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The plain and practical side of medical office managing

Equally as important as regulations, revenue, coding, and Medicare are the day-to-day issues of running the office and managing people.

Here are solutions to many of the ongoing and aggravating issues managers face every day. They don’t come from management school. They are the wisdom of consultants and of managers in medical offices. And they are all simple, workable ideas.

Solving common staff problems

First are people problems that don’t warrant discipline but still have to be corrected.

Here are three of them.

• The staffer meets the requirements of the job but does only the bare minimum.

People become work minimalists when the manager doesn’t tend to the details of what everybody should be doing. Over time, it’s easy for staff to start skipping a duty here and there or get careless. Sometimes they do so without even realizing it.

A good way to get people back on track is to do an appraisal of three things: all the things the staffer does well, what the staffer needs to do more of, and what the staffer should do less of or should stop doing altogether.

Make it part of the annual review, or do it sporadically as a job refresher.

This tells staffer that the manager is indeed aware of the seemingly minor things each person should be doing and is noticing which of those things each staffer is and isn’t doing.

It’s also an inoffensive refresher for the staff who have let their performance drag unintentionally.

• Staff dress isn’t bad, but it’s a little sloppy or not professional.

Spend a staff meeting asking staff how they want to appear to patients.

Cover everything from shoes to hairdos to jewelry, and discuss what looks sharp (such as pressed uniforms and white shoes) and what’s not so sharp (such as stains on an otherwise clean uniform or too-long fingernails or hair that needs to be pulled back). Then have them select two or three staffers to draw up a written policy. Discuss it at the next meeting and vote on a final version.

• A staffer doesn’t respond to the manager’s question or comment.

Just stand there and wait. Keep the spotlight turned on. The silence will become uncomfortable, and the staffer will come up with a response.

• Staff constantly bring complaints to the manager.

Accept the complaints, but make everybody think them through.

Set a rule that for any complaint or problem to be considered, it has to be in writing. If it’s important enough to tell the manager about, it’s important enough to write about.

Along with the complaint or problem, the staffer has to offer at least one possible solution.

Writing things out, staff see immediately if a complaint is worth talking about in the first place. And having to come up with a solution makes them see when something simply can’t be helped.

Creating a professional staff

Medicine is a profession, and a medical office should be staffed by professionals. Here are some ways to create that type of environment.

• An inexpensive way to encourage professionalism is to give staff business cards and tell them to use the cards often with patients and also outside the office as personal introductions.

For clerical employees, business cards are an ego boost. They give staff a little something more than their colleagues in other practices have.

The cards can also market the office, because every person who gets one is a potential patient.

A caution, however: the cards need to be personal. Don’t print a generic card with a space for the staffer to write in the name and position. That does nothing for morale. It also looks cheap.

• Evaluate professional skills along with the regular review items. List whatever performance standards the office wants to emphasize and put them on a form.

They can include things such as patient contact, professionalism, attitude, and citizenship.

Don’t use any rating numbers. Simply put a space beside each item for the manager’s comments.

Also put in a few spaces for “areas of desired improvement,” “employee strengths,” and “other.” In the “other” space, the manager can mention things such as “you did a good job on X” or “I appreciate the effort you have shown in improving such-and-such” or “you still need to improve Y.”

At the bottom, leave space for the employee to write in comments.

Give the evaluation weight in deciding raises or use it simply as an addition to the regular review.

• Train the top staffers to act as interim directors when the manager is on vacation.

Teach them how to do the less complicated tasks such as taking attendance, ordering supplies, or even attending a meeting. Then assign specific tasks for each person to do while the manager is out of the office.

Assigning the tasks to several staffers instead of just one means more people get professional recognition. It also means all the tasks get done. Nobody wants to tell the returning manager in front of the others “I didn’t do what you said.”

• The receptionist needs to convey a professional image at all times.

To ensure this happens, establish protocols for every type of situation the front desk encounters – what to do when a patient wants information on the physician’s credentials or complains about an account or wants information about a procedure.

In addition, post a list of comments as a constant reminder of what to say to callers:

  • – I can appreciate how you feel.
  • – I can understand how that must have upset you.
  • – Which time is more convenient for you?
  • – I enjoyed talking with you.
  • – I can’t help you with that, but I’m going to send you to Staffer A and she’ll get it straight for you.
  • – I’m sorry you’ve had a problem. Tell me how I can help you.

And because it’s the receptionist who gets most of the nonclinical questions, keep a notebook at the front desk with the basic information about the office – the services it offers, appointment hours, the hospitals where the doctors have privileges, and driving directions from north, south, east, and west.

