Attitude Adjustment

Three medical assistants in one practice I know of fight constantly -- often in front of patients, sometimes violently -- while their physician employer seems helpless to stop it.

They've shoved each other and thrown charts across rooms. The physician has tried quiet chats, incentives, even threatening dismissal. Nothing works.

Elsewhere, a solo physician sneaks into the back door of his clinic, trying to avoid his practice manager. She's a hypersensitive recent divorcÈe who blames the physician for every problem with the practice and cries at the slightest criticism. He just can't deal with her.

And then there's the RN who refuses to wear gloves while drawing patients' blood, flouting safety standards. She is the longest-tenured employee in the group, and the physician prefers to let her have her way rather than risk her quitting if he insists on doing things right.

What do all these practices have in common? Their biggest practice management problem is their inability -- or unwillingness -- to deal with staff who break the rules, cause tension, and upset the office flow. It's one thing to change your billing or check-in processes. Changing the attitude of your staff is quite another.

People don't like change.

Take the practice manager who is blocking one group from getting started on the process of buying an EMR. The physicians want it; she doesn't. She figures it can wait until she retires -- in five years.

I wish these were isolated cases. But in fact, gossiping, laziness, bad attitudes, and general apathy are rampant in the groups I speak with. And so are physicians and managers who can't find a way to fix it.

But fix it they must. Because in business -- any business -- motivating people is the key to success. All industries deal with problems like this, but I think it's a little worse in our world since physicians tend to be nicer to staff than most managers in nonmedical businesses.

This has been a revelation to me. I tend to think of human resources as mushy, girly stuff, but getting people to change is serious work and vital to getting the practice on track.

Why is it so hard? Human nature, that's why.

I've been meaning to lose a few pounds but can't quite give up that Friday night pizza; my evening run often turns into a walk to the ice cream store. The eventual promise of comfortable jeans just isn't strong enough to overwhelm the immediate satisfaction of fudge swirl.

It's the same with your patients. Even people set on a sure course for obesity or open-heart surgery can't change. The prospect of death itself is not scary enough to change their behavior. You can bet that compared to that, a physician's idle threat to fire someone the next time he hears an argument makes almost no dent at all.

So how does a logical physician manage illogical, emotional staff?

First, resolve that you will manage it. It isn't OK to let an employee's bad moods determine your career satisfaction or whether your million-dollar business succeeds or fails. Physicians are too nice and too often let decisions wait because they don't want to confront staff. Deciding to do something is the first step.

Then what?

Lead by example, for starters. Change the tone yourself. If staff complain about one another all the time, start complimenting everyone instead. Let your staff know that gossiping isn't allowed and every time you overhear it the offenders have to put $5 in a pot. Donate the monthly proceeds to a battered women's clinic. If there is one bad apple who just won't change, fire him.

If a manager isn't interested in an EMR, pull her aside and let her know you really value her input and will start shopping for it yourself next week.

Or play Dr. Phil. What is going on to motivate the behavior? Why would a nurse not want to wear gloves when drawing blood? She probably doesn't have a death wish. Would more comfortable or non-latex gloves make a difference?

These ideas should help. But there must be more. I'm going to spend the next month interviewing experts in human resources and change-management, and I promise to bring you all the insights I can gather in next month's cover story. In the meantime, send me your horror stories or solutions at pmoore@physicianspractice.com. What makes change happen for you?

This article originally appeared in the September 2005 issue of Physicians Practice.