Technology: HR in a Box?

Most practices don’t spend much time thinking about human resources. If you have a small number of employees, you really shouldn’t have that many HR issues, right?

Wrong.

Letting HR issues slip can be bad news for your practice. In the worst case it can prompt a lawsuit from a disgruntled former employee, but even in the best cases it can mean chaos and confusion in your working environment, which can lead to high turnover rates.

The good news is that there are solutions to your HR dilemmas, and some of them are available right out of a box containing customizable software. Just as an EMR can help streamline work flow with patients, technology is available to better manage staff and reduce turnover.

Taking the first step

The first step in getting help is admitting you have a problem, and nowhere is this truer than in HR. Just because you have a small number of employees, or your practice doesn’t have a dedicated HR person, doesn’t mean your practice isn’t dealing with HR issues and paperwork on a daily basis.

“Historically, if there is not a dedicated HR person, usually the person who has been doing the record keeping for the HR function suddenly finds themselves in that position,” says Jana Abrams, human resources and marketing director for Atlantic Urological Associates and president of the Human Resources Society of MGMA.

Generally that person is the office manager - and the office manager often is overwhelmed. Consequently, HR matters tend to get a minimal amount of attention.

Don’t live in denial about the amount of paperwork and drudgery that HR issues can generate for your practice. With time and attendance sheets, health and retirement benefits, keeping current with licensure, and managing employee records, there’s hardly any time to deal with serious issues such as getting a new hire settled in or taking disciplinary actions when needed. And that’s not even counting payroll!

If your practice doesn’t have an HR plan, then it definitely has an HR problem.

Begin at the beginning

“I think most people tend to choose time and attendance programs to implement first because they feel that it directly impacts the bottom line,” says Abrams.

That’s especially true for practices like Atlantic Urological, which has eight offices throughout central Florida. A simple time and attendance program allows multi-site practices to import employee information into a single database. With all of that information in a central location, the practice can run reports that help it identify staff drains and reduce overtime costs.

Equally as important is the time-saving factor. While Atlantic Urological outsources its payroll to a third-party organization, some HR software is designed to interface with time and attendance programs to make the payroll and benefits process seamless. “When you use a software package, you lose a lot of time involved in having to manually compile those records to process the payroll,” says Abrams.

Time and attendance programs also allow you to compile trending reports. Is your staffing configuration correct? Does the physician have an adequate amount of support staff? Are employee absences more prevalent at certain times of the year? These are all questions that the software can help you answer.

Time and attendance programs can also make the process of establishing a new hire much easier by helping determine average salary, establish pay grades, and monitor the average annual salary increase for each position.

The downside of benefits

Whether it is health insurance or a 401k plan, employee benefits are great incentives for retention. They also take a large amount of time to manage. Typically, the office manager takes care of enrolling new employees, fielding questions about insurance benefits and reimbursement procedures, and acting as a liaison between the retirement plan and the practice’s staff. Not only does this require a lot of time, it usually entails an incredible amount of paperwork.

Luckily, many benefit providers have implemented Web solutions that can make life easier for both employees and their practices. These Web programs allow employees to interact directly with the provider to receive reimbursement information, locate appropriate services, and change benefit allocations when needed - all of which moves the work away from the office manager and onto the provider itself.

This can prove especially useful with retirement benefits, where the process of managing accounts and fund allocations can prove time consuming. Many health and retirement benefit providers can also handle new employee enrollment over the Web.

While there will still be plenty of paperwork for the practice to deal with, at least these third-party provider programs can help make the process more manageable.

An EMR for employees?

If you are looking for a versatile solution to your practice’s HR needs, you should consider software that can help you build a database beyond just attendance or benefits. For example, database software that allows you to track applicants can help you compile information for Equal Employment Opportunity reports. Or how about a database that tracks OSHA training and licensure requirements for staff? Not only does that help keep training and licensure current, it also allows you to see at a glance the skills and abilities present in your practice’s employee mix.

“When you have openings you can do some succession planning and see how you can utilize different employees in different capacities within your practice so that you can promote from within,” says Abrams.

Atlantic Urological managed its HR paperwork by creating an EMR for staff records. “There are a lot of packages and database systems where you can actually scan your personnel files,” says Abrams. “We’ve actually used a program that we already had to track medical records for accounting and invoice management, and we’re starting to use that also in HR for the paper files.”

With some federal requirements for keeping employment records being as long as 30 years, electronic HR records can cut down on the amount of paper storage. For a medium-sized practice, 30 years’ worth of paper records can fill a sizeable filing cabinet.

An “HR EMR” can also be useful for multi-site practices. A centralized electronic database helps keep employee records confidential. Just as an EMR can be modified to give certain staff privileges, an HR records database can be set to allow supervisors access only to their own employees’ records.

