Holding Your Medical Practice Staff Accountable

Several readers of last week's blog on getting what you really want from medical practice staff had the same question: "How do I hold my medical office staff accountable?" The question seemed to be looking for practical advice, and some broad principles are presented below.

Please note: This post assumes that practice expectations have already been made clear to staff and gives strictly practical reasons for the advocated behaviors. By most standards, they are also the proper and ethical behaviors, but that is outside the scope of this article.

1. Maintain a professional demeanor.
This can be very hard for anyone who is stressed, tired, and frustrated. It is even harder for physicians who have not thought much about productive employee interactions. Many doctors have also been subject to more than their fair share of yelling and sarcasm during training, and they may unconsciously treat their subordinates as they have been treated.

The physician's volume and tone of voice will affect everyone within earshot, not just the target. If her voice is aggressive, patients and other staff are likely to conclude that their turn for the same treatment is coming. An aggressive tone is scary by design. Fear paralyzes employees and drives out initiative, which is not in the doctor's best interest. Neither patients nor other employees who hear a heated interaction will see the physician as reliable and cool under pressure. A calm, reasonable manner builds trust and lowers resistance.

The doctor may later feel guilty for aggressive behavior. If so, it will be difficult to apologize for rudeness without effectively taking back the valid criticism that went with it. At the same time, a sincere apology may be necessary to mitigate interpersonal damage. The best course of action is to be respectful in the first place.

While aggressive behavior is bad, assertive behavior is essential. Sighing deeply and saying "Guys, …" expresses frustration and impotence, not leadership. It will not change the current situation, and it will not prevent a future recurrence. The physician will have wasted the time and the energy required for the dramatic exercise, and called attention to the fact that he is not taking responsibility.

2. Assume staff members are competent, well intentioned, and responsible.
Almost all the performance failures associated with employees of this type stem from communication failures, bad tools, and systemic shortcomings. Being accustomed to trust and respect allows them to enter a performance discussion without a lot of defensiveness. They are secure enough to be honest with themselves, their peers and their bosses. When they have made an error, they can admit it and hold themselves accountable.

It can take awhile to be certain the assumptions are accurate. When in doubt, the prudent course of action is to give the employee the benefit of the doubt. Employees have a strong tendency to perform up or down to expectations.

Once convinced that a particular employee is not, and cannot or will not become competent, well intentioned, and responsible, the employee should be terminated as soon as possible. While termination may be seen as holding the problem employee accountable, it is actually the physician holding herself accountable to treating the all employees fairly.

3. Take advantage of errors and omissions as opportunities for learning and systemic improvements.
Devote some time in staff meetings to an objective discussion of major or recurring failures. The purpose of the discussion is to identify reasons, or root causes, and possible changes that will help prevent the situation in the future. Discussing the failure with the team and taking steps to avoid a repetition reduce the sting without minimizing the importance of the event.

Whining, complaining, blaming and excuses are not appropriate elements of the discussion, and they are generally good indicators of someone avoiding accountability. This is valuable information.

Effective accountability is not harsh or contentious. It is respectful, fair and constructive. Doing it right pays big dividends in reliability, productivity, and satisfaction for patients, employees and physicians.

Find out more about Carol Stryker and our other Practice Notes bloggers.