Practice Pointers: What goes into an employee handbook

Every medical practice needs a clear, concise handbook to help new employees start off on the right foot, and prevent the kind of misunderstandings that otherwise might simmer and develop into major problems. After all, if your employees don't know what you expect from them, how can they live up to your standards?

Group practices typically have two different office manuals. The policy and procedures manual, usually addressed to office managers and supervisors, sets forth the practice's objectives and the procedures designed to carry them out. The employee handbook-a must for any size practice and the focus of this article-interprets and clarifies those policies and procedures as they apply specifically to the staff. It should clearly establish their duties and responsibilities, and a code of conduct for their behavior with colleagues and patients.

Why is a good handbook so important? By setting clear ground rules for employees, the handbook can also protect you from lawsuits if someone claims to have been unfairly disciplined or fired. If you can show that you acted based on a clear violation of office rules contained in the handbook, and that the employee was aware of those rules, you'll have a much stronger defense.

The introduction should make it clear that the handbook doesn't cover every possible problem or situation, and that you reserve the right to add, delete, or change any policy or guideline at any time without prior notice. The introduction should also state clearly that the handbook isn't an implied contract or a guarantee of continued employment.

Present new employees with a copy of the manual as part of their orientation. Ideally, that training should include a review of the manual, with an opportunity for the employee to ask questions or seek clarifications. "It's not enough to simply give someone the handbook and hope they read it," says David Karp, a risk management consultant in Cloverdale, CA. "When personnel problems arise, some employee will always say, 'Oh, I didn't know that was the office policy.' " That's why you should require new employees to sign a statement acknowledging that they've read, understood, and accept the handbook's contents. Keep that document in their personnel file.

To keep the manual up to date, a qualified attorney should review it annually to make sure it conforms to changes in federal or state labor laws. (Note that some state laws may be more extensive or have stricter requirements than federal laws.) Distribute a copy of each new revision to your employees, and have them acknowledge that they've read it.

Let's take a closer look at what a good employee handbook should include.

WELCOME MESSAGE. Start the handbook with a welcome message, plus a brief history of the practice and its philosophy or mission statement regarding the treatment of patients. It should present an organizational chart with clear lines of authority for clinical and clerical support personnel.

WORK SCHEDULE. Outline the practice's normal hours of operation, including regular breaks and lunch, flexible schedules, and overtime. Because habitual tardiness or repeated unapproved absences can be contagious and affect staff morale, the manual should state that both may be grounds for termination. Exceptions may be granted for personal or family emergencies, sudden medical problems, or hazardous driving conditions.

ABSENCES. List the criteria and prior notification requirements for excused absences, including sick days, sick leave, family and medical leave, jury duty, military duty, and bereavement.

VACATIONS. Detail eligibility requirements and accrual rates for vacation time, including requirements for advance notice and limits on days that can be carried over from one year to the next. For example, to make sure the practice doesn't end up short-staffed during holiday periods and summer months, some practices limit the number of staffers who can be out at the same time, or limit vacations to 10 consecutive days.