A Job Well Done

"They're lucky to have jobs."

Lately that's a common response to questions about employee incentives. A regular paycheck in a feeble economy seems like incentive enough. But tough economic times mean you're depending more than ever on the professionalism and morale of your staff. Now is not the time to sacrifice the incentives that keep your staff happy and motivated. But it is important to make sure any incentives you have in place are actually working -- and they don't have to be expensive or complex.

"You don't have to offer a trip to Hawaii," says Hobie Collins, a consultant with the Medical Group Management Association (MGMA) Health Care Consulting Group. "What really succeeds is creating a family-type environment where people are working together and everyone has the opportunity to establish long-term relationships with their colleagues and patients."

In fact, quality of life incentives may be the most powerful type of reward you can offer. Throughout the 1990s, studies by the Families and Work Institute found that having the flexibility to manage home and work responsibilities is more valued by employees than money and advancement, and that employees will work hard to keep jobs in workplaces that offer this flexibility.

Pyramid power

Three powerful keys to providing quality of life incentives are:

• offering a fair base salary;
• creating measurable goals; and
• getting employee input on the type of incentives you offer.

First, the salary. "We try to accommodate our staff with appropriate salaries first and foremost," says Paul J. Kayne, practice administrator at Seacoast Orthopedics and Sports Medicine in Somersworth, N.H.

"I've been managing group practices for 27 years, and I'm not convinced that creating the kind of incentive system that says, 'Five pieces of paper out the door and you get X prize, 10 pieces out the door and you get Y,' really works. You don't want to pit departments against each other, or put achievement in the context of asking staff to do the same thing better this year than last year. Our people work hard, and they get a good salary that reflects that."

Kayne hires an outside consulting company to visit the 11-provider practice once a year to study job descriptions that staff create with their managers and validate the salary ranges Seacoast is using.

"We monitor positions, do surveys, and collate our results," says Kayne. "We adjust salaries if they're falling below the average range, and we spend a good part of the year analyzing our practice."

The salary adjustments take into account the cost of living each year, but no one is guaranteed an automatic increase. "We'll say, for instance, that increases this year will be between 1 and 10 percent," says Kayne, "and it's up to the manager and employee to figure out what's appropriate based on overall performance."

This attention to financial compensation is an investment of time and money that Kayne says pays off. "If you do any less, sooner or later you hit a tight labor market and you're hiring new people at higher salaries than employees you've had for years, and that's no incentive."

Setting fair goals

Once you've established fair and flexible pay scales and accurate job descriptions, you can address creating measurable goals for "beyond the call of duty" performance.

"Establish goals that break down clearly," recommends Peg Stone, senior vice president at Cejka & Co. in Atlanta. "Avoid asking for things like 'improvement to the bottom line'  -- it's too elusive. There are too many factors involved, and it's hard to know where individual performance really fits in."

Instead, Stone suggests analyzing job descriptions and tailoring incentives to specific positions. "Instead of saying 'we need to make more money,' you break it down for each group. For the front desk it could translate into maximizing scheduling. You sit down with the people at the desk and figure out how they can do that. Then you can create an incentive for meeting that goal."

Stone cautions practices to avoid offering a striated plan with somewhat equal goals but unequal rewards. The rewards need to match the importance of the goal, she says.

Clarity and appropriate incentives also are important. "If it's a one-time reward, make that clear. And find out what employees really value -- is a company dinner a good idea, or an added expense for people who have to find a sitter? Does a seminar really offer an employee an experience valuable enough to make up for the backlog of work they'll return to?" Stone asks.

Discover what's important

Linda Wiener, practice administrator at Park West Women's Health in Rochester, N.Y., agrees. "We've just finished a merger and everyone's doing 10 different jobs right now so we're really crunched. But we offer all our incentives during the workday --lunches out, potlucks, breakfasts -- because we found that most of our staff don't like going out at the end of the day or on weekends. They need that time with their families. And when we offer the incentive at a time that works for everyone, it is more appreciated, and it makes the office where we spend so much of our time much more fun."

Listening to staff input in this way is the key to offering incentives that jibe with your staff. "You can't forget to ask the people on the front lines for their opinions," says Stephen Deas, executive director at Georgia Neurological Surgery (GNS) in Athens, Ga. "They're the ones who can see where there might be ways to get from A to B much more quickly. Saving money and getting patients in and out quicker -- these are goals employees can suggest as well as help you reach. Everyone has to be involved to make it a cohesive environment."

Deas agrees that base salary and yearly bonuses based on clear criteria tied to job descriptions are the bedrock of GNS' incentive plan. But on top of that, Deas works with GNS' practice manager to encourage employee suggestions.

"We want to reward creativity," says Deas. "We ask for employee suggestions on how to cut expenses. We don't want people to just do their jobs as they were told to do them the day they started. We reward innovation and encourage people to loosen up and think outside of the box."

Put it in writing?

In a world of jam-packed schedules and widely variable goals and incentives, what's the best way to put an incentive plan in place? The first decision is whether or not to write a formal plan.

"Offices very often don't even have a formal job evaluation process in place, let alone an incentive plan on top of that," says Collins. "Typically, only when you get into very large groups do you see formal incentive plans. But even if you don't write up a formal plan, you can at least think up sophisticated ways to reward and recognize your employees."

Larger practices may benefit from a formalized plan, according to Kayne. "With a process in place, you can be fair -- there's a way to settle disputes, and there's no accusation of playing favorites."

Kayne says he sets the incentive plan budget and then passes it along to a team of three supervising managers; the managers have to work together to divide the budget fairly.

"Clinical sits down with billing and medical records, and they work it out so one group doesn't end up with a 2 percent adjustment while another gets an 8 percent adjustment. Management teams advocate for their staff but the final result is fair across the board."

If your practice is small, it's better to keep the plan informal, but you still need a good administrator, according to Stone. "Usually you won't get a lot of complaints about incentives when employees are long-term and feel like family. But sometimes people do begin keeping score once incentives are introduced. The key is to be very upfront about what you're doing -- what accomplishments are being rewarded, why, how, and how often."

Wiener agrees. "We emphasize fun since we can't emphasize money with big bonuses every year. We let our employees come up with the best ways to reward themselves for jobs well done, and everyone knows it's important to our practice to make sure those rewards keep coming."

Lori Rogers-Stokes can be reached at editor@physicianspractice.com.

This article originally appeared in the May/June 2002 issue of Physicians Practice.