“We also use it to track disciplinary actions for employees so that our policies and procedures are practiced consistently across the board,” says Abrams.

The next step: retention

The ultimate goal of any HR package is to foster a better work environment so that trained and skilled employees will stay. Although the programs mentioned above can streamline HR efforts, they may not make much difference to the staff.

“Practices focus on some of the nuts and bolts, like tracking staff, but they forget about the next steps,” says Beth N. Carvin, president and CEO of Nobscot Corporation in Honolulu, Hawaii. Nobscot Corporation generally offers HR retention solutions for larger organizations, but lately it has seen a real demand from the healthcare industry. “In the healthcare field, retention is a fairly critical piece of the puzzle ... There’s a shortage in nursing, CNAs, and some of those other positions. There’s a little bit of a war for talent out there,” says Carvin.

WebExit is one of the products offered by Nobscot to help practices get a handle on why employees leave. Although exit interviews traditionally have been conducted person-to-person, departing employees aren’t always at their most truthful when talking to a real person. WebExit allows departing employees to answer a series of exit questions via the Internet - and with complete honesty.

Sometimes it yields interesting results. One medical organization that was using WebExit had a number of people leaving from their pharmacy and wasn’t sure why. A WebExit answer from one employee cited lack of training and the employee’s feeling of frustration: “I’m afraid I’m going to kill somebody!”

“The scary thing was there were a couple of other people that had left from the department, and they, too, were saying very similar things,” says Carvin. “So the organization was able to see that and say, ‘We need to completely revamp how we’re treating and training these pharmacy people.’”

Another product Nobscot offers is FirstDays, which helps employees with the initial experience of coming into a medical practice. “When someone’s getting ready to start a new job, they’re excited and enthusiastic and have a whole set of expectations of what they think it’s going to be like,” says Carvin. “Then they get on the job and they have to sort of acclimate and sometimes readjust those expectations to settle into the position.”

FirstDays was born out of the feedback from WebExit, which indicated that many employees were struggling during the first year of employment. Either they weren’t acclimating to the practice or simply weren’t learning the things they needed to succeed. FirstDays creates a Web survey for new employees at a predetermined interval after they start - 30 or 90 days, for example - and asks for honest feedback as to how the new employee feels in the job. Is the position measuring up to their expectations? Are they receiving the resources that they need to be successful? Are they receiving the training they need?

Although programs like WebExit and FirstDays may be overkill for small practices, Carvin believes the principles behind the programs are sound. “You don’t necessarily need to have a full blown system like ours, but if an organization is trying to make sure their employees are acclimating or if they are having some issues with employee turnover, you really want to find out why,” says Carvin. “A technology solution could be a simple solution or it could be more complex, depending upon the size and complexity of your organization.”

Thinking big

James Ayo thinks that what is good for the largest organizations is good enough for the one-physician primary-care practice that he and his wife run in Farragut, Tenn. Ayo takes care of the business side while his wife, a doctor, tends to the clinical. With a background in business and engineering, and a strong foundation in the Six Sigma management approach pioneered by General Electric, Ayo immediately began searching for technology solutions for managing their small practice. Not only does the practice barcode its entire inventory, including pharmaceutical samples, it also employs the SuccessFactors software, a total HR software package for medical practices.

“The issue I have in this industry is that in primary care there’s this huge transition from a classic paper office into a very highly technical and paperless office,” says Ayo. “One thing I run into is employing people with enough capabilities and the ability to develop quickly enough to handle the technology that is involved in the office.”

The other frustration for Ayo is making sure those employees will stick around. “It’s really troublesome because you start talking about $15-per-hour employees who you’re then going to spend $15,000 upfront just to give them the technical training,” he says. “MAs, LPNs, and receptionists in medical offices seem to bounce around quite a bit. We just can’t afford to have that because primary care is a high-volume, low-margin business.”

Not only does SuccessFactors allow the kind of record keeping, time and attendance tracking, and database management as other individual programs, the software also coordinates long-term practice goals with short-term employee goal setting and provides a complete performance review and employee evaluation module. There is a legal function within the program that reviews employee evaluations for any questionable or potentially problematic language. Another function allows the supervisor to “rewrite” an employee’s evaluation with the touch of a button - a slider can make the tone of the evaluation more or less positive, according to the supervisor’s requirements.

Ayo believes this can be particularly useful for new employees. “My office manager is fairly new to a managerial role, especially to HR. Having a tool that provides evaluations to the subordinates is great, especially for those who don’t have great ‘soft’ management skills.”

Robert Anthony, a former associate editor for Physicians Practice, has written for the healthcare and practice management industries for six years. His work has appeared in Physicians Practice, edge, Humana’s YourPractice, and Publisher’s Weekly. He is based in Baltimore, Md., and can be reached via editor@physicianspractice.com.

This article originally appeared in the November 2008 issue of Physicians Practice.