Free motivators that work

Here are two ideas for motivating staff – and doing so at no cost.

• Let staff earn a value day, which is a day off with pay, once a quarter. And don’t make it easy to earn.

During the quarter, evaluate staff on three things.

Punctuality. Not just getting in on time but being at the desk working, not drinking coffee.

Appearance. White clothes are white and not dingy, uniforms are pressed, shoes are clean and in good repair, and so on. Patients notice those things.

Initiative. Doing more than what’s required – coming up with a new idea, doing something extra such as phoning a patient who’s left something in the office or keeping the break room clean without being asked.

Also keep informal notes on any outstanding things individual staffers do.

At the end of the quarter, meet with staff to recommend one or two staffers for a value day. Then say “Staffer A has done X and Y. What do you think?” Staff give their opinion on the performance and vote yes or no. Staff can also recommend one more person for consideration.

• Recognize good performance. Recognition can be formal, such as honoring a staffer at lunch. But it can also be as simple and inexpensive as sending a complimentary note or letter to the staffer or spotlighting the staffer in a meeting.

The most motivating recognition of all comes when the physician joins in and signs the letter or attends the meeting when the staffer is honored.

Simple, practical marketing ideas

If there’s no marketing department, the manager has the added job of finding ways to attract new patients. Here are some easy ones.

• The best referrals come from patients. To encourage them, make visiting the office just a little better than visiting the office down the street.

One office, for example, gives an apple plus a brochure on healthy snacks to patients when they leave. And carrying the theme further, it sends new patients apple refrigerator magnets with the office’s address and telephone number.

• Use local merchants for the printing and office supplies.

• Sponsor a school sports team or a Little League team and get the office’s name printed in the programs and on field signs.

• Invite the staff of a referring practice to lunch each month. It’s often the staff who give patients referral names.

• Call the communications directors of large local businesses and offer to write health columns for their newsletters.

• Call clubs such as Rotary and Kiwanis and offer both manager and physician as speakers for their meetings. Topics can be new plastic surgeries, how colds are passed, allergies, diet, weight loss, exercise, and so on.

• Call the local TV stations and newspapers and offer to provide information in the office’s specialty whenever they need it.

• Set short meetings with the managers of referring offices. Just ask if the manager has problems with or recommendations for the referrals and leave some literature about the specialty and the practice.

To make sure the visit is well received and doesn’t get forgotten afterwards, bring along a box of gourmet sweets for the manager, doctors, and staff.

How to cover for absent staff

When a staffer is out, parts of the job usually fall through the cracks.

To prevent that, have staff list all the tasks their jobs entail. Tell them to include everything from routing the mail to watering the plants and turning out the lights.

If a job is done only on certain days, show which days, for example, “take deposits to bank – Wednesday and Friday.”

Then draw up a form for each job. Down the side, list all the duties and add spaces beside each item for “completed” and “comments.” The covering staffer checks off the duties that get done and in the comments space mentions any points the manager needs to know about such as “bank was closed today, so the deposits are in the safe.”

At the end of the day, the covering staffer returns the form to the manager. It shows that everything has been taken care of.

Logical theft prevention

No manager should spend time looking for theft, but every manager should take steps to prevent it.

Theft is caused by neglect and opportunity, and the only way to prevent it is to keep tabs on what everybody does. The basic protections:

• At least two people should handle the incoming checks and cash. One opens the mail and lists the payments and the other posts the money to the accounts.

• Write-offs should have written authorization from either a physician or the manager. Or have one person authorize the write-offs and another post them.

To find out if write-offs are being manipulated, call a few of the accounts that were written off and verify that they were never paid.

• Every check should have an approved invoice attached before it’s signed. That eliminates the possibility of someone’s writing checks to a fictitious vendor.

• If theft is suspected, go to the billing office and say “we’re going to run all the statements right now and mail them today.” Include a letter with each one saying “please verify your balance, and if there is any discrepancy, call the office manager.”

If money is being deposited into bogus accounts, there will be calls from people who have paid but whose payments have not been posted.

Show staff how to respect patients

Give staff guidelines for treating the patients respectfully.

• Especially with older patients, give physical as well as verbal instructions. Don’t just say “the gown opens in the font.” Show the person the ties and say “this will tie in the front.” Or if a urine specimen is needed, show the patient exactly where to place the filled container.

• Don’t escort patients to the exam rooms only. Escort them to the check-out desk as well. In a large office, it can be confusing which way to go.

