How Healthy is Your Staff's Morale?

They spend more time with your patients than you do, so it pays to keep them happy.

By René Luthe, Senior Associate Editor

In a weak recovery from a serious economic downturn, staff should be happy just to have jobs — so goes the conventional wisdom. You have plenty to do just caring for your patients. Is it really necessary for you to keep staff morale up too? The answer is yes — and your patients are the reason why.

“The patients have more interaction with your staff than they have with you,” Dan Durrie, MD, in private practice in Overland Park, Kan., points out. Thus the satisfaction of the staff with their jobs and the support their contributions make are important, he believes. “I think sometimes we get hung up with technology and surgery and the things that we do and don't realize that we need to look at the needs of our staff.”

What may happen should you overlook these needs, in light of all your other duties? You could very well lose patients even if you provide excellent care and have a sterling reputation in your area; yours is not the only bedside manner that matters, according to consultant Martha Land Young, a practice development consultant with 29 years experience in ophthalmology. “It matters very, very much how staff treat patients,” she maintains. Further, she says, dissatisfaction with the treatment they receive at a practice is a big reason why people switch practices. “They call their insurer and say the company will have to get them another doctor because they didn't like the way they were treated at this office.”

While the presence of a conscientious, dedicated staff is particularly important at a private-pay only practice like Dr. Durrie's, where patients have no incentive to put up with staff who seem subpar, the importance of an engaged staff is true across the board, Ms. Young insists. Fortunately, creating a healthy morale among your staff may be easier — and less expensive — than you think. Much of it comes down to communication and in learning to bring some fun to the daily routine.

First, Know What You Want From Them

Communication is essential to fostering a good attitude among staff, but first you have to think carefully about what you want to communicate. Ms. Land maintains that practice culture needs to be emphasized from the job interview on. It must be made clear to staff what the practice values, how they expect staff to treat both each other and patients, and how they are expected to relate to the doctor.

Maureen Waddle, a senior consultant with BSM Consulting, says that practices that succeed at creating a positive work environment do it around a mission statement that specifically mentions providing better vision or caring for patients. She favors mission statements that are short and sweet, noting that people tend to forget the lengthier ones. Short and to the point means that it's easier to keep in mind.

Once you've articulated your mission statement, empower staff members to fulfill it and tell them that they have done so, Ms. Waddle recommends. “Say, ‘Thank you for helping us achieve our mission. This patient said that their vision is better thanks to the wonderful work of our office,' just to show that the work they do every day has meaning.”

When Dr. Durrie was building his practice, he sought the advice of a friend who had the reputation of having one of the best practices in the United States. He was told that their key to success was their ordering of priorities: Patients come first, employees second and doctors third. Dr. Durrie chose to incorporate those priorities as well. “Any time we are making a decision about what we should do in our office, we always ask: Is this the best thing possible for the patient? Is it the best thing for the staff? If so, the doctors will support it. This is something of a reversal of the doctor leading everything. We not only say staff are important, we act it, and they feel it.”

Laurie Brown, administrator at Drs. Fine, Hoffman & Packer in Eugene, Ore., says that her practice's culture has always been one of change, whether it is conducting research on new technology or finding small steps to improve everyday performance. “We want each employee to continually work to become knowledgeable and better; that makes our practice better,” she explains. One way they communicate the importance of keeping up with change and keeping their knowledge current is to bonus technical certification. What the practice expects is clearly rewarded across the board.

Walking the walk is only one means of reinforcing your culture. Once you know what kind of culture you want to foster, the practice must continually communicate it in ways large and small. For one thing, don't keep that mission statement, and practice expectations, in an employee manual that no one ever opens after their first day on the job. Post the mission statement around the office (another reason to keep it short and sweet), and post it on an employee-specific intranet. Dr. Durrie keeps a detailed employee manual that includes dress and behavior codes on one so that it's always accessible when staff has questions.

Sorry — Meetings are Necessary!

Staff may groan at the mere mention of them, but meetings are a great opportunity to review, address challenges and new ideas, and to inculcate the practice culture into new employees. The doctors should speak at these, both to provide leadership and to be aware of what is going on, as well as how staff feel about it.

Beverly King, practice administrator at Fishkind Bakewell & Maltzman in Arizona, reports that the doctors take turns speaking at monthly meetings. Their presentations may include demonstrations of new equipment or an update about new regulations or pending legislation. “Our staff meeting is sort of like a pep rally,” Ms. King says, where the practice leaders can build support for new projects and goals. Meetings were particularly helpful, she explains, in keeping staff motivated and informed over the past year as they have transitioned to EHR.

But don't use meetings to simply repeat a “to-do” list. Ms. Waddle recommends using the occasion to affirm that staff is exhibiting the kind of behavior you want. Behavior that is rewarded is repeated, after all — especially when it is publicly rewarded.

It's a Two-Way Street

Communication, however, must run both ways to keep staff engaged. While many businesses claim to have an “open-door” policy, staff need to actually see that their input has a chance of being heeded.

At meetings of Dr. Durrie's practice, staff feel quite free to question whether a new policy or procedure meets those stated three criteria. And staff should have input on the work they themselves are performing, he notes. “As doctors, we are the ones who come in and see patients, so we shouldn't be the ones controlling the schedule, or how people are checked in. And that policy has worked extremely well for us.”

Ms. Brown says that her practice takes a similar approach. It is important, she believes, to provide staff with the tools they need to perform their duties well. “If someone says at the front desk that she thinks she can cut two minutes off check-in if she has a double-sided scanner, let's talk about that. Are we using the right tools? It's got to be a win-win.”

