Recognizing Medical Practice Staff

Forget the year-end bonuses. When it comes to recognizing your staff for a job well done, it's often the rewards that cost the least that yield the biggest return. Indeed, while many practices utilize profit-based incentives, Courtney Price, president of VentureQuest, a management consulting firm in Denver, says a strategy that promotes ingenuity, teamwork, and a better patient experience has a far greater impact on corporate culture. "When you reward and recognize, it reinforces positive behavior," says Price. "As morale goes up, your employees are more willing to share new ideas." It's not that money doesn't matter. To be sure, your compensation must be competitive - lest your best and brightest bail for greener pastures. But as the industry moves to pay-for-performance reimbursement models, it's more important than ever to praise your troops for putting patients first, says Susan Murphy, a business consultant in Rancho Mirage, Calif., who wrote "Building and Rewarding Your Team."

Much is at stake. Positive reinforcement has been linked repeatedly to lower turnover, improved patient outcomes, and increased productivity in the healthcare setting. But the reverse is true as well. Managers who fail to give their staff the kudos they deserve create a toxic environment that can deal a devastating blow to your practice. They also become a distraction, taking the focus of your team away from the patients. "I often say that people join an organization and leave a manager," says Murphy. "A negative culture can be fatal. It's the carbon monoxide effect. You can't see it or smell it, but it's deadly."

Set goals

Effective employee recognition programs begin with a clear objective, says Murphy. Practices should determine first what they hope to achieve - shorter wait times, increased patient safety, better patient outcomes, fewer billing errors - so they can tailor their rewards to promote their agenda. Such goals should also pass the "SMART" test, says Murphy, meaning they must be: Specific, Measurable, Achievable, Results-oriented, and Time-bound.

Next, leadership should attempt to quantify where they stand at present with their stated goals. Patient and employee surveys, which can be done informally and in-house, take the guesswork out of the equation, adds Price, who co-wrote "Acknowledge! Appreciate! Applaud! 172 Ways to Reward Staff at Little or No Cost." "Some group practices can accurately describe what their culture is, but you want to verify it with others because if you are in management you may feel the culture is X, while your employees may think it's Y," says Price. The data you collect becomes a yardstick for measuring progress.

Lastly, identify opportunities for process improvement, says Murphy. Examples include better patient flow, faster check-in, same-day call backs, and scheduling that ensures the bulk of your workers are in their seats during the busiest parts of the day. With that in hand, you can then address the various ways that each person in your practice can be a catalyst for positive change.

Share your vision

Now it's time to communicate with your staff. Spell out the types of behavior you seek, and how it benefits both the individual and your practice, says Barbara Hotko, a workplace coach with Studer Group healthcare consulting in Gulf Breeze, Fla. If you want your staff to treat each other with courtesy and respect, offer examples. Value a positive attitude? Explain how that contributes to morale and the patient experience. If patients wait 15 minutes past their appointment time, instruct your staff to apologize, explain the reason for the delay, and ask if there's anything they can do to make their wait more comfortable. Or, you may wish for those who greet your patients to "manage up." To that end, Hotko suggests trading in the cursory "hello" for something more like this: "Hi Sally. My name is Karen. I've been a registered nurse for 20 years and I'll be taking excellent care of you today."

Managers should model such behavior themselves so it becomes "hardwired" into your practice culture, adds Hotko. And they should never miss an opportunity to reward staff members who follow suit. "When positive behavior gets noticed by leadership, you have a greater chance that your staff will do it more often," she says. "The exciting thing is that this can improve patient outcomes." Hotko notes that patients who leave your office unhappy are less likely to make follow-up appointments that help them manage their health.
 

Murphy agrees: "Before you start giving out rewards, people need to know what's important and what your expectations are," she says. "Leadership needs to say, 'These are the ways we want to improve patient care over the next quarter or six months,' and come up with a strategy to achieve that."

Public recognition

One of the cheapest and most effective ways to praise is public recognition. Be sure to applaud staff members who set a good example at the earliest opportunity, says Murphy. If it's not appropriate to do on the spot, make a fuss over that employee at your morning huddle, or next staff meeting. And, once again, offer specifics. "People really like to have someone come up in front of their peers and say, 'Hey, I heard your conversation with that patient. You really connected with them and explained things well. Good job,'" says Hotko. "If you just say, 'good job,' they may still like hearing it, but they may not know exactly what they did that was good so they can repeat it again later."

She also suggests being proactive in asking patients for names of staff who provided excellent service, so managers can collect and deliver such compliments personally. That process has the added benefit of leaving patients with a lasting memory of the most positive part of their visit.