And once at the check-out desk, introduce the patient to the staffer there and give a pleasant goodbye.

• Make eye contact with patients. Don’t hand somebody a form to fill out without looking at that person and saying something nice.

• Watch for patients to come in and be the first to say hello. Don’t make the patient come to the window and wait to be acknowledged.

An easy way to track whereabouts

To track who’s where, keep a loose-leaf book with a page for each week.

Down the left side, list all the areas that have to be covered, such as reception, insurance, lab, billing, and so on.

To the right of that, put in a column for each day and write in the name of whoever is responsible for each area for each day. Make the entries in pencil so when people are out, so it’s easy to make changes.

Most of the slots will list the same person for every day. But when the regular person is out, everybody can see who the backup is.

Some positions aren’t so regular but may get filled on some days by one person and other days by another. The schedule keeps everybody straight.

Post the schedule Friday afternoon so it’s ready for everybody to see Monday morning.

Good benefits at very little cost

It’s not always possible to give staff the raises they’ve had in the past. But it is possible to give them benefits they appreciate and that don’t cost much.

• A well appreciated perk is a set amount of hourly paid leave. The office might give, say, 16 hours a year. It can be part of the other leave days or in addition to them.

Staff use the hours however they want, and the advantage is that they can be out for an appointment without having to take a full or a half day off.

Staff submit a written request for the hours noting the time they will leave and the anticipated return time. The manager approves it, and when the staffer returns, the form goes back to the manager who notes the actual amount of time taken.

To make the tracking easier, count each partial hour as a full hour.

• Education is an appreciated benefit because it says the office recognizes its employees’ potential and want them to grow in their jobs.

Some good ways to provide it:

  • – Cross train. That increases everybody’s skills and also fosters a sense of cooperation.
  • – Bring in outside speakers. Cover topics that benefit staff personally, such as financial planning or child psychology or applying for a mortgage or the laws on divorce and child custody.
  • – Have one of the doctors explain a diagnosis or a procedure the office sees often.
  • – Pay for professional certifications.
  • – Pay for membership in professional associations.
  • – Take advantage of vendors’ free courses, especially courses on using various softwares.

Be a listener and a leader

Finally, there’s the issue of self management. And two elements employees expect in their manager are good listening and good leading.

• Being a listener

The art of listening is no more than showing staff their message is being delivered.

The body language: Get at eye level with the staffer so it doesn’t appear the manger is trying to be superior to the staffer. Lean forward so the staffer sees the manager is engaged in the conversation. That says right off “I’m listening to you.”

When the staffer speaks, nod. Don’t interrupt.

The listening language: Ask open-ended questions, which are questions that being with “tell me” or “give me an example” or “can you explain more what you mean?”

Acknowledge the staffer’s position with statements such as “you seem worried about getting a raise” or “you sound upset about not getting your vacation request approved.” The manager isn’t criticizing but wants to hear the staffer’s views.

Show understanding. Summarize what’s been said as in “so what you’re saying is that you’d like to move to a workstation where you can have more privacy.”

Besides making sure both sides are on the same page, this is a polite way to tell the staffer that time’s up.

• Being a leader

Be a role model. What’s good for the manager is good for the staff. They can’t be expected to get to work by 8:00 a.m. if the manager doesn’t get in even earlier. Neither are they going to dress and act professionally if the manager chews gum all day.

Expect the best. If the manager thinks staff won’t do something, take it to the bank they won’t. Think they will do it and it gets done.

Show confidence. And the best way to get confidence is through education. It can be formal education such as business or practice management courses. It can also be informal through seminars and workshops.

But the best education comes from maintaining peer contact through professional associations and from reading professional publications. Knowing what’s happening in other offices and what to expect for the individual office builds confidence that what the office is doing is right.

Know how to talk to staff. Be specific. Instead of “you’re not showing any interest in your job,” explain what needs to be done, perhaps “you need to smile and say something personal to every patient you meet.”

Encourage questions. End every assignment and directive with “is there anything you’re not clear about on this?” or “what’s the hardest part about this for you?”

Show confidence in staff. “I can see you’re trying to do a good job” inspires anybody to be productive.

Acknowledge that bad news is bad news. If someone is being fired, say “I feel terrible about this, but I know it’s even worse for you.”

Self evaluate. The best but also the most painful way to build leadership skills is to role play situations and videotape them.

Have a friend or a group of people play the role of staff and practice giving directions, explaining procedures, and disciplining. Watching the playback can be a cringing experience, but it shows how the manager comes across to staff as well as to the doctors.

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