Get What You Really Want From Your Medical Practice Staff

.Most physicians are not getting what they want from their office staff. The specific complaints vary widely, but the consequences are the same: The physician makes less money, works harder, and is less satisfied with the practice of medicine than should be the case. Although almost universal, the condition is not a law of nature. Five steps, consistently followed, can almost always remedy the situation.

1. Decide what you want.

This is harder than it sounds. Most of us react to circumstances and say "I like this" or "I don't like that." Not as many articulate their wants independent of external and often random stimuli. The lack of definition makes it impossible to control, or at least influence, ongoing circumstances and events.

2. Prioritize those wants.

Some of your wants will be in conflict at least part of the time. When two or more objectives conflict, which one should take priority? As an example, if the phone is ringing; you are calling for a chaperone; and the MA entering an exam room would leave the desk unattended, what should the MA do? Let the caller go to voice mail? Put you off? Lock the door to the reception room? It all depends upon your specific preference.

It is not always possible to get everything you want when you want it, but by prioritizing you can make it more likely that you will get what you want most.

3. Communicate your expectations and priorities to your staff.

As intuitively obvious as your desires are to you, they can be obscure and confusing to your staff. Even if they had the same knowledge and breadth of perspective as you, which they do not, there is no reason to assume that they would apply the same reasoning to a given situation.

In communicating your expectations and priorities to staff, three things are particularly helpful:
• Write them down.
• Give a brief statement of your rationale.
• Ask staff to paraphrase, not parrot, the messages.

4. Hold staff accountable.

One of the biggest advantages to items one, two, and three is that they make it possible for you to hold staff accountable. There is a coherent message and a logical structure. A breach can be addressed and resolved objectively.

Many performance failures result from faulty communication. Calling the offender to account is an opportunity for clarifying and teaching as long as you can focus on the what and the why.

Without clear expectations and correction, performance issues persist and it is not possible to identify root causes. It may be that the employee if fatally flawed, but it is entirely possible that she is applying a different algorithm to a fact set. Clear expectations and counseling make it possible to distinguish between the two and react appropriately.

5. Encourage your staff to ask you for guidance when your instructions are in apparent conflict with your stated objectives.

Doing anything other than immediately complying with instructions from you is generally difficult for staff, and that is a shame for several reasons.

It puts staff in a bind. They can do what you say now, and be chastised later for violating your earlier instructions. They can conclude that the rules you have set forth are not really rules, meaning they have to rely upon you for instruction in each individual situation, a condition known as learned helplessness.

Staff may know something you do not. A situation may have developed while you were in the exam room or out of the office. If you knew about it your instructions might be different.

You may be stressed, and opting for a quick solution with negative long-term effects. Staff can serve you well by saying "OK, but …"

This is not an invitation for staff to argue with you. It is an opportunity to utilize them as real support and increase their value to you.

Your staff generally wants to please you and do a good job. They just need to know with some specificity how you define a good job. The process described does take time and focus on your part, but you will recoup the investment quickly as staff performance conforms to your expectations, and voluntary staff turnover comes close to disappearing.

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