more complete picture of his or her thoughts and feelings.

CLOSED QUESTIONS
Closed questions restrict the range of an applicant’s response by calling for a factual or yes/no answer. Closed questions are used to gain a clear position or opinion or to establish a point of fact. By their nature, closed questions do not encourage conversation.

The following examples demonstrate how to get at the same basic information with the two different types of questions. The difference will demonstrate why the open-ended question will keep the applicant talking more as well as call for a statement of position when required:

    Closed: Do you mind working overtime?

    Open: Since some positions may involve working overtime, could you describe the circumstances when you would or would not agree to work overtime?

    Or

    How do you feel about working overtime?

    Closed: Would this position help you achieve any of your goals and ambitions?

    Open: Could you describe the ways in which this position might be related to any of your goals and ambitions?

LEADING QUESTIONS
For the most part, these questions should not be asked. They encourage the applicant to misrepresent true feelings or intentions. The essence of a leading question is its implied pressure for a particular answer. The question implies what an appropriate answer should be.

    Example: “Working overtime wouldn’t bother you, would it?”

    “You wouldn’t mind transferring to _________, would you?”

SECONDARY QUESTIONS
As discussed earlier, your interview will be as successful as you are in engaging the applicant in real communication. Be willing to follow up to a previous response. In this way you are asking for clarification or enlargement of a response.

    Examples: “Could you please explain what you meant by…”
    “Could you tell me more about…”
    “How did you feel about that?”

Secondary questions should be used to probe abstract or generalized responses.

Example: When in response to the question, “What is one of your greatest strengths?” an applicant responds by saying, “My ability to get along with people”. You, as the interviewer need to explore that response to achieve any meaningful understanding of what the applicant has said.

Example; In response to the question, “What are the qualities of an effective supervisor?” the applicant mentions “leadership”. You have no real understanding of the applicant’s concept of leadership. You might ask, “What are some of the qualities you believe leadership involves?”

You want to really know what the applicant is saying and get as clear an understanding of who they are as possible. Abstract or generalized answers must be broken down to more behavioral, specific dimensions for clarity.

COMMON AND IMPORTANT QUESTIONS
Listed below are some of the more common, yet important, questions that can provide valuable insight into an applicant’s job qualifications. They aim at technical and motivational data as well as provide a picture of the applicant’s self-knowledge and communication skills. Some questions may be more or less relevant, depending on the job’s scope of responsibility, complexity and difficulty.

  1. What did you like best about your previous positions? What did you like the least?
  2. What skills are required for getting along with and working cooperatively with others?
  3. How do you expect to be treated by a supervisor or a manager?
  4. Describe the qualities of a good boss.
  5. Describe the qualities of a good employee.
  6. What do you find most appealing about this position?
  7. What are the strengths or assets you would bring to this practice?
  8. What are your limitations that need further attention and development?
  9. What is your definition of a “successful” practice?
  10. What is required to succeed as an effective employee?
  11. What should happen during an effective performance review?
  12. We are looking for an employee that is ________________ (list the criteria). Convince me that you are that person.
  13. What goals do you feel this position will help you attain?
  14. What does “being motivated” mean to you?
  15. (Describe a hypothetical pressured scenario, and ask) How would you handle that?
  16. How would you feel about attending seminars to enhance job training?
  17. What would you do if you saw another employee violating company policy?
  18. We are all defensive about some things. What do you get defensive about?
  19. What is the biggest mistake you have made on the job and what have you done about it?
  20. We all have difficulty getting along with some types of people. What are the people like with whom you find some difficulty?
  21. What are some things you have done that demonstrate initiative and creativity?
  22. What do you know about our practice and what we do?
  23. What have you learned about yourself from your previous job?
  24. If we didn’t hire you, what would we be missing?
  25. What are the greatest reservations you have about taking this position if it is offered to you?
  26. How do you react to criticism?
  27. What does an effective communicator do?
  28. Employment is a mutual relationship. What makes you feel we are right for you?
  29. In what ways would you be both an easy as well as a difficult person to work with?
  30. When you have difficulty with someone, how do you handle the situation? How do you handle defensive people?
  31. What do you hope to accomplish through this position that you were unable to achieve in you last one?

