Management Essentials

The Employee Handbook: The Spine of Your Practice

By Farrell "Toby" Tyson, M.D., F.A.C.S.

Today's ophthalmology practice is no longer a single-celled organism. It has evolved into a complex multi-cellular organism with vast specialization and intricacies. Like any complex animal, it requires a structural backbone to function and survive. That backbone is the employee handbook, and the brains are the doctors and the practice administrator.

Most doctors do not realize the importance of a well thought out employee handbook. This ever-evolving document enables and protects the doctors and administration. It sets down the rules for all to see. It prevents many misunderstandings or misinterpretations. The time and money spent tackling just one problem per week that could have been spelled out in the employee handbook is time, money and stress that could be better spent advancing practice goals. Many times employees will "shop" their ideas, as well as their grievances, between managers, doctors and administrators until they find the response they are looking for. Having a detailed employee handbook keeps all parties on the same page and removes many ambiguities.

In setting up a handbook, one needs to start with the basics. This includes a mission statement of the practice, and the expectations of the employee and employer. This graduates into office policies such as attendance, attire, vacation/sick leave or paid time off, resignation, termination and introductory period of employment and/or probation. The more detailed the handbook, the fewer questions a practice will encounter.

Over time, all things are tested and through this process your manual will evolve and mature. Each time a problem presents, the manual should be revised to ensure that you don't have to deal with that issue again. At first glance, our manual has several unusual sections, but they are there because we have been tested in these areas and learned from our mistakes.

For example, our practice believes strongly in staff development, so we have no problem sending our techs for additional education. One year, we sent a tech to the AAO conference at great expense to the practice, only to have her turn in her resignation upon return — to go work at a competing practice. When asked why she did not resign prior to the trip, she stated that she wanted to enjoy the travel prior to leaving. As you may imagine, this left a bad taste in our mouths. The handbook was quickly amended to state that any employee receiving educational funding had to sign a promissory note against future earnings that would be prorated over the following year. That way, if an employee left prior to completing a year of employment, the practice could recoup some of its investment.

These types of scenarios crop up most often surrounding resignation and termination. In our manual, we have had to clarify that any remaining paid time off will only be paid out following a fully worked 2-week notice. This stopped the practice of receiving a 2-week notice along with a request for vacation — leaving the practice without coverage and time for a smooth transition. Termination policies also need to be carefully spelled out from a labor law standpoint. This allows employees to understand the ramifications of termination from benefits to be received or withheld. From an administrative standpoint, this is protection and support for the dismissal.

This transparency is key to running a smooth practice. It helps eliminate favoritism, as all employees are held to the same rules. It is important not to deviate from the manual as deviation then undermines its importance and reduces its legal support of the practice. That doesn't mean that flexibility cannot be built into the handbook. Several areas of the employee handbook require that there be practice discretion allowed, but this can become a slippery slope.

The manual should be updated annually and reviewed by your labor lawyer on a regular basis. This allows for input from staff, addressing situations that may have come up and the education of managers and administrators. Most importantly, the doctor(s) of a practice must review the handbook to make sure any additions/deletions/manipulations are what the practice owners intended, not necessarily what the staff desired. All staff members upon hire must read and sign an acknowledgement of their understanding of the handbook. Only when all parties are informed does the true value of an employee handbook shine through. OM