Resolving the 24 Top Staff Gripes
How to defuse your practice team's most common complaints.
BY JOHN B. PINTO

Before we get into the exposition of staff grievances and gripes, let's start off on a positive note. In my experience, most lay staff are really quite happy about the work they do, and where they do it. But after conducting thousands of individual staff interviews, and applying hundreds of written surveys to ophthalmic support staff over the past 25 years, I've developed a short list of what workers in eye care find the most frustrating about their jobs.

Well, actually, the list isn't all that short -- with some trimming, it comes to 24 key items in all. I've arranged these below, with half of the employee complaints more directed toward doctors, and the other half more applicable to department heads and administrators.

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Chances are excellent -- or at least we can hope -- that only a few of these staff gripes will apply in your office setting at any one time. And hopefully, you're consistently chipping away at these sore points to improve staff morale, increase performance and reduce turnover. But even if you're staying on top of staff concerns today, or feel your team is perfectly content, keep this list handy for future reference.

Staff issues rise and fall not so much like the moon and tides, but like solar flares, with long periods of calm interspersed with unexpectedly violent eruptions. Knowing what to look for in your practice can help you cool down just one small problem at a time, rather than trying to contain a concerted storm of staff discord.

Gripes Against Doctors

1. Our practice lacks leadership. Staff will sometimes back this up by saying: "The staff here seems to care more about our practice than the doctors do." Have you established a culture of excellence, or a culture of 'just getting by?' Have you become progressively disengaged from the details of the practice, and put the harness on your administrator to pull the team along? Chances are, no matter how well you think you're leading the company, your staff is looking to you for more direction than you're giving today.

2. We don't understand our goals as a practice. Your employees want to know where the practice is heading in the future. What's our territory and service span? Are we adding a doctor? How fast do we want to grow? Staff members especially become anxious when there's one senior provider nearing retirement and no clear successor.

3. We don't feel the doctors respect us, or understand our roles. Staff want and deserve to be treated as fellow adults, not children. Doctors should periodically review the job descriptions of all staff, and the senior physician or lead/managing partner should meet informally with small groups of lay staff every month, on a rotating basis, to talk shop.

4. Doctors reprimand us in front of patients and co-workers. This is a common hot button, and often poorly understood by physicians. Here's why. Doctors are acculturated in a training environment where it's common and acceptable, in the interest of an intense educational process, to point out errors for everyone to see. For some people, this brings out their best work. But lay staff will usually perform poorly in such an environment. All reprimands, unless there's an emergency afoot, should be given privately. If, as a physician, you're not particularly adroit or gentle about offering criticism, defer this to supervisors.

5. The doctors don't acknowledge good work. The flip side of private reprimands should be public praise, evenly and fairly doled out. And not just with the technical staff you work with most closely, but with clerical workers, as well. In all but the largest practices, every doctor should know the name of every employee. (Give a pop quiz at doctors meetings and you may be surprised how few do.) Give all staff oversized name tags so it's not so obvious when you have forgotten a name (nobody likes to hear, "Hey, you!"). To get other doctors in the praise habit, hand out 3 x 5 cards to all providers with the names of staff who are to receive praise that week. Ask each doctor to check off the names and turn the cards in at week's end.

6. We only focus on what's wrong with our practice. Doctors are trained to be critical thinkers, but such criticism can ooze over from clinical affairs and poison team morale. I see this often at staff meetings. Doctors will almost unconsciously stand up and deliver a blistering critique of staff screw-ups over the past month. It's far more effective to varnish anything negative that has to be said with a few coats of praise for what's gone well.

7. We don't treat patients as well as we should. Staff will often be the first to wince when doctors are brusque or dismissive with their patients, or when physicians don't take enough time to listen. Ask a few trusted back office staff to give you feedback on how you interact with patients. Have you become colder as you've grown older and more bored with your practice? Are you now seeing more patients than you can comfortably handle alone? Believe what these reliable reporters tell you, and work to make improvements, which will not only increase staff morale, but will improve the care you provide. Whether your report card is good or poor, chances are if patients notice, staff will, too.