CLOSING
Unfortunately, some applicants who are later rejected are misled into believing that their chances for an offer are high. How an interviewer closes the interview not only generates positive feelings about the practice, but can sometimes prevent the filing of a lawsuit. If, because of an inappropriate closing, an applicant is mistakenly led into believing that the position will be offered and then it is not, the natural feeling of betrayal and hostility could lead to a charge of discrimination. To close on a positive note and minimize the possibility of a lawsuit, the following practices might be followed:

  1. Indicate that you have pursued all of the issues on your agenda.
  2. Ask the applicant if they have any questions or if they feel that there are any remaining issues that should be explored.
  3. Avoid any general comments indicating approval or disapproval of the applicant’s responses; don’t build false hopes or unwarranted discouragement.
  4. Thank the applicant for providing useful information.
  5. Indicate what will happen with the information:

    a. Who will evaluate it;

    b. When the decision will be made;

    c. How the applicant will be notified.

Stand first, indicating finality of the interview, and escort the applicant to the appropriate exit.


Larry Silver

Putting Your New Employee On the Job

Posted by Larry Silver

If bringing on a new employee involves another employee leaving, see to it that the employee who is leaving writes up how all of the duties and functions of the job are to be performed. The employee would then place all of those detailed descriptions in the existing “Job Description” manual for the particular position. This manual would include, but not be limited to:

  1. Any little things that are required of the post on a day-to-day basis which are successful.
  2. Special things that the “old” employee does that she feels are beneficial and helpful to the doctor, the other staff and the patients.
  3. Anything that a new employee would need to know such as where things are kept, where things can be found, who handles various functions, specific policies relating to that position, etc.

The doctor and the office manager should review this “write-up” and make any necessary additions, changes, modifications so as to ensure that a full job description has been put together.

If you are in the process of filling a position where there is no one available to do this job write-up, then the office manager should put this together the best she can and add it to the general job description.

PERSONNEL FILE

The Office Manager should create a personnel file for the new employee that contains:

  1. A full job application and resume
  2. Any other forms used in the hiring process
  3. Any tests, if taken
  4. A copy of the signed acknowledgment of office policy and job description
  5. A checklist of everything the Office Manager will be doing with the new employee to bring her on post

OFFICE POLICY AND BASIC TRAINING
Give the employee his/her own copy of your Office Policies and Job Description manual and have him/her read through the policies within a stated period of time. Once the person has had an opportunity to read the policies, sit down with that person and handle any questions with regard to your policies. Have your new employee sign their copy of the Acknowledgment Page that indicates that he/she did receive, read and agrees to abide by the policies.

Ensure that the Job Description contains:

  1. The Office Purpose, Product and Ideal Staff Member.
  2. The Purpose, Product and Statistics of the position.
  3. All the relevant procedures and write-ups relating to the job.

FAMILIARIZING THE NEW EMPLOYEE WITH THE FACILITY
Be sure to take some time to familiarize your new employee with the office, showing him/her where things are, what they are, who uses what, etc. Walk through the practice with your new employee, and allow him/her to ask questions and take notes. Familiarize the employee with how your flow line works, and why you have set it up that way. You could develop a “New Employee Scavenger Hunt” to facilitate this.

GETTING TO KNOW THE OTHER STAFF:
Have the new employee sit down with each of your other employees and get to know them a little. This is a great time for that person to find out what each staff member needs and wants from them.

Your new employee will now feel much more comfortable and able to “get on with it”. Put the person on post and let him/her begin.

Ensure that ongoing training is occurring on the following:

  1. The use of proper organizational requests
  2. Graphs and stats
  3. Written communications
  4. Asking for referrals
  5. Office organization


Larry Silver

Termination of an Employee

Posted by Larry Silver

Of the many responsibilities of the office manager, having to terminate an employee is one of the most troublesome and difficult. Termination is the final step of investment protection, one in which the return on investment is wholly inadequate, justifying ending the investment. However difficult, it is part of the job and must be done in as timely and humane a manner as possible.

The materials that follow will help you make a better decision and, hopefully, provide face-to-face communication guidelines for handling the situation as confidently and gracefully as possible.

