Staff Retention on a low Budget

How to keep good employees, even when resources are thin.

BY RENÉ LUTHE, SENIOR ASSOCIATE EDITOR

Holding on to quality employees is frequently a tricky task. We live in a culture that expects job mobility and assumes that people are always on the lookout for a more lucrative opportunity So the financial burdens involved in retention programs can weigh heavily on medical practices, because we also live in a culture of declining reimbursements. And the burden can get even heavier when an economic downturn further complicates the situation, leaving even fewer dollars to bestow on deserving staff. Fortunately, seasoned practice administrators and owners say that there are a lot of ways to keep valued employees loyal and happy that don't involve breaking the bank.

Better Than Money…

The administrators Ophthalmology Management spoke with agreed that practices often rely too heavily on financial incentives to keep good staff. Strange but true — money may really not be everything. That may especially be the case for those who choose to work in healthcare, according to Maureen Waddle, senior consultant at BSM Consulting and co-author of a human resources column for Administrative Eye Care.

“These people are more nurturing and caring anyway, and they get their satisfaction out of doing that job,” she explains, “whereas people who are very sensitive to specific financial incentives tend to migrate toward sales-type positions. I think-that you have to look at what motivates people in the first place.”

Offering healthcare workers the means to improve their professional skills is a powerful tool for retaining quality staff, says Dawn Cavanaugh, chief operating officer at Pepose Vision Institute in Chesterfield, Mo. The practice provides continuing education to all staff. After applying for approval, employees are reimbursed for up to five college credits per semester, provided they earn a grade of a “B” or better in the course. Technicians are told upon hiring that they must maintain certification, and the practice pays for courses for that too, as well as JCAHPO credits. The practice also provides a $1-per-hour wage increase once the certifications are obtained.

Ms. Cavanaugh says that in her days as a consultant, she saw many technicians that either lost their certification or their employers didn't help them to obtain it. “But I think in this day and age, we need to be very proactive when it comes to education,” she says. “Because technology, as I remind the staff, does not stay the same — it's continuously evolving.”

And while the practice does require a signed commitment from the employee to remain with it for at least six months after completing the course, Ms. Cavanaugh says that they haven't had a problem with employees taking their new skills and leaving to work at a competing practice.

“I just hired a technician who had been with another practice 13 years. She said to me, ‘I gave them 13 years of my career, and I never got anything. I never got my certifications reimbursed; I was never encouraged to learn more. I'll be here the rest of my career.’”

The incentive to stay on the forefront of ophthalmic education does more than simply help the practice retain staff — it makes the practice more competitive as well. Other clinics, Ms. Cavanaugh reports, have called Dr. Pepose's practice to ask why their biometry is so accurate. The answer is that they certify their staff in biometry.

“All clinical staff are sent to courses on biometry and they need to pass prior to working with these patients,” Ms. Cavanaugh says. “Then it's an honor to be on that program. We don't just throw them into it and then say, ‘I don't understand why the doctor was off half a diopter!’”

At Eye Centers of Tennessee, practice administrator Ray Mays used his powers of observation to devise a good retention policy.

“I've been here 11 years now, and you didn't have to hit me with a baseball bat too many times before I realized that the doctor and I are the only guys here — everyone else is a woman,” says Mr. Mays. Because of that, he considered what they could do to make things more appealing for the mostly female staff members. “Whereas men finish work and go home and they're generally done for the day, when women go home they usually have another job to do,” given their family responsibilities.

His answer was to devise flexible schedules, including a work-week of four 10-hour days. Female staffers with children can work from 8 a.m. until 4:30 p.m., while others can choose different schedules.

Parents who have to deal with school closings on snow days are invited to bring their children to the office and let them spend time in the break room. “We've tried to focus on those things that make people's lives a little easier,” Mr. Mays says.

But Money Matters, Too!

Yet while monetary rewards should not be your primary way of keeping staff, realistically they do have their place. “The reason everyone is coming to work is to get paid,” Mr. Mays points out. “That's the reason everyone schleps it into the office every day.”

Keep in mind, however, these veteran practice administrators warn, that cash bonuses must be tied to performance. If it becomes an entitlement, it loses its impact to incentivize staff, warns Ms. Waddle. While it's fine for a practice owner to give employees a cash bonus when the practice is doing well and he or she is feeling generous, she says that if the bonus is given at the same time the next year, it quickly becomes perceived as an entitlement, she says, and has little impact on staff performance.

Mr. Mays agrees that bonuses should be tied to performance. At the Eye Centers of Tennessee's six offices, each location has a monthly collections goal, with bonuses based on the actual collections — not charges or “tricky math,” Mr. Mays says, but on actual deposits in the bank. While collections over the past year have not been as high as in other times, the policy does ensure that each staff member in the individual office has an interest in keeping the schedule full.

