Practice Impossible, Part 2: The Staff

Recently we became interested in the television program Restaurant Impossible. The Food Network show is hosted by Robert Irvine, a noted chef and restaurateur. The premise of the show is to help failing restaurants by giving them a complete makeover. The makeover is carried out by the chef, a builder and an interior designer. The catch is the makeover has to be completed in forty eight hours on a budget of only ten thousand dollars.

If you follow the program for a short time you will quickly see that the chef focuses on five factors of the restaurant business, regardless of the size and type of restaurant. The five factors are; leadership, the staff, the menu, the décor and marketing. You will also realize that the methods he uses are not applicable only to the restaurant business, but to any business.

This is why we like the show. The chef uses many of the same business principles we have used in running successful practices and consulting for other chiropractors. We have to note however, that our delivery is a little softer than the chef's. This series of articles works through these business principles from our chiropractic prospective. In this second article we focus on staff.

Good Help is Hard to Find

In the show, the management of the restaurants are usually unhappy with their staff and the staff is just as unhappy. From the outside looking in though, the chef and the television audience are quick to notice two specific reasons for the trouble. Both are primarily management problems, which is something management doesn't really want to hear.

First, management has hired the wrong people for the job. In the restaurant business, chiropractic business or any other business for that matter, the tendency is to hire people we like and hope they work out. Another problem is hiring in a rush. We need someone now and we hire the first person through the door. These bad habits can be compounded in some cases by hiring a friend, relative or patient.

Second, the restaurant owners have invested minimal time in the training and direction of their employees. Despite this, management is expecting a large return on its investment. The staff ends up being the victims of poor leadership.

Hiring the Right People

Prior to hiring, or prior to growing your staff in numbers, it is a good idea to invest your time in the creation of systems. The more you have your procedures systematized, the broader the pool of applicants you will have. In addition, having well-documented systems allows you to give accurate feedback for your people in terms of expectations and performance.

It is always important that we like the people we hire. But, they must have some basic skills and the ability to expand those skills. Apple™ hires employees based primarily on personality and attitude because their theory is they can teach skills, but not personality and attitude and we agree. But, who do you think would get a job, a person with a great personality who is familiar with Apple™ products, or a person with personality who isn't familiar with Apple™ products? Who would you hire?

There has to be an appropriate mix of personality and skill to the job required. Our example:

Chiropractic offices usually have one to three employees. In a small office with one chiropractic assistant (CA), the CA is a jack of all trades. In an office with two CAs, the responsibilities are typically split. One CA works the front office (front desk/insurance) and the other works in the back office (assisting with patient care). In an office with three CAs, the positions are typically split into three positions, front office, back office and insurance.

A good front office person must have a great smile and a friendly demeanor. No one wants to be greeted by a grouch. At the same time, the front desk person must be able to draw the line between being too friendly and standing firm on office policies. This is necessary as the front desk person has to collect money from patients and deal with insurance companies.

A good back office person must have a friendly demeanor, a caring nature and an attention for details. A person with a friendly, caring nature helps create a healing environment for patients. Attention to detail is important in providing and recording appropriate care.

A good insurance person also requires the ability to be firm and pay attention to details. A friendly demeanor is nice, but it is not as necessary to this position as it is to the others. Dealing with insurance companies requires being detail oriented and firm, if not mean, at times.

With the above facts in mind, the first two CAs must have similar personalities. Their training should also be similar as each will end up with all responsibilities when the other is absent for illness, personal days and vacations.

[pb]Growing Your People

Training and cross training are primarily the responsibility of the doctor. Doctors must be the leader here. Doctors cannot complain about the poor performance of an employee who never received proper training. Training is predominantly on the job. However, online training, local and national seminars are also available. Training on the job should be based on a plan because just tossing the new employee into the fray only works so well. A set plan helps make sure that all necessary responsibilities and skills are learned. This also involves having clearly established policies and job descriptions, a topic we will be discussing next.

The internet also offers a number of courses specifically for CAs and several general courses for the CA's benefit. A few states require CAs to complete a certification course and participate in yearly continuing education. Many of the courses are online. Trade schools also offer courses online or locally on insurance and medical office procedures.

Insurance carriers are known to host seminars on their plans and policies. These are very important as they relate directly to the bottom line. You must understand the plans and policies you participate in and are paid by most frequently. Seminars through individuals, your state and national organizations, as well as management consultants are also plentiful. This type of training is the most expensive and doctors tend to shy away from them, especially in the current economy. However, you must keep what Zig Ziglar always says in mind, "The only thing worse than training your staff and losing them to another job is, not training them and keeping them."

An additional benefit of seminars for staff is it is easier for them to buy into the mission and goals of the practice. When they are motivated and given the right tools, their appreciation for their own role increases and their job satisfaction increases.

Job satisfaction also increases when employees understand what is expected of them and they have the opportunity to meet those expectations. This is why having an employee handbook and written office policies are important. Examples of handbooks can be obtained from many different sources. Other chiropractors may provide a copy of theirs and management groups provide sample copies to clients. Other health care professionals (dentists, optometrists) might share theirs as well. The owner or human resource person from another type of business may also be willing to help. These are good places to start. You can borrow from these and then personalize the handbook from there. You should also review state and national labor laws in this process. Be sure not to change or contradict any of the policies from the summaries of employment rules and regulations you are required to have posted in the office.

An addendum to the employee handbook should be a clear financial policy for the office. The policy should inform the employees how the office will collect fees from patients, file insurance, appeal denied claims and handle accounts that are past due.

With written policies in place, when it comes to reviewing the employees performance regularly, there is a system in place to judge performance, raises etc. This means you need a form for employee reviews and you need to do them. The employee's attendance, punctuality, job knowledge, follow through, and other factors need to be reviewed at least yearly. These reviews can be done as often as monthly or minimally, annually pending your staff needs. The faster you give feedback to your staff, the faster they will meet your expectations.

Lead Your People

Some say working with staff is the most challenging aspect of private practice. It is our opinion that a staff member can "make you or break you." Therefore, managing staff is something you must focus on and plan for well. You must respect your staff with appropriate communication. This may include giving quick feedback (similar to what you might find in the book "The One Minute Manager" and not discussing issues about one staff member to another).

Lastly, our advice is to treat your staff with the same respect you would want them to give you.