A major issue over which the office manager has a great deal of control and influence is whether the employee is motivated to fight back after being discharged, or will that employee simply move on to a new endeavor. We cannot forget that after the bad news is communicated to an employee, many thoughts rush through the employee’s mind, provoking varying levels of feelings. These feelings about the situation, and how it was handled, determine if the employee will even call a lawyer and begin legal action against the practice. In other words, taking action against the practice depends on the employee’s frame of mind and perceptions surrounding the entire termination process. Those perceptions are well within the ability of the practice to mold and influence.

How a termination decision is made, how the organization handles problems before termination, and how the news is conveyed face-to-face, all impact strongly on the employee’s perceptions and consequent motivation to move on or to fight back.

MAKING THE TERMINATION DECISION
Deciding to terminate an employee is serious business for all involved. Considering the increase in litigation over terminations and the losses incurred by employers who have made unwise decisions, the termination must be based on a reasonably thorough assessment of the employment relationship. After all, that is what is being terminated, not merely the employee or the position.

Work is an investment relationship. However different or lopsided, the employee has invested something in the job and practice, and the practice has invested in the employee. Termination ends that investment. People don’t abandon investments unless the return is unfavorable. Remember, the employee’s investment is more risky (bills to pay; life to support), so he/she will have a hard time understanding why the company’s “investment” is being withdrawn and this will present a greater challenge to the office manager to communicate.

BASIC GUIDELINES TO BE AWARE OF IN MAKING THE DECISION TO TERMINATE:

  1. Protected Group: If the employee belongs to a protected group (minority), the likelihood of legal action is increased. Have all your documentation and facts clearly prepared.
  2. Defensible Paper Trail: Make sure that the decision to terminate is backed in writing by specific, detailed documentation.
  3. Risk Potential: Is the law clear or fuzzy regarding the facts of your case? Second opinions from labor lawyers are probably advised.
  4. Public Image: Can your practice withstand any adverse public exposure through the spreading of the bad news in the community?
  5. Organizational Culpability: A “failed relationship” usually has plenty of blame to spread around. To what extent has the practice “failed” the employee? Does the practice have a clear definition of its responsibilities to marginal or unsatisfactory employees?
  6. Continued Damage Potential: Assuming the employee is not terminated and situation doesn’t improve, can you stand continued “repeat performances”? What is at stake if improvement is not forthcoming?
  7. Remaining Morale: Management credibility is really on the line in termination cases:

    a. What impact would failing to terminate have on morale?
    b. What impact would terminating have on morale?

  8. Twelve Strangers: How would 12 people completely unfamiliar with you, your practice and the employee judge the termination? With the record you have, would they conclude the action was reasonable?
  9. Consistency: How have like situations involving other employees been handled? If differently, what differences justified such treatment?
  10. Shooting From the Hip: Are you just trying to get rid of someone you don’t like or does the evidence justify dismissal?
  11. Procedural Consistency: Have published guidelines for company disciplinary procedures been followed to the letter up to this point?
  12. Skeletons and Pretext: Sometimes companies try to cover up the “real” reason for termination and offer something that sounds plausible. Cover-ups usually unravel at very inopportune times, like with investigators and judges.
  13. Motivation to Organize: Terminations can impact on seeking representation for employees. Do all the factors guiding your decision and your company’s termination policies provide adequate “protection” against the perception of unfairness?
  14. Receptivity to Help: To what extent has assistance been offered and how has the employee responded? Demonstrated willingness to cooperate and improve? Evidence?
  15. Influence of Personal/External Difficulties: Are there any off-job problems which, in not being resolved, create or add to on-job performance?
  16. Track Record: Why consider termination now? Does the employee have a history or track record of problems or is this something new?
  17. Undeveloped Potential: Does the employee have potential for success in another job or part of the company? Working for a different supervisor?
  18. Pre-termination Conference: Having followed the pre-termination warning and gotten nowhere, have you talked with the employee and given full hearing to his/her side of the situation? Assuming the stories differ significantly, have you accounted for why the differences exist?