8. Dr. Meanie, who shouldn't be here, is allowed to stay. In larger practices, the odds are 100% that one doctor will be the least favorite. If this doctor's behavior is below an acceptable baseline, he should be improved or removed, even if he's a big financial producer. Drawing the line on bad behavior falls to the managing partner of the practice, who should evaluate the problem in concert with the administrator and board. Of course, this isn't just a problem in large groups. In the smallest group practices, with just two doctors, having one unpleasant provider is toxic to the company and to staff performance.

9. We don't stay on schedule in the clinic. The most common patient complaint about your office is likely shared by your office staff. As uncomfortable as it is to be a provider in a chronically late clinic, how would you like to be the receptionist? Such staff are saints squeezed on all sides: by the patients who are asking when they'll be seen, by the doctors who want to pack as many visits into the morning as possible, and by the technicians, who are convinced that the front office staff are out to get them. Running late has many secondary causes (poor scheduling, incomplete training, lax supervision), but the most important primary cause is the doctor. Every provider must be accountable to arriving on time and staying on time throughout the day.

10. Our practice tries to collect every last dollar. In my experience, a doctor who's greedy gets that way progressively over the years. As unwarranted financial insecurities sneak in and rob his peace of mind, Dr. Mercenary over-treats, under-delivers, and plays a dicey game of over-the-line with third-party payers. This behavior is progressive, and with every passing year, staff cynicism grows along with the threat of whistleblower action.

11. Our practice is generous with patients at our expense. At the other end of the continuum, it's very frustrating to staff to see their doctor be excessively generous with professional courtesy or other write-offs. Yes, it's obviously the doctor's privilege to discount and write off accounts at will. But if this is perceived to be done at the expense of staff payroll and benefits, such doctors lose money twice . . . once from the unbilled patients, and once from the staff who leave in frustration, or worse, get loose with collections because their doctor doesn't seem to care.

12. Our doctor is more successful every year, but our incomes stagnate. We end this section with a not-uncommon lament from Sally, the head tech: "Last month, Dr. Jones said we all had to toe the line and watch expenses because of the coming fee cuts. He froze salaries and took away our dental benefits. Now, this month, he drives up to the office in a new Mercedes, and we learn that he and his wife are going to Australia for a 5-week vacation this winter. I'm so angry!"

Sally and her colleagues are perfectly right to feel this way. You've got to walk the talk. At the very least, leave the new Mercedes at home, and settle for 10 days in San Diego, where they've got a whole zoo full of koala bears.

Gripes Against Supervisors/Administrators

1. Our practice administrator doesn't have the doctors' support. Lay staff are almost perfect instruments in their understanding of where their administrator stands with the owners of the practice. If the office manager or administrator is out of favor, the chain of command is markedly weakened and staff morale craters. It falls to every lay practice leader to understand his or her status with the doctor (or board of doctors) and to either win the abiding respect of the employer or step down. Remaining in a leadership position without clear support from the top is nearly as damaging to the organization as it is to the ego.

2. We need middle managers, but don't have them. People working in groups, by their nature, deplore a power vacuum. In a practice with any more than 8 to 10 staff, it's appropriate to name department heads, or team leaders at the least, to make clear who's in charge. I've seen practices with as many as 24 equal lay staff, with just one beleaguered administrator trying to maintain a direct reporting relationship with everyone on the team. It can't be done well, even if you're a superhero.

3. We have the wrong people in supervisory positions. Department heads are usually selected for their tenure or their technical skills, not for their ability to manage other people. And in smaller offices, and smaller communities, where the stock of available candidates is small, there's no practical solution, except to pick the best people available for leadership positions, and then provide ongoing coaching to improve their supervisory skills.

4. We don't consistently make good choices when hiring new staff. Employees complain the loudest, and with every right, when new staff are selected to join the practice and existing staff don't participate in the interviewing process. Every potential staff member, from partner-track associate doctor to housekeeping staff, should be interviewed by a reasonable cross-section of current staff. In smaller practices with 20 staff or less, there's no reason that every new hire can't be interviewed by everyone and accepted for employment only after being approved by a vast majority of existing staff.

