Your practice— A great place to work?
by Vanessa Caceres Contributing Writer
It's not easy in today's medical world to create a collegial work environment. First, because of cuts in reimbursement, the vast majority of ophthalmic practices see a high volume of patients, leaving doctors and staff to work at a frenetic pace. "There aren't the same opportunities as before for collaboration or to get to know one another," said Liz Ferron, MSW, LICSW, vice president of service delivery, Physician Wellness Services, Minneapolis. Second, it's a challenge to find staff who fit into the corporate culture, said Michael J. Lutz, COE, CMPE, MBA, chief operating officer, Associates in Ophthalmology, with seven locations in and near Pittsburgh. "We make sure to evaluate personality and ability to work in teams during our interview process to ensure we don't hire someone who will adversely change the environment," he said.
Third, physicians often operate in isolation as they treat patients. "There's a lack of coordination of roles and responsibilities because people are on their own gerbil wheel, doing their own thing," said Seattle-based Dike Drummond, MD, a life and career strategist for physicians who manages the website TheHappyMD.com. Finally, traditional medical school training focuses on competition and a defensive attitude, instead of collaboration and an openness to feedback, said John-Henry Pfifferling, PhD, director, Center for Professional Well-Being, Durham, N.C.
Despite the challenges, a workplace that's pleasant for both doctors and staff is crucial to reduce medical errors. "Most medical errors are caused by system failure," said Dr. Pfifferling. It also can boost long-term employee retention—which is less expensive and time consuming than a new-employee search. Just how can ophthalmologists ensure that their practice is a place of welcome collaboration and collegiality?
Communication is key
Much like in a marriage, clear and frequent communication can make all the difference. That communication starts with a clear mission and vision statement for your practice.
"It's predicated on a joint vision, which leads to clear, defined goals. It has to be something you read and look forward to going to work for," said Dr. Pfifferling. Many corporations have vision or mission statements, but most medical practices do not, he said. You could work with staff members to create that vision, or you could share that vision as new employees start. Many doctors might think their practice already has good communication protocols in place but would be surprised to hear from employees that they could be lacking, Ms. Ferron said. "Communication has to be more than good intent," she said. "We found in our recent survey on organizational culture that respectful and transparent communication and an open dialog across roles was highly valued by physicians, and it's a continuing theme in our work with both physicians and other clinical and non-clinical employees."
Next, quick staff meetings—also called huddles—twice a day will make sure that everyone is clear on plans for the day ahead. The huddles should include physicians and anyone involved with patient flow, said Dr. Drummond. He recommends three-minute huddles before seeing patients. These meetings should be the time to review the schedule, make sure equipment and rooms match patient needs, and decide what to do with overbookings and empty appointments. The half-day huddle can be the time to review any problems that arise and fix them quickly.
If there are any problems that come up during huddles that require more than a quick fix, they could be added to a monthly staff meeting agenda. Monthly staff meetings should be a time to get to know team members better, run through a problem list from the previous month, take action on the top problem, and review things the practice wants to start and stop doing, Dr. Drummond said.
As practices expand to various locations, it becomes important to have all-staff meetings at regular intervals, Mr. Lutz said. "We hold staff meetings for all 120+ employees at our main office every six months. During these meetings we cover mandatory training topics, updates on strategic plans, and team-building activities," he said.
At Cleveland Eye Clinic, with six locations around Cleveland, physician partner Shamik Bafna, MD, said that all doctors meet quarterly to discuss certain medical topics. They do this because most of the doctors operate autonomously when treating patients, so the quarterly meetings provide the chance to set some standardization of care and share news on doctors who may offer specific, unique treatments.
Although meetings are part of clear communication, one-to-one communication with various staff members can help everyone feel recognized—and give quieter staff members the chance to share ideas. "The key to getting along is to have a healthy relationship with your colleagues and staff, and this comes from investing time in your relationship when there is no crisis," Dr. Drummond said. "Even informally checking in with staff to find out about them outside of the workspace and talk about their challenges so they don't feel isolated is helpful," Ms. Ferron said. It may be as simple as making sure you check in with individual employees over a cup of coffee on a quarterly or monthly basis, she said.
If the concept of asking about life outside of the practice sounds odd, then take to heart the observation from Dr. Pfifferling that a work/ life balance does not always come easy to physicians, especially in a perfectionist-focused crowd like ophthalmologists. However, he added that newer physicians from the Millennial generation tend to have a greater interest in building a vibrant life outside of work.
Written communication is also part of a practice's communication tools and should include frequent emails and regular newsletters sent to all staff, Dr. Bafna said.
Appreciating all staff
It sounds basic, but truly appreciating what other staff members do for the practice can get lost in the workflow shuffle.
"When you see people working hard, look them in the eye and say thank you. When your team achieves a milestone, get them all together and celebrate in some way. A thank you and a high five may be all it takes to make a huge difference in everyone's day," Dr. Drummond said.
One employee recognition step used at Mr. Lutz's practice is sending thank you cards to an employee who goes above and beyond the normal duties. Mr. Lutz or one of the senior partners handwrites the note, which is then sent to the employee's home. "Receiving the note at home involves the employee's family or significant other and has been very well received by the staff," Mr. Lutz said. The practice tried programs like Employee of the Month and Customer Service Bucks, both based on employee nominations. However, they did not have the intended effect, which is why the practice switched to the thank you notes.
Regular social events throughout the year are another way to show appreciation. At Dr. Bafna's practice, the partners aim for a special event once a year. Last year, they rented a restaurant for the celebration. "We did line dancing with the staff," he said. Mr. Lutz's practice also offers appreciation-focused incentives such as an hour of paid time off for employment anniversaries, discount tickets to local amusement parks, and an Employee Day of paid time off that's usually in conjunction with another holiday.
Set the tone at hiring, encourage training
Finally, practice leaders should look for candidates with the right team attitude at the time of hiring. It starts with finding the right physician partner. "When you bring on a partner, it's sort of like a marriage," Dr. Bafna said. "Bill Wiley [MD] and I have the same core values. If you don't, that's where problems arise."
"We have placed more emphasis on physicians' ability to work in a team environment with our existing physicians and staff," Mr. Lutz said. "We are very honest about the expectations and the practice culture during the recruitment process. The senior partners work very well together, which sets the tone for the other physicians and staff."
The same principle applies to non-medical staff. "We can train on ophthalmology. I'd rather go more for the right personality," Dr. Bafna said. Solid training plans to boost employees' skills help show a practice's interest in promoting from within. For instance, at Dr. Bafna's practice, if a non-certified ophthalmic assistant is hired, he or she will be encouraged to become a certified ophthalmic assistant and then work up to certified ophthalmic technician. "Some staff members take advantage of that," he said. If staff members—physicians included—go to CME training, they should share relevant information they have learned with other related staff members, Dr. Pfifferling said.
A new orientation process at Mr. Lutz's practice gives employees the opportunity to rotate through multiple roles in the practice, including observing surgery. "This helps them appreciate everyone's role in the practice and the scope of services we provide," he said.
Finally, don't feel you need to approach this collegial work environment challenge on your own. "There are $50 million practices with 46 doctors who are still trying to have a practice manager run that," Dr. Pfifferling said. More physicians both inside and outside ophthalmology are now earning MBAs to meet business challenges, but they don't necessarily have MHAs or human resources backgrounds, he added. That's when hiring more administrative staff, such as an HR director, can come in handy. Dr. Bafna's practice recently recruited an HR person from Lexus, in part because of the person's customer service background.