GUIDELINES TO FOLLOW WHEN TERMINATING

  1. When to do it: The best advice is to communicate the decision as soon as possible to the employee.
  2. Time of day: The end of the workday is preferable when everyone else has left; this saves embarrassment.
  3. Witness: Do have a witness present. This offers protection as well as evidence that various things were or were not communicated.
  4. What to tell others: Simply let your staff know that ____________ (name) is no longer with the practice. If anyone has questions, tell them it is company policy that they would have to ask the person themselves.
  5. After the News: It is wise to escort the employee out of the practice or else the anger often present could result in some destructive actions; necessity depends on the person and particulars of the situation.
  6. Reasons: An employee deserves the respect and the dignity of knowing why they have been discharged. To fail to communicate or to try to cover something up with the employee is sure to provoke more outrage on the part of the employee. Convey the reason very simply; do not engage in a long discussion about it. Communicate it with respect. However, you need to use caution in what you communicate; we are in a litigious society and you don’t want to give them grounds for a wrongful termination suit.
  7. Firing Your Friend: This is hard to do, but has the built-in trust that will allow communication between you and your friend to help them understand. This does require you to be tough, as it would not be good for you to continue to carry a friend in a job when their performance is disastrous.
  8. References: The safest policy to use as your guideline is the work history, their statistics, their performance review results, written warnings and reprimands, etc.
  9. When the Employee Begs: If an employee begs for a second chance, you have got to be tough and be willing to explain things, yet without the slightest indication that you don’t stand by your decision.
  10. Arguing The Reasons: Don’t argue with the employee. Indicate that you have the specific documentation supporting the reasons. If, on the other hand, the employee’s arguing convinces you something has been overlooked, then indicate you will check it out immediately or as quickly as possible.
  11. Breakdown: Do nothing unless your safety seems to be at stake. Let the catharsis run its course, then resume appropriate discussions. If the breakdown continues, let the employee know that you understand and that you will give a moment to regain their composure before completing the meeting.
  12. Written statement: Providing a written termination statement for the employee is a bold communication that relays your ultimate confidence in the matter. Understand that the written statement could become part of the legal record and must be clear and strong enough to stand up in a legal arena.

GOALS FOR A CONSTRUCTIVE FACE-TO-FACE TERMINATION
The person doing the termination will be less likely to get distracted by emotions if the goals are kept in the forefront during the process. Concentrate on what is being attempted, not just the fact that you have to convey bad news, and the anticipated fear and discomfort usually can be minimized.

Five goals could provide direction for communication when announcing the termination:

  1. Convince It’s Best For Everyone: If the guidelines for making a termination decision are followed, you will probably have a good termination. Most employees who are in trouble know there is trouble but for economic reasons just can’t admit that a termination might be justified. They are usually quite unhappy in their work and, were another job to be readily available, would probably (maybe at least in their own minds) thank you for the termination.

    In short, they know it’s a bad relationship that is extracting costs that are probably even more troublesome. Your goal is to try to help them understand that larger perspective; the relationship isn’t working out and should be terminated.

  2. Minimize Possibility of Legal Action: How the employee is treated during communication of the termination makes a significant difference in his or her state of mind immediately following the announcement. In short, how employees are handled can encourage or discourage them to “fight back” or move on with their lives. You want them to “move on”. Treat them with respect and understanding, yet firmness throughout the process.
  3. Provide A Positive Exit; Build Self-Esteem: Few people are total washouts. Termination represents ending a relationship as opposed to indicating that the employee is a failure. Focus on this fact in an effort to make him/her feel worthwhile. Avoid anything that smacks of humiliation since you don’t intend to decrease his/her self-esteem.
  4. Minimize External/Internal Adverse Impact: Employees who are terminated usually have friends left behind; how you handle the termination can impact on the morale of those people. Your goal is to minimize injuring that morale. How you convey the bad news can demonstrate a caring, sensitive organization or one that is arbitrary, uncommunicative, and insensitive. The employees left behind will have perceptions one way or another. You want them to be positive.
  5. Facilitate Orderly Departure: Tools, uniforms, etc., have to be turned in and various documents must be processed and signed. The employee’s cooperation is needed to do this; therefore, communication must not give the employee an additional motive for obstructing an orderly departure.

THE FACE-TO FACE TERMINATION
Knowing that this is a “good” termination does not make the face-to-face encounter less difficult. It is intense. It is a task few people want, much less perceive as a constructive learning and growth experience for the employee. A reasonably humane, sympathetic attempt to end the painful encounter as quickly as possible is tempting.