Award walls in the break room or front office, in which employees get recognized by name are another way to reinforce behavior. And they're free. One practice Hotko worked with posts a photo of every employee on staff and each time a patient compliments them they receive a gold star on their picture. "When your best performers start to get a lot of recognition, their colleagues start to look at them and say, 'Hey, how can I do that?'" says Hotko. "They begin to notice where their manager's attention is going."

Don't forget to include your physicians on that wall, too. "Some people say that's hokey, but when doctors get acknowledged believe me it's a big deal and they love it," she says. "The main thing is that the awards are behavior-based, so you have a better chance of educating your staff on what it is you're looking for."

Cheap ways to praise

Other ways to praise that don't cost a thing include handwritten notes for staff members who go above and beyond, says Kenneth Hertz, a consultant with the Medical Group Management Association's Health Care Consulting Group. "At-a-boy" notes that get sent home to the employee's family carry particular weight when penned by the doctors, he says. If the entire staff deserves a pat on the back or shows fatigue after a particularly rough week, Hertz says practices might consider bringing in a masseuse for 10-minute massages in their seat. Or, if your budget allows, charter a bus for a day trip to a local attraction, or to see a show.

It resonates more when you keep it fun, says Murphy, who once worked with a group that gave out SOS awards, or "spirit of service," awards. "It was just a printed piece of paper from the computer that you could fill in with a co-worker's name and anyone could give them out, employees or managers," she says. "The manager kept those in their employee file for performance appraisals." Another group, she says, gave a standing ovation at weekly meetings to recognize those who contributed something special to the team. And one showed its appreciation to top performers by giving them brightly colored socks, which they wore for the week under their scrubs; cheap, but sufficient in giving hard workers their 15 minutes of fame.

If you can spare the manpower, you might also consider giving out coupons for half days off, or an extended lunch break. Gift cards to a local coffee shop, or movie passes for the family are also budget friendly. Just be sure you're doling out rewards that serve to motivate your staff. The only way to know what they want is to ask. "Often practices reward in ways that are not meaningful," says Price, noting the growing diversity of today's workforce make it more important to customize your rewards. "Maybe you're giving [local coffee shop] gift cards and half of your staff doesn't drink coffee." {C}

Keep in mind, too, that not everyone on the payroll has an opportunity to interact with patients directly. As such, your reward system should not be tied exclusively to customer service, says Murphy. Make sure everyone who contributes behind the scenes, including those in the billing department and the assistants who keep the exam rooms clean, have a chance to be recognized for what they bring to the table.

Round for outcomes

As you keep an eye out for opportunities to reward, Hotko says managers should take time each day to "round for outcomes." That means interacting with your staff informally on the floor, asking what worked this week, what didn't, and whether they have all the tools and equipment they need to do their job well. It also means watching from the sidelines, however briefly, to observe your team in action. "Rather than always speaking to your employees when there's a fire to put out, be proactive in finding out what is going well," says Hotko.

Rounding one-on-one with your staff allows you to solicit feedback on coworkers who deserve a personal thanks. "Your receptionist may tell you that Mary went out of her way to call a patient's family and share important information with them, so through that process you are not only learning about what systems can be improved upon, but you are also harvesting wins." Using that strategy, your well of candidates worthy of recognition should never run dry, says Hotko.

Inspire creativity

It's equally important to reward for new ideas, which keeps your team engaged. Forget the staid suggestion boxes of old, says Price, which were rarely monitored and thus ineffective, and start a "Bright Ideas" campaign instead. Encourage staff members to suggest cost-saving measures and process-improvement ideas using a paper or digital form. Assign a person or a committee to review the suggestions weekly and always thank the worker for their suggestion. "It's important to get back to the employee in a timely manner and have a plan in place to reward for good ideas," says Price, noting the most innovative ideas often come from the folks in the trenches.

Employee recognition programs need not break the bank to get results. Public praise, staff awards, and common courtesy (try "please" and "thank you") reinforce behavior that improves patient care more effectively than monetary incentives ever could. But it must be sincere. Management must make a genuine effort to lead by example, says Hertz. "The staff has to buy into the mission, vision, and values of the organization or nothing will work," he says. "They need to see leadership living it, walking, and talking it every day in every way." Such initiatives must also be sustained. "If your focus is to impact your culture, that's a long-term commitment," says Price. "Often times, the people who are driving that effort become impatient when they don't see immediate results." Don't give up. Over time, she says, consistent praise for a job well done will set your practice apart.{C}
 

In Summary

Recognition of your practice staff can come in many forms. Regardless of how you choose to reward hard work, remember:

• Positive reinforcement leads to lower turnover and better patient outcomes.

• Employee recognition programs should start with a clear objective.

• Rewards should be behavior-based, which helps to educate your staff on what you're looking for.

• Public praise and "at-a-boy" notes are free, but powerful.

• Leadership should round on their staff to "harvest wins."

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the May 2012 issue of Physicians Practice.