Best Practices

Dodge those HR nightmares

How to ensure your practice steers clear of staffing dramas.

By Elizabeth Holloway, COE, CPSS, PHR

A practice’s largest expense category is usually related to staffing. Most practices offer their employees competitive wages and vacation time, and many offer health benefits, profit sharing and other special incentives to attract and retain quality staff as well. With nearly one-third of practice net collections allocated to staff wages and benefits,* physicians need to ensure that their employee policies do not leave them vulnerable.

But even in practices with updated policies and procedures, HR issues can arise. In the following case study, Kathy, the practice manager, hired a new employee, Sarah. Kathy trained Sarah for three weeks and felt that Sarah fit in well with the team. At the start of the fourth week, however, Sarah did not show up for work. Concerned, Kathy called Sarah several times, but never got through. After three days, Kathy had to accept that Sarah was not coming back to work. Since the practice called Sarah on several occasions and received no response, Kathy sent Sarah a “job abandonment” letter via certified mail.

Immediately following the receipt of the job abandonment letter, Sarah called Kathy and asked for her job back. She stated that she had slipped into a deep depression and was unable to get out of bed. Kathy listened sympathetically but could not give Sarah her job back. Sarah had missed over a week of work before she had contacted the practice. Shortly after that conversation, Kathy received a petition to receive unemployment benefits. Ultimately, she had to participate in an unemployment hearing. While the judge ruled that the practice did not have to pay Sarah unemployment benefits, the incident cost the practice time, money and stress.

PROTECT YOUR PRACTICE

Practices that focus on developing trained staff, well-informed management and a positive culture can help minimize issues similar to the one described above. However, even the best, most well-managed practices likely will experience HR issues similar to our case study.

What should you be doing to protect your practice?

• Create a policies and procedures manual. Every practice should have an employee policy and procedures manual that outlines expectations for the practice and its employees. The manual should be reviewed every one to two years to make sure it contains the most up-to-date information. If you download a template to use as a guide, make sure the policies match how your practice actually functions. For our case study, Kathy’s practice had an excellent P&P manual, and she was able to demonstrate to the unemployment judge that Sarah had received the manual and was informed of the practice’s “call-out” policy.

• Educate your administrative and management staff on HR regulatory issues. Many employment laws have changed in recent years; practices must remain compliant with wage and hour laws, EEOC regulations, OSHA, FMLA and more. Practices can provide HR training to managers through resources such as the American Society of Ophthalmic Administrators and the American Academy of Ophthalmic Executives, the Society of Human Resources Management, or regional training offered by a reputable company. Management HR training should occur annually, and managers should be connected to List Serves so they understand when major changes in law occur.

• Retain counsel that specializes in labor issues for your state. While the department of labor provides guidelines for federal employee law, many states have adopted more stringent laws. In cases where state and federal laws differ, the law that best benefits the employee will prevail. Practices need to have counsel review their policies and procedures manual every time they make an update. The practice’s attorney can also provide guidance on issues (such as the one described in our case study). Kathy was able to call the practice’s attorney prior to the unemployment hearing. Legal counsel reviewed Kathy’s evidence and helped prepare her for the unemployment hearing.

• Document, document, document. Too often, employee issues arise and the practice has no documentation to support its position. Just as a physician must document detailed patient chart notes, practices must keep adequate employee records. Even if an employee is verbally counseled, a brief paragraph outlining what was discussed should be placed in the employee file. In our case study, Sarah signed a form during orientation to indicate she had received a copy of the practice’s policies and procedures manual. That form demonstrated to the judge that the practice had made Sarah aware of the “call-out” policy, ultimately helping the practice avoid paying unemployment benefits.

• Hold employees accountable, even legacy employees. After your practice has updated its policies and procedures, it is important for all team members to be held accountable to practice standards. For example, if the practice decides to enforce a new policy about coming to work on time, the physicians have to be willing to enforce the policy. If the doctor allows a long-term technician to continually show up late, but the newer employee is disciplined for tardiness, the practice opens itself to issues.

• Develop a clear path for grievances. To help employees express issues before HR nightmares develop, create a clear path for employees to provide feedback. Practices may develop an “open-door policy,” conduct employee satisfaction surveys, or outline steps an employee can take to address a concern. All staff members should be made aware of these options during orientation, and they should be outlined in the policy and procedures manual.

• Don’t try to ignore the problem. Though HR issues can be painful to address, they only get bigger when they are ignored. The worst course of action is not to take any action. In our case study, Kathy took immediate action, calling Sarah and then notifying her that her position was no longer available. While Kathy still had to attend an unemployment hearing, her decisive action and documentation allowed the practice to avoid paying unemployment benefits.

AVOID POTENTIAL PITFALLS

Employees are the greatest — and most expensive — practice asset. While we all want our employee relations to go smoothly, practices must have effective policies and procedures in place to avoid stepping on possible landmines. By making sure your practice HR components are up-to-date and compliant, your team will know what steps to follow when issues arise. OM

FOOTNOTE:

* The suggested healthy benchmark range for burdened payroll ratio (wages and benefits) is 26% to 31%. The burdened staff payroll ratio is calculated by dividing total staff wages and benefits by net collections. The benchmark range amounts are based on benchmarks developed by BSM Consulting, working with ophthalmic practices throughout the country. This information is then corroborated with other industry data, including the American Academy of Ophthalmology benchmarking database results.

Elizabeth Holloway, COE, CPSS, PHR, is a senior consultant with BSM Consulting, an internationally recognized healthcare consulting firm headquartered in Incline Village, Nev. and Scottsdale, Az. For more information about the author, BSM Consulting, or content/resources discussed in this article, please visit www.BSMconsulting.com.