Practice Management
December 2022
by Corinne Wohl, MHSA, COE, and John B. Pinto
Practice volumes have returned, perhaps surpassing pre-pandemic levels. Efficiency has been reestablished. The most fortunate practices have learned how to operate in a tighter labor market.
But not all practices can make these claims. What is the difference? And how can you help your practice finally shake off the lingering business equivalent of “long COVID?” Here are six areas for your consideration.
1. Lax or unenforced office policies. “We purposely became lax and stopped enforcing our office policies. We were fearful of losing staff that could not be easily replaced. We are not sure how to begin applying the rules fairly and consistently again but realize that if we don’t, we will lose the staff that do follow the rules while they wonder why some coworkers don’t have to comply.”
In a group meeting, acknowledge this management gap and your plans to correct the situation. For example, “We are much closer to being fully staffed than we have been for the last 2 years. During this time, we did our best to give leeway for attendance and tardiness, in recognition of how the pandemic impacted everyone’s personal lives. But now, in all fairness to all employees, we are reinstating and will be enforcing the following policies (policy 1, policy 2, etc.). We will continue to provide as much flexibility as possible with your schedules, while at the same time prioritizing customer service and patient care, for which we need dependable staffing schedules and attendance.”
2. Staff favoritism. “Some of our staff feel angry or jealous of their coworkers. It seems to be resulting in lower staff productivity for some. They complain that some ‘favorites’ enjoy preferred workday schedules, office location assignments, and PTO approvals for prime days or weeks. There is a general feeling by a few that ‘I always have to work harder than her’ or ‘Why does she get more recognition and appreciation from the doctors than me?’”
Actual or perceived favoritism has the same result in a practice. Similar to the policy enforcement issues above, favoritism seemed to creep in at a higher than usual frequency during the pandemic years. Considering the chaos and uncertainty of those times, this is not a surprise. But not applying policies fairly and consistently can create the opportunity for cliques, bullying, a toxic/negative environment, and low staff morale to develop.
Take the time to find out all the possible reasons (especially the root causes) rather than jumping to conclusions that could be wrong or incomplete. Here are specific steps to take:
- Conduct a confidential written employee morale survey. Even if the perceived problem is in one department, use this opportunity to check in with all employees.
- There are numerous ways to collect the information, and it doesn’t have to be a large expense; your advisors or peers in other practices will have survey examples you can work with. This survey must be confidential or it will not generate the complete and honest results you desire.
- Collate and share the results with the management team. Have this team be responsible for creating a plan to address each priority item.
- Hold an all-staff meeting to share the confidential survey results. Provide each meeting attendee a copy of the written results. The purpose of the meeting is to acknowledge any serious issues and show appreciation for their anonymous candor. “We cannot fix problems that we are not aware of. Thank you for helping us improve our practice for employee satisfaction and providing excellent patient care.”
- By this time, you have likely made a few improvements based on their feedback. Share those early actions with the group, and discuss any others under consideration.
- Report back to the group as relevant (at a future all-staff meeting) about additional plans and progress made.
- If the survey shows that morale is high and there is little to improve, celebrate this with the group. Recognize the importance of this finding and congratulate them.
- Even if the improvements take more time than you would prefer, the process of evaluating and communicating is still considered progress, and the effort alone will be appreciated by staff.
3. Poor communication. “The discipline of scheduling and holding meetings slipped when our staffing was low and working remotely or part-time was more prevalent. It’s been difficult to reestablish our department and practice meetings. It feels like we do not have time for meetings, so even when they are held they are rushed.”
One of the top issues we hear from staff during an onsite client visit, no matter the size of the practice, is “We need to improve our communication.” There are many ways to enhance communication. Here are some of the basics.
- Hold regularly scheduled meetings. Typical meeting frequency includes: all-staff meetings held quarterly to annually, depending on practice size; department meetings held monthly; management team meetings held biweekly; board meetings to review financials and support administrator efforts held monthly; all- provider meetings held monthly or bimonthly.
- Schedule the meetings at least 1 month in advance, or calendar it out for the whole year. Send the message to staff and doctors that meetings are important.
- The meetings need to be productive to be well received by attendees. Most people don’t object to attending a productive, useful meeting. If you hear negative feedback about having to attend meetings, it is likely that the meeting leader needs to improve their meeting leadership skills. (Google “How to run an effective meeting” for suggestions.)
- Go beyond the verbal and encourage written communication throughout the practice. This includes written policies and procedures, meeting agendas, meeting minutes, and
follow-up emails after a conversation so action plans and their “owners” are clear. - Listen more than speaking. Don’t assume you know how others feel and think.
4. Fear of confrontation.“Our managers’ and doctors’ real fear of losing staff has resulted in the delay or avoidance of confronting issues that in the past we would have resolved sooner.”
This may have been an issue in the practice long before the pandemic and is now aggravated. Perspective here is critical. Take a broader view of how the practice can suffer when problem-solving actions are pushed off. Human nature can lead some managers down the path of narrowly thinking about the one person who they have to have an uncomfortable conversation with, rather than the impact of silence on the entire team. If you need help confronting issues, look for guidance and support from someone you trust and can practice doing this with you. A client recently told us, “I confronted a lead technician who I was fearful would leave. It turns out she respected my opinion, and I didn’t die in the process of confronting her.” Be a brave leader. Sometimes your bravery will fail. But it will always be a failure if you don’t try.
5. Lack of benchmarking key performance indicators (KPIs). “Staff turnover and competing pandemic priorities have led to lapses in data collection and analysis.”
Establish or reconstitute a monthly KPI report. There are about 50 operational and efficiency KPIs. (There is an updated list in the recently published John Pinto’s Little Green Book of Ophthalmology, 6th edition.) Present these metrics to the practice owners at a monthly meeting, and use this information to make data-driven decisions. Things go better in the board room when the traditional financial reports are combined with a robust set of KPIs.
6. Workplace enjoyment and showing appreciation. “We used to be great at this. The staff and doctors enjoyed attending events together; office and department celebrations were common. Now it seems like we are time poor, understaffed, and it is more difficult to get staff excited about spending time away from their desks or family for a work event.”
If these activities have slipped in your practice, reconsider how important they are for employee morale, which is key to retention in a still-tough hiring environment. Develop fresh ways to help staff and doctors reconnect and celebrate. Use every holiday as an excuse to dress up or have lunch brought in. Have a no-cost betting pool for every sports season. Acknowledge all birthdays. Ask the staff what makes them feel appreciated at work, and do more of whatever they describe. Focus on brief in-office gatherings rather than blowout annual picnics. You will be more successful with a lot of small events throughout the year.
About the authors
John Pinto
President
J. Pinto & Associates
San Diego, California
Corinne Wohl, MHSA, COE
President
C. Wohl & Associates
San Diego California
Contact
Wohl: czwohl@gmail.com
Pinto: pintoinc@aol.com
