Case study: Five questions for improving your practice

By Bradley Reiner

As we start another new year, consider taking a good, long look at your practice. I know, your first thought is “my practice runs very well. I don’t need to make any changes.” However, by answering five questions, you may be able to identify places where you have room for improvement. Grab a pen and notepad, the five questions are:

1. Is there a lack of leadership in your practice?
2. Do you feel sometimes your staff do not have the same commitment to the goals you have for the office?
3. Do you feel frustrated by staff who are not doing their share of the work?
4. Do you feel like you are putting out fires all day instead of being productive?
5. Do you think it’s a staff issue or could it be one of the physicians causing the problem?

Any one of these could be hindering the practice and keeping it from reaching established goals. So, how can you assess the problem if you feel one of these questions applies to you?

I recently worked with a practice that was investigating these same questions. They had been without a manager for over a year and it was becoming clear that lack of leadership was stifling the practice, causing decreased morale, and contributing to other operational problems.

In addition, it was rumored that some of the providers were causing problems. Stories had emerged that some doctors were difficult to work with, at times even yelling at the staff. Because of this, staff were leaving the practice. It was clear there were major issues that needed to be addressed.

One of the first things I did was complete a front- and back-office operational review to identify the operational problems that could be keeping the practice from succeeding. Just as important was to determine why the staff were so frustrated and the turnover so high. Individual interviews were completed with key front- and back-office staff to get their opinions and recommendations for resolving them. I discovered a number of interesting things that I believe are more common than we think.

• Staff felt underappreciated. Doctors showed little if any consistent appreciation for the work they did. Doctors were quick to criticize rather than thank them for what they had done well.
• Staff felt they were not being paid appropriately and wanted to be paid more consistently with the market.
• Staff felt there was a lack of leadership. Since the manager had left, the practice was being managed by one supervisor. This meant there was little accountability, if any, and substandard staff continued to do substandard work.
• Operational work flow issues were evident. The flow in the practice was not efficient. New doctors and staff were added, but no plans were made for the growth.
• Rewards or opportunities to be appreciated were not evident. This made staff feel like their work wasn’t important to the organization.

After analyzing the practice, I made a few recommendations. We started with a much-needed change of attitude. Doctors needed to acknowledge good work and let staff know they are appreciated. Doctors discussed this in a meeting. Specific quotes from staff were reviewed to impact the importance of this change.

Salaries were adjusted. An analysis of the staff salaries was completed with recommendations made for changes. When compared to peers, it was determined some individuals were underpaid.

The practice needed a strong leader to deal with daily human resource issues, and to initiate strategies for improving the practice. The doctors wanted someone who could develop a budget, perform a financial analysis of ancillary services, as well as handle marketing. A strong leader would be needed to accomplish these objectives.

The current phone system was inadequate, causing backlogs and dropped calls; the practice needed a new system. Also, the back office needed improved efficiency with phone calls, so the practice hired a triage person to handle the daily phone calls and referrals that were reducing the floor nurses’ time.

They needed to develop polices and procedures. Many practices, including this one, need policies and procedures for daily activities. This can be used for new staff training and for consistency in how the practice should handle certain office situations. Staff had to be accountable for bad behavior and also be rewarded for good behavior. Doctors came up with ideas to reward behavior such as recognizing an employee of the year, and providing movie tickets and Starbucks gift cards for exemplary work.

The practice needed a more refined employee manual. This manual, and others I have reviewed, was not detailed enough to address specific problems that could arise. This caused confusion and frustration about how things should be interpreted.

As you look at issues within your own practice, try to get to the root cause. If you find the cause you can begin to make the changes necessary to help your practice thrive. Don’t be afraid to ask your staff what problems exist as well as how you can best fix them. You just might get some great ideas on how to improve the practice.

Bradley Reiner, formerly with Texas Medical Association, is now owner of Reiner Consulting and Associates. He can be reached at (512) 858-1570 or by e-mail at breiner@austin.rr.com.