From terribly wrong, to on the right track

Any practice’s hiring and firing program needs logical, well-constructed steps. Without them, there will be chaos.

By Steven R. Robinson, FASOA, COE

“We seem to be running a hiring and firing mill,” the managing physician partner told me, his consultant, during a special meeting to discuss the practice’s employment problems. “There are times when it seems as though we have about as many employees go through here as patients.”

The frustration in his voice expressed a sobering conclusion reached by himself and his partners: Something was terribly wrong with the five-physician practice. In the past five years, the managing physician partner said, the turnover rate had reached at least 25% ­— clearly unacceptable and very expensive.

Is this practice unusual? Not that I have found in my 28 years as a consultant. I offer it as a case study in hopes it can help others in the same predicament.

A bit of background

Over the past 10 years, the practice grew from a solo practice with 12 employees to its current 54. The partners added subspecialties, an ambulatory surgery center and expanded its optical operation; patient response from the community was positive. On the surface, the practice appeared to be very successful. But while money was flowing in, it was evident that the joy of working at the practice had simply vanished. A never-ending string of personnel problems had inundated the physicians that they could not escape. Coming to work each day was no longer a positive experience, and they all dreaded it.

A thorough examination of the group’s interviewing, hiring and firing practices showed many reasons for the problems — but the primary one was that they lacked logical, well-constructed processes. They had no standardized human resources criteria. Management preferred reaction rather than any planned approach. Once a person was terminated — the practice’s preferred method of handling employee issues — or resigned, his or her replacement was immediately sought. Little thought was given as to whether another person should be hired; this just became an automatic exercise. Rarely did management consider whether the position was superfluous.

As for how the new person was found: through an ad in the local newspaper; a notice tacked on the bulletin board at a local hangout for off-duty medical personnel; or employees asked friends and family if they were interested in the position. In other words, the practice “put the word out.”

Interviewing was more whimsical than scientific, as there were no guidelines, and these “interviews” disintegrated into conversations that meandered everywhere. Nor was there much rhyme or reason behind the decision to hire an individual; it seemed the term “hit or miss” guided the hiring exercise.

Eventually, management made a choice and the applicant was offered a position. Once hired, the newbie underwent “formal training” that was anything but: Management hoped existing personnel would take the new person under their wing and teach him or her what was necessary. The new person was thrown into the fray, hoping he or she might succeed.

You can see why I called this whole process terribly wrong; now, let me explain how we set them on the right track.

The first steps

After carefully reviewing the salary and hiring records, practice policy and procedures, and having an in-depth conversation with the administrator and managing physician, we decided to revamp the practice’s hiring and training processes. The first step was to determine the desired end result. The partners wanted to see the employees develop a major shift in attitudes and make long-term commitments to the practice. The steps to achieving these goals, which would be discussed at a strategic planning meeting, involved:

• Making sure that management and all physicians acquired the necessary assistance in learning about strategic planning to become well versed in the necessary procedures.

• Having each department compile a list of what it required for each job description and then task those departments with reporting that information.

• Determining the date of the strategic planning session and informing all who would be required to attend.

• Assigning the practice administrator and managing physician the task of determining the form and appearance of the data to present at the strategic planning meeting.

• Committing the physicians and senior managers to those procedures necessary to formulating and implementing the plan.

• Initiating the plan, reviewing it with employees and permanently placing it on display.

When change happens, what happens?

Generally speaking, some changes in practice philosophy will occur initially. Once the outcomes of the strategic planning session are determined, the balance of the change in practice philosophy can commence.

What can the practice do immediately?

• First, make changes in the job application and interview processes. This will encompass complete and accurate job descriptions for each position in the practice.

• Establish standards for each position and pay close attention to the formulation and implementation of the job description processes.

• Base interviews with prospective applicants on the job description information.

• Hold all personnel accountable for performance in accordance with the requirements listed in the job descriptions.

• Redesign the employee evaluation system. Design and implement a new program that is closely tied to the items on the various job descriptions.

Some personnel will welcome these changes and begin performing in accordance with the standards desired. Others will resist and eventually leave. Yet a third group will take a wait-and-see approach. It is important that leaders know who is in this group and work with them to bring them on board. Eventually, staff members in this third group will migrate toward one of the other two groups.

It is vital to a practice’s success that its members develop “ownership” in the practice. Ownership will give them a sense of pride in who they are and what they do, ultimately permeating their activities. If properly led, this “can do” attitude will eventually become a large part of their practice “personality.” Nothing is as powerful to the patient as appreciation, and nothing so negative to that same patient as being treated as an “interruption” by the employees.

And the results are in

Two years into the program and monumental changes have occurred at my client’s. Both the employees and the physicians are happier and more content in their roles. The sense of “gloom and despair” has disappeared from the physicians’ demeanor and, while not perfect, improvements in personnel attitudes are easily detected.

Practice management personnel and physicians have developed a bonus program for all employees, based on profitability. Bonus sharing is based on longevity, salary level and evaluation score. This profitability bonus has replaced all other prior bonus types. Also, staff meetings are held on a regular basis; the emphasis is on the practice’s financial position. The information disclosed is broad in nature, but easily digested so staff can appreciate the practice’s financial footing. These meetings also offer a great opportunity for management to present items like changes in insurance coverage, retirement plan information of a general nature and human resource issues that are essential to the smooth running of the practice.

The monthly staff meetings also are used as a communication tool. The physicians present changes to job procedures and new types of medical procedures; if no new procedure is on tap for that month, a physician gives a presentation on an existing medical procedure or treatment. Time is allotted for all to ask questions. This newfound employee knowledge is essential to practice growth.

The practice has also created an internal Intranet for its employees. Items like the policy manuals and the procedure details are easily accessible. Also, any changes to those manuals can be made with a few keystrokes.

And the turnover numbers? Seven employees have left in the past two years; one an age-related, voluntary retirement. Two left because their spouses got new jobs and had to move. Of the remaining four, one wasn’t replaced — management re-evaluated the position and decided it wasn’t necessary. And, as we predicted, some left the practice because they did not want to change.

The employees have been invited, and have accepted, to take ownership of the practice and have become ambassadors for the physicians. The community is responding favorably to the changes in the practice and to the staff. And the practice is growing — favorable outcomes all around. OM

About the Author
	Steven R. Robinson, FASOA, COE, is the principal consultant with S & R Consulting of Chattanooga Tenn., working with physicians’ offices, clinics and optical operations in the areas of human resources, finance and operations management. He is a national speaker on topics of interest to the medical management community. He can be reached at steve@srr2.com