PRACTICE POINTERS

Turn a problem employee into a pearl

Helping staffers succeed can be good for your practice—and save you money.

By Gail Garfinkel Weiss
Senior Editor

Veteran medical office manager Betty Doria has dealt with her share of employees who lack the requisite job skills, work slowly or carelessly, argue with supervisors or co-workers, or flout office rules.

Still, the administrator of an eight-physician pediatric practice in Smithtown, NY, would rather keep these people in the fold, if possible. "When you terminate an employee, it can have a negative effect on the remaining staffers," says Doria. "They start thinking, 'What did this person do?' and 'Am I next?'" That problem is especially acute if the termination is perceived as unfair, says Alec Ziss, practice administrator at Weston Pediatric Physicians in Weston, MA.

Firing employees also has hidden costs. The American Management Association estimates that hiring and training a new employee—even one on the bottom rung of the earnings ladder—typically costs upward of $3,500.

And it's not good for your bottom line if an axed employee tells everyone she knows that you gave her a bum deal. "When employees leave with negative feelings, they'll try to depict the termination as a practice failure rather than their failure," says Nancy J. Becker, a longtime practice administrator who's now a consultant with Solutions for Management in Plymouth Meeting, PA. "Turning around a problem employee indicates that you care enough to put forth the effort, whether it be training, mentoring, or reassigning duties."

Good training right at the beginning of a staffer's employ is likely to keep problems to a minimum. (See "Getting off on the right foot".) But when an established employee falters, you'll have to examine the root of the problem, then come up with creative solutions.

Helping staffers find their niche

Sometimes, an employee who isn't cutting it in one job will be super at another. Betty Doria is a fan of switching people around to find out which job suits them best. "Some employees can't get the hang of the telephones, so we might move them to the reception desk if they have good people skills," she says.

Becker made a check-in person out of a checkout person who had difficulty asking patients for money. She also reassigned a detail-oriented—but poorly groomed—receptionist to the billing and collections department. "Most of the time, I discuss reassignment in such a way that the employee thinks she's being transferred because of her attributes rather than substandard performance," she notes.

Remember, most people want to get it right, but some need a little more guidance. "Don't say, 'You're doing this wrong. Fix it,' " says Kenneth Bowden of Berkshire Professional Management in Pittsfield, MA. "He or she could do it wrong again in a different manner. Rather, say, 'Here is how it should be done, and here's the time frame in which I expect to see the change made.' "

Can't everyone just get along?

Bowden works with a practice that fired its entire six-person staff after a year of trying to get the sextet to resolve differences. "The employees were shown the door at 9:30, and six new people showed up at 10," he recalls. "It worked splendidly. The practice has hummed ever since."

Individuals who don't work and play well with others often find themselves on the unemployment line. Some, however, might respond well to one-on-one counseling, or to having their grievances addressed openly.

When Betty Doria gets wind of employee discontent, she brings up the matter at a staff meeting. "We had an employee who would complain one week about not having enough time for lunch, and another week that the workload was too onerous," Doria recalls. "Without mentioning this person's name, we'd talk about workload or lunch breaks at the staff meeting. That way, everyone—including the disgruntled employee—knew that we were doing our best to respond to employee concerns."

Sometimes a procedural change is all that's needed to bring an unhappy staffer around, says Judy Capko, a practice management consultant with The Sage Group in Newbury Park, CA. She recounts the story of a medical assistant whose negative attitude was beginning to affect office morale. "We brought her in and asked, 'What can we do to help you feel less resentful?' She replied, 'The doctor doesn't return phone messages. Then he puts them on my desk at 5, when I'm ready to go home, and I have to take care of them.' We put a new procedure in place in which the doctor agreed to look at his messages at 11 and again at 4, giving the assistant plenty of time to return calls."

An employee fracas might call for arbitration. "If you have the people skills," Bowden says, "you can put the warring parties in a room and say, 'How can I help you resolve this issue? If it can't be resolved, someone will have to leave, because this dissension is disruptive to the practice. We have to resolve it here and now. I'll be the final arbiter.' "

Tardiness: Where do you draw the line?

Your workday starts at 9. So what do you do about someone who regularly rushes in at 9:15, or even later?

Consultants advise keeping your cool if an otherwise hardworking employee hauls in late every now and then. The staffer will appreciate the tacit message that you trust her, and you'll benefit from not sweating the small stuff. Habitual lateness, though, eats away at staff morale, and it's contagious.

In Betty Doria's office, frequent lateness or unexplained absences result in one-to-one counseling to determine what's going on—and if something can be worked out to preserve the employee's job. "If a longtime employee begins coming in late or her work falls off," she says, "I'll say, 'I can see something's troubling you. What is it?' Most people respond to genuine concern, and once the problem is in the open we can make adjustments to help the employee get back on track."

