Play Together To Stay Together

At The Heart Center in Kingsport, Tenn., you might find the pope trailed by some nuns, encounter a giant cow with inflatable udders, or spot a cross-dressed bride traversing the halls of the 26-physician practice.

It's just Halloween at a practice that prides itself on being a fun place to work - as well as offering expert patient care as one of the largest cardiology practices in the state.

"It is all in good fun. Your patients come in and everyone is smiling," Harry Turner, MD, says of the Halloween attire. The cow costume, in particular, "really brings the house down," he says.

Running a successful practice means more than reducing accounts receivables and having a low claims rejection rate. To Turner, it also means throwing social events for his staff, rewarding employees for a job well done, and keeping them connected to the happenings in the office through a monthly "Town Hall meeting."

All the efforts are aimed at fostering trust among the employees and physicians, which creates an "atmosphere where you have long-term loyalty from your employees, and where your patients feel comfortable," Turner says.

"The relationships with your coworkers are what makes the work satisfying," he adds. "Part of the joy of doing what you are doing is working with good people who are happy to help you."

Some practices celebrate Halloween, and most have annual holiday parties and picnics. Used properly, these events can help bring your staff together. But Turner and others say additional efforts, including hiring the "right" people and having frank, regular discussions with staff, can build a true community within a practice.

Come Together

In a busy practice, it is easy to focus more on patients and putting out day-to-day business crises, and less on how well your staff is getting along. But that is shortsighted. An office where there is a lot of fighting, either openly or under wraps, ultimately "will take up a lot of physicians' time. There will be poor morale in the office and that gets transferred into how patients perceive the office," says J. LeBron McBride, PhD, MPH, a family therapist and associate clinical
professor at Mercer University School of Medicine in Macon, Ga.

"An office is more than one person doing the billing, and one person over here doing something else. How those people interrelate and how they get along really sets up the dynamic" for how the practice functions, says McBride.

Problems can emerge and fester amid a "crisis mentality," where information is only shared in "bits and pieces," says McBride. "It can keep people in a defensive mode."

One key to enhancing office relationships is to view the group as a family. And a critical component of any healthy family is open and honest communication, adds McBride, who is also director of behavioral medicine for the family practice residency program at Floyd Medical Center in Rome, Ga.

Turner agrees. "Communication is what holds a practice together, whether you are talking physician to physician, or physician to patient, or physician to employee," he says.

With this in mind, his office holds quarterly "Town Hall" meetings. The head of each department, such as human resources and information services, as well as the president of the group, give a brief update, with word on new hires, changes in benefits, reminders about passwords. These meetings always end with a question-and-answer period.

"You don't want your employees hearing about things from the public before they hear them from you," Turner says.

Indirect communication is also important. Physician leaders and administrators should have a trusted confidant or advisor, McBride says.

"Physicians need someone in the office who can give them feedback and say 'the emperor has no clothes'; someone they trust and who trusts them," McBride suggests. In this way the physicians are not isolated or insulated from the problems in the practice. Problems that fester just under the surface can become "secrets; secrets are destructive to the community," McBride says.

A six-physician orthopedics practice in Virginia took its communications problems so seriously that administrator Sarah Odorisio organized a team-building session for the group's 80 employees and had each one take a personality quiz.

Odorisio, administrator of Orthopedic Surgery & Sports Medicine Specialists, in Newport News, resorted to those measures after six months of sitting through monthly meetings among her 10 top managers, where all the employees did was squabble. "These people just cannot get along!" she remembers thinking.

Today, four years later, the situation is much improved. With the help of a facilitator, changes in the practice to encourage the retribution-free exchange of ideas, and ongoing social events, Odorisio reports that turnover in the practice is very low, and that the practice today "feels like a family."

Prior to the team-building session, each staff member filled out a personality questionnaire called the Myers-Briggs Type Indicator, which sorts people into one of 16 personalities, such as introverts, extroverts, and intuitives. The idea is that a lot of conflicts arise due to differences in the way people absorb information and in how they make decisions.

Employees were invited to share their survey results - but they didn't have to. Then the facilitator led the office through a half-day session.