5. Staff who shouldn't be here are allowed to stay. You may be surprised to learn that your employees are tougher on their colleagues than you are as a practice manager or owner. They often know best who's pulling their weight and who's passing the buck. You obviously can't poll staff for a list of people who should be on the chopping block. But by developing a close working relationship with every staff member, the wise administrator learns soon enough where the trouble lies and can surreptitiously elicit a second opinion whenever a likely staffer is under review for termination.

6. We don't put enough resources into staff training. Your office should ideally be devoting 1 hour of training time for every 79 hours of work. And put that way, it doesn't sound like very much time. But I'd venture that not more than one practice in 25 devotes this much time to training. Ramp up training efforts for a year, and you'll see marked results in efficiency, morale and tenure.

7. Certain staff get special treatment. Workloads need to be evenly and fairly divided to every possible extent. And perception is reality. The techs may be pushing out many more calories of raw work in a morning than anyone else, but when they slow down to breathe for a few minutes at the end of the session -- just when the check-out desk and optical are getting pounded -- they earn the wrath of their peers for "goofing off."

8. Our supervisors overwhelm us with work -- or, our supervisors don't keep us busy enough. This problem can be addressed from both sides. Work should be metered to the available staff, and vice-versa. When there's too little work, the workforce should be trimmed or deployed to collateral duties, rather than left to be demoralized with too much time on their hands. When there's an uncomfortably large workload, the department head leading the team should be working twice as hard as everyone else to help get everyone through it.

9. The person supervising me doesn't know my job. All supervisors should ideally come up through the ranks so they understand the jobs they're overseeing. The most common complaints occur when an RN who once did floor nursing in a hospital or a former front desk supervisor is brought in to be the head technician. In all but a very few special circumstances, the tech supervisor should be on the floor working up patients at least a few hours every week.

10. We lack teamwork. At your next group staff meeting, pose this simple question: "On a 1 to 10 scale (1 being low and 10 being high), what's our level of teamwork in this practice?" Turn in the votes with a secret ballot and then tally the score. If the average teamwork number is anything less than 6 (or even if it's higher), continue with open discussion or more secret polling to find out where teamwork is falling down.

"Teamwork" can be a very elusive topic. Try to get participants to the point of naming specific steps that could be taken toward improvement. Examples include: a formal, moderated retreat session, clear written goals, leadership training for all supervisors, or more doctor participation at staff meetings.

11. Communication is poor. Staff meetings need to be frequent, upbeat and productive. For the typical three-doctor practice, all-hands staff meetings should be held monthly or every 6 weeks, and as many doctors as possible should participate. Department heads should convene with the administrator and managing partner at least every 2 to 3 weeks to discuss operations. Written communication, with increasing formality and frequency, becomes essential as the practice grows.

Any practice with more than 20 staff should have a brief, bi-weekly bulletin with training pearls, routine announcements and pats on the back.

12. We have staff conflicts that our managers don't resolve. Interpersonal harmony within each department is the basis for harmony in the entire group. Individual department heads should resolve conflicts between staff, and in the most extreme cases, terminate employees who can't work together as part of a team.

This task takes the emotional intelligence of a West Coast psychologist and the tough love of an Italian mama, which is why it's often best for doctors not to become involved with petty inter-staff grievances.

It's a Team Effort

No manager -- and certainly no doctor -- can create a perfectly happy work environment out of thin air. Support staff need to take a measure of the responsibility to make sure that legitimate grievances are aired calmly, and that the managers and owners of the practice understand what they're doing right as overseers, as well as in what areas they need to improve.

John Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979 with offices at 1576 Willow Street, San Diego, Calif., 92016. John is the country's most-published author on ophthalmology business and career management topics. Recent books include the second edition of John Pinto's Little Green Book of Ophthalmology; Turnaround: 21 Weeks to Practice Survival and Permanent Improvement; and Cash Flow: The Practical Art of Earning More From Your Ophthalmology Practice. He can be called at (800) 886-1235, e-mailed at pintoinc@aol.com, or found on the Web at www.pintoinc.com.