However difficult, termination can be a relatively productive experience if handled properly, with finesse, tact and directness. Some situations will make the attempt at being positive, forward looking, and constructive out of the question. But the attempt should be made.

The ideas listed below offer ways of making the difficult encounter a reasonably productive one:

  1. Indicate Intent – Be Direct: “Sally, the practice has made the decision to terminate your employment here (don’t’ say ‘terminate you’). The decision has been reviewed, but we need to discuss a number of issues. I hope we can do so in a reasonably friendly manner. You have a right to be upset, etc., and I will understand.”
  2. Don’t Apologize: Don’t say:

    “It’s hard for me to do this” or

    “I really hate to have to tell you this” or

    “We have tried to help you, but it just hasn’t worked” or

    “You have left us no choice” or

    “I’m sorry” or

    “The doctor is making me do this.”

    All of these phrases just make matters worse and make the practice look cheap and blameless. They add fuel to the emotions already operating and serve no constructive or situation-strategic purpose.

  3. Allow Ventilation and Catharsis: If the employee starts swearing, yelling, bad-mouthing, crying, etc., just sit there and don’t respond. He / she needs that emotional release for any constructive discussion to take place later on. Do not be tempted to put your arm around their shoulder, pat them on the back, etc. These innocent actions could be misconstrued as sexual harassment, even female to female.
  4. Explain Reasons Specifically: Don’t say things like “poor attitude” or “insubordination” unless you can cite the specific behaviors. Generalized statements leave too much room for interpretations and argument. You don’t want that now, so have the hard evidence or documentation in hand.
  5. Avoid Counseling: Trying to help him or her understand “where he / she went wrong” is productive if placed in the context of how it could be avoided elsewhere in a future position. Anything short of such a context not only won’t work, but probably will add to the employee’s emotional upheaval, or even begging for another chance, saying they’ll change.
  6. Discuss Remedial Actions: Offer Direction: Tell him or her how to apply for unemployment compensation, vocational training for skill development – anything which gives the employee hope for the future. Indicate that although the relationship hasn’t worked out, you still feel a social/moral obligation to try to help the person adjust to the situation.

The above are guidelines intended to help you in this area. It is not intended to be, nor is it, legal advice. You should consult an attorney on any specific legal problems that might come up with employee discharge.



Larry Silver

How Valuable is that Employee?

Posted by Larry Silver

Performance Evaluation in a Practice

The performance evaluation is viewed as a process to ensure a high quality of service to the patients and clients of the practice by fostering personal and professional growth of the staff. A performance evaluation does not necessarily mean that the employee will be receiving an increase in pay. That is not the purpose for the review and should be addressed as a separate issue at another time.

The employee performance evaluation is a broad process covering many aspects of performance. It attempts to provide a fair, equitable and valid approach for assessing the performance of professional employees. It is also designed to provide a sound basis for the recognition of good performance and identification of areas of deficiency, which require correction. Each employee will have his/her performance evaluated at least once annually.

The evaluation of performance is a joint effort between the staff and the administration. Through joint participation the greatest possible level of trust and understanding of the performance evaluation process will be achieved. It is believed that acceptance and understanding must exist if the process is to be effective.

The performance evaluation process attempts to measure:

  1. A minimal acceptable level of job performance
  2. Individual strengths and weaknesses as they relate to job performance
  3. Professional and personal development

Performance evaluation is not a cure-all. It is an important tool to the functioning of the organization and execution of the individual job. This tool is utilized to initiate dialogue (which is continuous over time) between the supervisor and employee. It helps to monitor progress and provides a sound basis upon which the supervisor can monitor performance, recognize good performance, detect deficiencies and implement plans to make improvements.

THE PROCESS OF PERFORMANCE EVALUATION
The process is founded on several important factors:

  1. Orientation of the staff member with discussion of:

    a. Organizational goals

    b. Job Description for the Ideal Staff Member

    c. Job Description for the individual position

  2. Systematic assemblage of data on performance
  3. Evaluation to include:

    a. Assessment of performance

    b. Employee feedback

    c. Measures to correct deficiencies

The new employee will have a review at 30-90 days to provide an assessment of his/her performance up to that point (markedly deficient performance will be dealt with as soon as it is evident). In most cases, this review will afford the employee an opportunity to make improvements before the next formal review. Formal reviews should thereafter be conducted every 6 months for the first year, and then annually after that (although more frequent reviews may be required as deemed necessary by the office manager). Each formal review will focus on past performance and a plan for future performance.

