Management Essentials

Ophthalmic Prenuptials, Better Matches

By Farrell "Toby" Tyson, MD, FACS

If history has taught us anything, it's that relationships are very hard to maintain. Over 50% of marriages fail, likely because they optimis tically begin with neither full disclosure nor realistic expectations. This has led to in creased use of prenuptial agreements to protect all parties involved.

With ophthalmology partnerships facing the same failure rate, we now apply the same prenuptial concept in a disclosure document to secure the employer/employee relationships in our practice. Employment relationships are most rewarding to all parties when everyone's expectations are met. Before entering into a relationship, everyone must know what the nonnegotiable issues are.

Great Expectations

The practice prenuptial, also known as the "Employment Expectations" disclosure, informs the applicant of the practice culture and allows the employer to set the stage for what future employment will entail.

We list our non-negotiable issues first: a drug-free workplace, assigned parking spaces, no visible tattoos or body piercing, strict dress code and uniforms. We do not hire smokers. We clearly disclose that all staff must be certified or licensed if programs are available, and that continuous education is required of all staff in order for the practice to remain on the leading edge of ophthalmology.

Prospective applicants read the disclosure before they fill out an application for employment, saving them the time and embarrassment of applying for a position they may not want. Giving potential applicants the opportunity to self-eliminate also saves the practice time.

All applications for employment should be kept on file for a full year; employers may be liable for hiring litigation and discrimination claims whether they hire the applicant or not. By limiting the number of applicants through the use of an "Employment Expectations" disclosure, the practice limits liability risk and the overhead of document storage.

Eight Steps to a Solid Relationship

In the disclosure, we clearly state our practice vision, followed by what we call the eight As:

Attitude is probably the most accurate predictor of employee success. We expect a pleasant, positive and respectful attitude to patients, doctors and other staff. When frustrations or grievances over policies or procedures arise, they should be taken to a supervisor rather than co-workers. Change should be embraced with a positive attitude and interpersonal matters should be dealt with in an open and honest manner — no gossip.

Attendance can be a deal-breaker for many applicants. We expect everyone to be at work on time every day they are scheduled, clocked-in, in uniform and ready to work. Responsible management of PTO and child-care arrangements are expected. If they can't follow little rules, you can never trust them with big responsibilities.

Appearance can be very subjective if not spelled out clearly. We expect all our staff to arrive in the assigned uniform, including a smile. Appearance is not just about clothes; it is how one portrays themselves in correspondence, and in their professional interactions and workspaces.

Accuracy and aptitude remind potential applicants that results do matter. For satisfactory job performance, one needs to be accurate in all tasks. This includes being careful and asking questions to avoid mistakes.

Accountability means that employees accept responsibility for their performance of duties and will comply with all practice policies, procedures, regulations and guidelines.

Adaptability is probably one of the hardest ideas for job applicants to embrace. We expect all employees to enthusiastically embrace selfimprovement and continuing education as a daily experience.

Accomplishment is obtained with help from all of the previous categories; it is not just personal and professional, but includes being an integral part of the accomplishments of the practice through hard work or suggestions to improve the practice.

Happily Ever After

If you could eliminate the bottom 20% of your employees, you would probably eliminate 80% of your personnel problems. It is even better if you never hire them in the first place. Hiring the right staff may be the most important practice management decision that you will ever make, because no amount of coaching or training will overcome a poor selection. OM

Farrell C. Tyson, MD, FACS, is a refractive cataract/glaucoma eye surgeon at the Cape Coral Eye Center in Florida. He may be reached at tysonfc@hotmail.com.