Doria remembers an assistant who was chronically late, and the rest of the staff had started to take notice. "It turns out that she was a single parent, and she had to get her daughter onto the school bus before she could leave the house," Doria says. "We work 8:30 to 5:30 every day, and the doctors usually run overtime—until 6 or 6:30.

"We switched this woman's hours to 9 to 6. That way, we took some pressure off her, and we didn't have to pay overtime to get the 5:30 to 6 slot covered."

Judy Capko recommends installing a time clock if your office has at least 10 employees and lateness is a common problem.

An employee problem, or management's fault?

"If several employees are having difficulties, then you're probably dealing with a management issue rather than a personnel problem," says Doria. "Perhaps you made a system or policy change and didn't bring your staff up to speed, or maybe your training process needs improvement."

Also consider whether you're asking too much of the people who work for you. Capko was called in after a practice went through seven receptionists in nine months. "The practice had become very large, and no receptionist could simultaneously manage the front desk, answer the telephones, and pull charts," she says. "We persuaded the doctor to hire a part-time person to handle records retrieval."

You need to be consistent, fair, and supportive of new people, Doria adds. And you have to document incidents. Ken Bowden seconds that motion. "Anyone you're having problems with is potentially going to get fired," he says. "So record all incidents of poor work, discussions, and warnings. If the employee is terminated and tries to sue, you want to have a file that discourages any lawyer from taking the case."*

Keeping communications lines open is essential to being a good manager. Sam Platia, administrator of the five-clinician Northwestern Medical Center in New Tripoli, says he periodically meets with employees and asks for their ideas on how their jobs can be modified. "They know their jobs better than anyone," he says. Feedback from them and making them feel part of a team increases the likelihood of a successful staff and smooth-running practice."

*For more on this topic, see "When it's time to give an employee the boot," July 26, 2002.

Getting off on the right foot

You're much less likely to have to deal with "problem employees" down the road if you provide good training and orientation for newcomers. "When people come on board, set up a realistic training regimen," says Alec Ziss, practice administrator at Weston Pediatric Physicians in Weston, MA. "Save the most difficult things for later, when they understand the flow of the office and what their main responsibilities are."

At the get-go, give every new employee a job description and an employee handbook (see "If you have employees, you need an employee handbook"). Training periods, naturally, depend on the nature of the job and the needs of the office; if you're without a billing clerk, for example, you might need to hire someone who can hit the ground running. But ideally the new person should have a certain amount of time to get up to speed.

"You need to set performance standards based on how long it has traditionally taken your employees to master certain tasks," says Judy Capko, a practice management consultant with The Sage Group in Newbury Park, CA. She offers the example of a new telephone operator: "How many calls per hour is she expected to handle? At what point should she be able to triage calls on her own? How long is she permitted to keep a caller on hold?" Such standards give both you and the employee goals to aim for and a clear yardstick to measure whether the employee is working out satisfactorily.

Encourage trainees to watch and listen to established employees. "Often there is more than one way to get a task completed," notes Nancy Becker, a consultant with Solutions for Management in Plymouth Meeting, PA, "and being able to observe all the ways proves helpful."

Watching others helps new workers get a handle on the office's priorities and how the workflow is managed. "Sometimes new employees fall behind because they're spending too much time on unessential tasks and letting critical duties slide," notes Sam Platia, administrator of the five-clinician Northwestern Medical Center in New Tripoli, PA. "I'll sit with them—or have a seasoned employee sit with them—and work hands-on."

Additional training might mean extending your in-house tutelage program for another week or two, or you might even spring for an outside seminar. "A lot of practices don't spend enough money educating their staff," says Kenneth Bowden of Berkshire Professional Management in Pittsfield, MA.

If you have employees, you need an employee handbook

One of the first things Sam Platia did when he became administrator of Northwestern Medical Center in New Tripoli, PA, was to put together an employee handbook. "Until then," he says, "a staffer who had a question about office rules would try to catch the doctor between patients."

You have better things to do than make policies on the fly—and you'll have fewer personnel problems if all employees know up front what's expected of them. A typical employee handbook covers job performance standards, training periods, termination policies, severance pay, benefits, and your rules regarding substance abuse, smoking, safety, sexual harassment, overtime, performance evaluations, salary reviews, dress codes, work schedules, lateness, absenteeism, vacations, sick leave, and family and medical leave.

The Professional Association of Health Care Office Management has a sample employee handbook on its Web site; visit www.pahcom.com/roccy_hndbk_complete.html. The Medical Group Management Association's Job Description Manual for Medical Practices contains hundreds of job descriptions that you can customize for your practice. You can order it on the organization's Web site, www.mgma.com, or by calling 877-ASK-MGMA.

Gail Weiss. Practice Pointers: Turn a problem employee into a pearl.

Medical Economics

2002;24:19.