The evaluation will be based on performance in two broad categories:

  • professional responsibilities
  • organizational responsibilities

Within these categories, specific areas will be assessed.

In the category of professional responsibility, the following areas will be assessed:

  • quality of care
  • effectiveness in patient management
  • professional development

In the category of organizational responsibilities, the following areas will be assessed:

  • adherence to the policies
  • adherence to Job Duties of an Ideal Staff Member
  • communications
  • interpersonal relationship
  • practice development

The data collection phase of the evaluation process will involve the gathering of information by the office manager from all sources that she/he deems appropriate. Generally, input will be from:

  • patient comments
  • quality control data
  • statistical data observation
  • documentation regarding compliance with organizational policies.

Following the information collection, the office manager, the doctor and the staff member will complete the performance review forms and a performance review meeting will be scheduled

STEPS TO FOLLOW FOR THE EVALUATION PROCEDURE

  1. The office manager will distribute to the employee a copy of the Job Duties for an Ideal Staff Member and Job Duties for the position the employee holds.
  2. The staff member will fill in their rating of each point (the office manager will also provide ratings).

    SUGGESTED RATING SYSTEM

    a. Place a check mark (“) next to any item that is deficient and is in need of improvement.

    b. Place a star ( ) next to any item that is excellent.

    c. Leave blank any item that is fine as it is, although the goal would be to work toward excellence in these categories.

  3. The evaluation process begins with the orientation of the new employee. During orientation, the employee is made aware of the organizational goals. The individual’s job description (both as a staff member and for the professional position that they hold) is discussed, and an understanding of job expectations and standards for evaluation is reached.
  4. At this meeting, the performance for the previous period is reviewed, and the employee is given an opportunity to comment on any area of the assessment.
  5. As the review is progressing, both the office manager and the staff member should keep notes with regard to areas to work on and goals that are set. In cases of deficiencies where correction seems achievable, and reasonable in terms of practice resources, every attempt will be made to work with the employee to effect change.
  6. The employee then signs the document. An understanding is reached concerning past performance and expected future performance and an outline of future performance expectations is drawn up and discussed


Larry Silver

How Do You Get Your Employees To Think Like You Do?

Posted by Larry Silver

HOW DO YOU GET YOUR EMPLOYEES TO THINK LIKE YOU DO:
THE MISSION STATEMENT

A primary responsibility of the owner of a practice or a business is to set the pace and direction for the practice or business by contemplating, defining and establishing exactly what the mission of the practice or business is. By doing so, the owner provides the guiding principle for the entire activity.

A mission statement can be used to maintain the focus for the owner and staff. It can be used as a point of reference all along the line. Oftentimes a staff can simply get caught up in the day-to-day functions of their individual jobs, forgetting (or maybe never having really known) what the purpose of the activity is. A fully functional “team” then never can truly come to fruition.

It is up to the owner to determine why he/she is engaged in the activity to begin with, what the purpose and goal is and to form a team that is mutually in agreement with the purpose and the goal. It is that understanding and agreement that will allow people to evolve into a coordinated group, working together toward the long-term objectives of the owner.

Following is a sample Mission Statement. Use it as a model for developing one that suits your practice or business. Once it has been developed, distribute it amongst your staff, go over it as a group at your staff meeting and have each staff member place their copy in the front of their respective staff binders.

SAMPLE MISSION STATEMENT:

Our goal and policy is to treat our patients/clients as we would treat our families. We will offer a high-quality, friendly service in a gentle, caring atmosphere. Our patients/clients are the heart of our practice and the reason we are here. At all times our patients/clients will be treated with respect, dignity and compassion. Being of service to our patients/clients is the definition of our purpose and the mission of our practice.

To accomplish our mission we will provide:

  • A highly trained and professional staff
  • State-of-the-art equipment and technology
  • A genuine concern for our patient’s/client’s time

As a result of these provisions, we hope that:

  • Our patients/clients will be highly satisfied with their personalized care
  • They will continue as a part of our practice family
  • Our patients/clients will feel a desire to refer their friends and family
  • Our patients/clients will uphold their scheduling and financial commitments.