Ms. Brown keeps a file of the employee suggestions the practice implements, or draws from, and at meetings the employees who proposed them are thanked. It encourages employees to offer ideas, she points out. More sweeping changes will be tried for a specific time frame, she says. At the end of the period, she gets input from the staff involved as to how that change worked from their perspective, rather than using a top-down approach.

Fostering Teamwork and Education

In the grind of daily practice life, though, it will probably take more than meetings to keep morale up. To help build a spirit of teamwork, Ms. King says that her practice has begun cross-training all positions within departments. It's a great help with the “heavy burn-out” jobs, she reports, such as check-in and appointment scheduling.

“If we can get those people off their hot seat for a couple sessions, half days each month, it really does help,” Ms. King says. “We have pulled some people from check-in and off the phones, and they were just smiling away!” She notes that these staffers seemed re-energized when they returned to their own tasks, and that those filling in for them felt they were helping the practice by doing so.

Additionally, all new employees at the practice must cross-observe. As part of their orientation, they are scheduled to spend time with each department before beginning their own position. “One of our initiatives is to revisit that with people who've been here a long time.”

Seminars for the public, usually aimed at seniors, are another way to foster a sense of solidarity. Staff are paid to attend and assist. “They listen and learn, they make appointments, greet attendees, pass out snacks and surveys. They represent the practice to the public,” explains Ms. King.

There are fun ways to help staff stay on their game as well. The need to be aware of changing regulations and new devices requires ongoing training that can often be accomplished via games and contests. Scavenger hunts can be aimed at finding an obscure piece of equipment, Ms. Waddle says. “Or the tech has to find out where to locate the ICD-9 code in the book, or find an EOB, things that they don't typically deal with, but which are part of the whole practice.” Some practices have done a “Jeopardy” type game. The winner, or the winning team, gets a prize of some kind. “It's educational, yet you get the competitive juices going and you have fun at the same time,” Ms. Waddle explains.

Ms. Young has held in-service meetings over lunch to educate staffs. These were particularly helpful for dealing with one of the typical challenges of an ophthalmology practice: communication between the front and back offices. At one meeting, the front office, for example, would hold an in-service for the whole practice and explain what they did every day. Facilitating this meeting gives the front office the opportunity to explain why they require other areas to complete or obtain certain information. “Speaking the truth in a safe environment may teach the whole practice why something must be done, as well as what will go wrong when a task is not completed or done properly,” explains Ms. Young. “We are again teaching our people how to communicate positively and constructively with each other.”

At the end of the meeting, the presenter was required to give staff a little quiz. Anyone who answered a question correctly was rewarded with a crisp five-dollar bill. “That's not a big deal, but it's fun,” she says. “And your employees could use it to put gas in their tank, or buy lunch.” One presenter hit upon a great motivator — candy bars. “You wouldn't believe how they wanted those candy bars! The presenter just told them she had Milky Ways and Snickers in her bag, and they listened very carefully after that.” Small rewards like those, Ms. Young points out, are affordable even for small practices, and fun for staff.

Personalize It

While perhaps nothing motivates like a big, fat bonus, never underestimate the power of a heartfelt thank you. It is especially gratifying when it comes from the doctors — something many of them may forget during the course of a busy day.

“Some doctors are notorious for running in late, throwing on their lab coat and running in to see the first patient,” notes Ms. Waddle. Taking a moment to look a staffer in the eye and say, “Thank you for helping me take care of those patients” definitely elevates morale.

Remember to do this, too, for those employees who aren't right under your nose. At Dr. Durrie's practice, the surgery center and patient check-in are on different floors, so it would be easy for their contribution to slip his mind. “I have to remind myself every once in a while to go downstairs and thank the check-in staff, because we are usually doing surgery after they've left,” says Dr. Durrie. “Otherwise, they won't feel that they are recognized.”

Ms. Young concurs. Employees in insurance and billing, as well as the front desk, may feel like the doctors don't notice them. “One doctor started to seek those people out and thank them every single day of the week — well, they were eating out of the palm of his hand!”

One “Christmas bonus” Ms. Young particularly liked was that of a doctor who would hand-write a little thank-you note at Christmas for staffers' contributions to his practice and his patients over the year. She concedes that that's an easier task when one has a small practice. “But I've seen notes that were saved for 10 years. It just means an awful lot. We have gotten away from the written word because of computers, but a hand-written note has a special significance when a doctor will take his/her personal time to thank a staff member.”

Expressions of appreciation from patients also help. Ms. Waddle recommends hanging their thank-you notes in the staff lounge. Alternately, after obtaining permission from the patient, you could post it on the practice's Web site.

And don't overlook what the appreciation of coworkers can do for morale. Ms. Young once created certificates for each practice employee on which she printed a fellow staffer's compliments on his or her performance. They were then posted throughout the office. “Once you recognize a quality in an employee or an act of kindness and put it in writing, the staffer feels so good about that recognition that she wants to do more to experience that positive reaction. It's a wonderful thing to watch them blossom.”

If this sounds like a lot of work for people who just wanted to practice medicine, those in the know swear that it is worthwhile. For those who are more reserved by nature, Ms. Waddle assures that with practice, frequent thank-yous will come more easily. These people should be disciplined about reminding themselves to affirm others. “Put it on your calendar if you need to!”

“The most difficult part of any practice, and the largest part, is the human resources element because it's your biggest asset for having the practice perform well, as well as your biggest expense. So it's well worth your time and attention,” says Ms. Brown. OM