Understanding different personality types, styles of learning, and communicating has had a lasting effect on the practice, Odorisio says. "It makes you very tolerant, accepting, and forgiving," she says. For example, someone might appear to be aloof when in reality that is just the impression he or she might give because of their "type," she adds.

Her meetings have improved, too. Employees understand that "you can't say anything wrong. You can't get into trouble. You are among friends," she says. Employees who want to make a comment "just throw it out there and see what happens. And that is how we have come up with our best ideas."

Make Time For Fun

Another way to build a sense of togetherness is to have off-site gathers so your staff so can relate to each other on a nonwork level, McBride says.

In addition to the Halloween festivities, a Christmas party, and fall picnic at a park, Turner's practice also holds a special "Employee Appreciation Day," which begins at 7 a.m. with all the doctors donning chef's hats and aprons to rustle up breakfast for the employees - pancakes, bacon, sausage, the works. Those workers who may skip other meetings make it to this one.

The orthopedic group also is big on parties. "We have a big Christmas party at a country club, with dancing, cocktails, and tons of food." Odorisio says, adding that employee anniversaries are also celebrated at the holiday gathering, with those who marking 10 and 15 years receiving items such as jewelry, iPods, or DVD players. Movie tickets are given at birthdays. "If anyone leaves, has a baby, gets married ... we do something for them," she adds. There is even a "turkey fry," a nontraditional (but regionally appropriate) way to commemorate Thanksgiving. Held in a restaurant, the event now draws up to 150 people (spouses and children are also invited).

There is also an annual staff-only event; doctors are specifically excluded from the Cinco de Mayo celebration at Odorisio's house.

But events "can be overdone," McBride warns. "You have to do what people want. Sometimes people feel awkward [together] outside the office. I would be more in favor of building [opportunities] in so the office manager or physician is taking time to talk to each employee."

McBride recommends that a physician leader or office administrator sit down with each worker, once or twice a year, and discuss how he or she is feeling, how the job and personal life are going. This can be combined with an annual review but it may be more useful as a separate exchange so that the employee is more likely to honestly express any concerns.

And use every opportunity you can to offer praise. Not just formally recognizing years of services, but catching someone in the act of doing something correctly or beyond the usual.

"A good office environment focuses on accepting people and finding the good in them, and affirming that. Be specific. Don't
just say, 'You're doing a good job.' Recognize specifically what they did right," McBride says.

Hiring Right

Building your office's community starts with building your staff. When you are hiring don't just focus on applicants' skills but ask questions about how well they get along with others.

Tell applicants about the sort of office environment that you are trying to cultivate; emphasize that the relationships between co-workers are valued on par with good patient care and that staff are expected to be supportive of one another. Aim for imbuing them with a sense of the "greater good" that their work is achieving, McBride says.

"Even if the person is doing coding, if they have a sense that there is a kind of mission here, that they are helping people in need, then they will have meaning and purpose in their work and that translates into a more satisfied worker; a better worker," he says.

Turner, who is on his practice's recruiting committee, says job applicants are asked during the interview whether they have good relationships with their co-workers - "not just their colleagues," Turner says. "If they do, you won't have problems with them."

When checking references, he recommends asking those on the applicant's official list for the name of "anyone who might have a different perspective" on the candidate. He also suggests going beyond the names supplied by the applicant.

"One of the most useful phone calls we can make is if we can get to one of the secretaries who deals with [an applicant] on a daily basis and say, 'Tell me about this person. Are there any negatives?' If there is a long pause we don't hire them," Turner says. "Being able to play fairly in the sandbox is really important."

Turner will not add someone to his practice who seems arrogant. His perspective is that every employee is valued, and each must value one another.

"I think, as a group, we have always valued our custodial people as much as our upper administrative staff because they are all part of trying to give good care to your patients," Turner says. "Our best employees are those who have worked somewhere else and have had a bad experience where they were not respected. They work hard at not replicating that."

Theresa Defino is an editor for Physicians Practice with more than 15 years' experience covering economic, legislative, and clinical aspects of healthcare. She can be reached at tdefino@physicianspractice.com.

This article originally appeared in the November/December 2005 issue of Physicians Practice.