We pledge and guarantee that we will always do our very best to serve you.


Larry Silver

Basics On Bonus Plans

Posted by Larry Silver

GETTING STAFF TO PRODUCE AT THE QUANTITY YOU WANT:
BASICS ON BONUS PLANS

It is very wise to have a bonus plan for staff in operation in your office. If you reward staff for increasing their production and the production of the practice, they will naturally want to continue to do that and the whole staff will tend to operate much more as a team.

In structuring a bonus plan, the simpler you can make it for yourself and your staff, the better. Bear in mind that you want the staff working as a team and that there are several areas of concern. Consider the following:

The best bonus plan are ones that get the entire staff working together towards increased viability for the whole practice, while rewarding their own increased production. A plan that gives staff bonuses when the practice is not viable is a loser for the doctor/owner. At the same time, not providing bonuses to staff for their increased production when the practice is getting more and more viable, provides no incentive or reward for the staff and will lead to a less cohesive and productive group. So you have to put together a system that takes into account the major statistics of the practice, the viability of the practice and the individual production of the staff members.

Certainly, you want higher production statistics. But if you pay bonuses only on increased production, you could be painting yourself into a corner if the collections do not keep up with the production. You could be paying bonuses out of your own pocket!

At the same time, generally, only one person is handling collections. But even so, a team effort can come into play in this area. Staff members who do not formally have anything to do with collections can still be of assistance by not overburdening the person in charge of collections with other matters. The staff can offer to help out with getting statements out. If appropriate, the staff can offer to perform other helpful functions (as time allows) so that the person in charge of collections can handle financial matters. All staff should be cognizant of relaying important financial related information to the Accounts Manager if they become aware of a situation that could affect the financial area. Additionally, the better service a patient/client receives, the easier it is to collect payment. All staff can contribute to collections by doing their own jobs well.

If the staff is focused only on production statistics, they may not focus an appropriate amount of attention on promoting new patients/clients in the practice. New patients/clients coming into the practice is one of the prime factors involved in your being able to generate more production and collections. The new patient/client area ties in closely with the growth and viability of the practice. All staff can be responsible for the inflow of new patients/clients into the practice by their own promotion from their job area, as well as outside of the practice.

The point becomes self-evident. The staff must be focused on all of the above and working as a team to keep all of those statistics going up. The practice will grow and they will be rewarded for their contribution to that growth. At the same time, the practice’s viability must be looked at.

The following is a very simple and effective bonus plan suggestion:

  1. For starters you must confront the viability status of the practice. Determine what the break even point of the practice is – what it honestly costs to operate. Don’t forget reserves too! It is advisable to confer with a consultant on this as he/she will be able to help you determine whether or not you have considered all factors.As you are determining this figure, take into consideration the fact that the practice does have variable expenses, so you will want to average those figures in. Work them in on the high side to ensure you are not cutting yourself short.
  2. Once you have determined what the baseline viability figure of the practice is, you will know exactly how much you must bring into the practice to keep the doors open and operate in a solvent fashion. Remember, it is better to figure high than to cut yourself short. You now know that anything above that figure can be used for giving bonuses to the staff.
  3. You would now take a percentage of the amount above and beyond this figure to be used as a staff bonus fund. This could be anywhere from 15% – 20%. Of that percentage you would figure what percentage each staff member would be paid as a bonus. This could be based upon seniority of position (i.e. the office manager would probably be bonused more than the receptionist), years of service, etc. Each individual staff member would be eligible for their share of the bonus amount based upon whether they met their own individual production quotas. In this way, the staff is being rewarded for helping to make the practice solvent and viable and for their own production that contributed to the solvency level of the practice.

SAMPLE: Cost of operation is $20,000. Production target is set at $24,000. Collection target is $22,000. A New Patient/Client target would also be set (to keep staff focused on all three areas). If all three targets are met, the staff bonus plan operates for the month.

Let us say that the Production target is met. The collections is $22,000 and the New Patient/Client target is met. The staff would qualify for their bonuses.