“If someone calls and asks if we have a cancellation today, the answer is yes. Or when it's time to call people and remind them that it's time for their annual exam — every opportunity becomes important,” Mr. Mays explains. “If someone cancels an appointment, our first question is, ‘When can we reschedule you?” It works great, because there's peer pressure and everyone is engaged in the process.”

Pepose Vision Institute has a very effective means of staff retention that, though not exactly financial, does involve an outlay from the practice: a trip to Hawaii. Ms. Cavanaugh reports that they schedule the trip every five years at a time to coincide with the Hawaiian Eye Meeting, so that staff may participate at the meeting. The practice lodges staff in a condominium that sleeps 10 people, pays for their transportation, as well as for transportation for one guest. Staff members take turns going on the trip, with just a few sent each time. Readers probably won't be shocked to learn that Ms. Cavanaugh calls it “a great retention program.”

“We dangle the Hawaii trip in front of them every so often,” she says. “Someone will say, ‘I'm so stressed, I'm having such a bad day!’ And I'll ask, ‘How much longer before you go to Hawaii?’ And you can see the tension melt.”

Small Tokens of Appreciation

Fortunately, some rewards don't have to be as costly as a trip to Hawaii. Small rewards can provide a big boost to staff morale and hence, retention, says Debbie Weiss, administrator for Dallas Eye Care Associates and on the board of the American Society of Ophthalmic Administrators. She holds “Lotto Days,” on which she creates lottery-type scratch-off tickets. A technician or scribe who can bring a patient to the optical shop for an eyeglass purchase gets his or her ticket scratched off by the optician; each member of that employee's team then gets whatever dollar amount is revealed on the ticket.

“I try to think of different, fun little things that get them out of the normal routine, but don't cost the practice a whole lot,” Ms. Weiss says. Other strategies for team building include blue-jean Fridays, catered lunches and assigning teams to decorate for holidays and trunk shows.

Ms. Waddle says that rewarding staff for superior performance can be as inexpensive as a gift card for Starbuck's or taking the staff bowling and providing bowling shirts with the practice's name on them.

Those Lines of Communication

Good communication with staff is another powerful tool for retention. For instance, it is not enough for a surgeon or practice administrator to merely tell staffers, “Good job!” when they perform their duties conscientiously, or to tell them long after the fact. Feedback needs to occur as close to the observed behavior as possible to really have an impact, says Ms. Waddle. Additionally, it needs to be specific.

“It should be something like, ‘Sue, when you escorted Mrs. Smith out to her car because she was having difficulty, that really showed you giving a great deal of care to our patients, and that's what we're all about here at this practice, so I really appreciate you doing that.’ It really doesn't take much time, but it has so much impact,” she says.

Offering praise before fellow staff members can be particularly effective. Ms. Cavanaugh reports that at her practice's annual holiday party, Dr. Pepose reads a brief narrative for each employee about the special contributions he or she made over the course of the year. With the large staff, it takes a good deal of time, Ms. Cavanaugh says, but employees enjoy the recognition.

“We don't give undue praise,” she explains. “But if someone has been hitting major home runs, we list those home runs. And it doesn't cost anything!” All it requires is for her to make notes, on a weekly basis, about employee performance in a desk diary so that the praise can be specific and genuine. Ms. Cavanaugh says she writes approximately half a page on each employee for Dr. Pepose to read.

But “communication” in a more personal, everyday way works as a retention tool as well, according to Daniel S. Durrie, MD, of Overland Park, Kan. He believes both managers and physicians practice this with their staffs.

“I think you need to understand what their personal situation is,” he says. “When you come in on Monday morning, ask them how their weekend was, ask them what is going on in their lives. You don't want to have somebody whose husband has lost his job and you don't know about it.”

What Doesn't Work

While there is a lot of variety and room for creativity in what makes an effective retention tool, there are some things these veterans of the staff- retention struggles say don't deliver. Mr. Mays takes issue with practices that, he says, “incentivize a lack of bad behavior instead of incentiviz-ing good behavior” — such as rewarding people for coming to work on time. Ms. Cavanaugh cites policies of rewarding perfect attendance as such an example.

Dr. Durrie warns against pressuring staff with unrealistic expectations, such as targets for certain levels of performance. Targets may need to be re-evaluated, particularly in the current economic downturn.

“These targets can have a negative influence on staff morale in a down economy,” he says. “They are sometimes very hard to hit if the phone is just not ringing or people are deciding to put off elective surgery until their economic situation is more secure. Don't put undue pressure on your staff.”

Heed these guidelines and staff retention should become much less complicated. “I think some people make personnel things harder than they need to be,” Mr. Mays says. “For staff retention, treat people nicely and pay them a competitive wage.” OM