You would take the amount collected over the baseline viability figure, which in this case is $2000. Let’s say that you are putting 20% into the bonus plan, which, in this case, would be $400. Let’s also say you have 4 full-time staff and you work out that the office manager gets 30% and each other staff member gets 23.3%, if they made their own production targets. So, the office manager would get a $120.00 bonus and the rest of the staff would get a $93.20 bonus. That is a very nice incentive for the staff and allows the owner to get a nice bonus as well.

It is suggested that the percentage amount that goes to bonuses be based upon the present viability of the practice. If you are just starting this and don’t have much in reserves and are just covering your bills, you would put a smaller percentage toward the bonuses and use the rest to pay off bills and build reserves. As you build more reserves and get debts paid off, you become more and more viable and can thus afford to put a higher percentage toward the staff bonuses.

The effectiveness of this bonus plan lies in the fact that each staff member knows they need to reach established targets to qualify for bonuses. They also know that the more they produce the more bonuses they will get and that nobody wins unless they and the practice all win. Thus they will want to push the statistics up and the practice will expand due to the focus and teamwork of the staff. Everybody wins!


Larry Silver

Did You Hire the Wrong Person?

Posted by Larry Silver
Having the comprehensive job descriptions has made staff management easy and, surprisingly, enjoyable."

"Having the comprehensive job descriptions has made staff management easy and, surprisingly, enjoyable."

A recent survey conducted with practice owners across the US revealed that the number one management problem practice owners have is personnel issues. Problems mentioned by the hundreds surveyed include procuring qualified personnel, getting employees to perform competently once hired, an inability to hold staff members accountable for their work, turnover and handling disputes amongst employees.

Correctly isolating and debugging non-optimum practice situations is a skill that every doctor finds he needs. Often a manager who is seeking solutions overlooks some administrative fundamentals which, left undetected, cause a problem to appear larger or more complex than it really is. Moreover, failing to discover the real source of a problem leads to poor decision making. In the case of managing employees this type of failure is not only frustrating, it’s expensive.

The real work begins after the hiring process ends, for each employee must be well trained for his/her position in the practice. Lacking thorough training, an employee will not perform to the expected standard and either the doctor or the employee will terminate the association.

There is an exact technology for finding and hiring good staff members. Assuming the hiring techniques are sound, the most devastating managerial mistakes are made during the training period. During this time an unskilled manager may make assumptions that lead to wrong reasons for poor performance, and these lead to bad decisions regarding personnel. Too many times a suitable person who is willing and trainable fails to receive the information needed to do the job. As a result, turnover occurs and doctors and office managers spend their time dealing with personnel problems rather than treating or servicing patients.

Written job descriptions are a must for each position in a practice. More importantly, these descriptions need to include simple fundamentals that are often omitted because the manager assumes the employee already knows what is needed from him. Common sense, or common knowledge, to one person may not be so to another. Verbal instructions are much less effective than thoroughly written job manuals.

Every job description in an office should include the following sections:

The position’s responsibility to the patients
A general description of the position which includes the purpose of the position
A statistic that quantifies the production of the position
A list of specific duties that one in the position is expected to perform
A list of the types of paperwork the position takes care of
A list of any financial responsibilities in the position
Responsibilities for the appearance of the work area

A manual should be created for every position and the job description, including the above sections, would be first on the list of training materials that a new employee studies. Following the description, detailed written instructions are required which enable the employee to do what is expected.

When employee problems arise, it is seldom due to the “wrong” person being hired. More often than not, it is a situation of no training, poor training, verbal instructions only and/or a failure to fully confront and document the important functions of the position. Problems can be rapidly debugged when the job reference material is available and a manager can use it to pinpoint exactly where the employee has failed to perform adequately. Usually a quick review of the appropriate points in the manual by the employee will be all the correction that is needed.

As one doctor stated, “When I’m with a patient I can give that patient 100% of my attention. I’m able to do that because the staff does what they are supposed to do and I’m not worried about how the office is operating. They’ve learned what they need to know from their job descriptions. Now we all have our attention on the patient and delivering quality care. There is no confusion about what we’re supposed to be doing and we’re not spending time handling confusions and upsets. Having the comprehensive job descriptions has made staff management easy and, surprisingly, enjoyable.”