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10 HR Issues That Kill Productivity


Medical practices are often fraught with poor policies and time sucks that undermine staff performance. Here's what to look for - and what to do about it.

You can blame bad apples all you want, but if you're stuck with a staff that consistently under produces it might be time for the $64,000 question: Is your practice part of the problem?

There are dozens of ways that medical offices mismanage their most important asset - human resources. From avoidable layoffs, to poorly planned workspaces, to policies that encourage sick workers to drag themselves into the office, it's a wonder anything ever gets done.

"Productivity to me is a really important issue that can easily be improved and I'm surprised by how often practices turn a blind eye to it, especially when staffing is the number one cost on their expense list," says Judy Capko, a practice-management consultant in Thousand Oaks, Calif., and author of "Secrets of the Best-Run Practice," in an interview.

If you find yourself wondering where your practice falls short, here's a list of the top 10 HR blunders that can send productivity down the tubes.

1. Misguided meetings

Staff meetings are a great way to keep your finger on the pulse of your practice, but they can also be a big waste of time. Ineffective meetings accomplish little, leave everyone running in circles, and create added frustration for all involved, says Prashanthi Sylada, a board member for the Society of Human Resource Management. Planning can help. Before your next meeting, draft an agenda that clearly outlines the objective, goals, and topics on the table. Don't forget to identify a point person to keep the discussion on track and always include time frames for addressing each point. It's equally important to distribute the agenda in advance as an e-mail or hard copy to each attendee. "Otherwise, people come to the meeting and start thinking out loud," says Sylada. "When they have the topic ahead of time they can start thinking before the meeting even begins and come ready to contribute."

2. Social media

It almost goes without saying: text messaging, e-mail, Web surfing and social network sites like Facebook, Twitter, and LinkedIn can be big office time sucks. A 2010 survey by news navigator onenewspage.com found that 39 percent of employees in the United States and the United Kingdom use social media sites at work, and 26 percent admitted to spending more than an hour a day on sites that were not work-related. Other studies have found the constant checking of "in-boxes" throughout the day interrupts workflow dramatically, taking employees sometimes twice as long to complete their tasks and increasing the rate of errors. But banning access in the office is not necessarily prudent.

"For physician practices, in particular, this is a double-edge sword," says Troy Jaklich, president of Legacy Human Resources in Denver, which specializes in medical offices. "A lot of physicians are creating company Facebook pages and blogs as a means to attract new business - as another marketing arm."

His suggestion: All practices should revisit their online policy annually, update their employee handbook as needed, and communicate their policy clearly to the staff. For example, make clear to your employees that online communications (even outside the workplace) that pertain to coworkers and the practice must be appropriate, should not damage the practice's reputation or business interests, or expose the practice to a potential liability. It's a good idea to put your social media contract in writing, making it clear that violation is grounds for disciplinary action or termination. Get each member of your staff to sign it and keep a copy in their personnel files. Such measures not only eliminate any uncertainty surrounding the use of social media, but help prevent missives that can land your practice in legal hot water. To prevent the watchdog effect, you may also decide that all personal use of cell phones and the Internet is forbidden during work hours. Or, you might wish to allow an occasional (content appropriate) YouTube huddle - so long as it's during their lunch break or after hours.

3. Layoffs

Reimbursement cuts have put many practices in a bind, forcing them to consider layoffs. After all, compensation is generally the biggest piece of a practice's expense budget - accounting for up to 30 percent of expenses in primary-care groups, according to Capko. More often than not, however, the impact on morale negates any short-term gain, says Jess Orrick, a practice management consultant with Orrick Associates in Newton Centre, Mass. "Many practices tend to be understaffed to try and save money, but that leads to morale problems which effect how employees deal with patients," he explains. "[Staff] get impatient and cranky. It's not the patient, though. It's the job. They don't like where they are."

Indeed, a 2009 study by the Workforce Institute at Kronos, a workforce management firm in Chelmsford, Mass., found that 40 percent of respondents whose workplaces had experienced layoffs in the past year felt that overall productivity of their organization was negatively impacted. Some 66 percent of them said morale had suffered and that people were less motivated, and 36 percent feared their office would not be adequately staffed to meet future demand.

Remember, reducing your headcount for purely cost-cutting purposes not only puts added pressure on an overworked staff, but belittles the contribution of those who remain, according to says Robert Greene, chief executive of Reward Systems, a compensation and benefits consulting firm in Glenview, Ill. "When employees believe downsizing is the first reaction to reduced revenues they believe people are the most disposable asset, not the most important asset," Green says in an interview. "Also, when they live through pay freezes or cuts and see executives prospering they become cynical about the way the organization values contributions."

4. Career angst

Job dissatisfaction in the healthcare field is rampant and well documented, yet it's rarely discussed in the context of lost productivity. It should be, says Wendy Lipton-Dibner, an author and consultant with Professional Impact in Wilton, Conn. "There's an amazing amount of unrest in the industry and that unrest gets in the way of productivity," she says. "Physicians are overwhelmed by things that have nothing to do with treating patients." They are frustrated, in many cases, because they can't get their staff to do what they want, upset because managed care dictates how they must treat patients, and angry because they're making less money than they anticipated. "There is a great deal of fear and frustration over a promise that has been broken from their perspective," says Lipton-Dibner.

It's not just the physicians, though. In many practices, staff members, too, are distracted by what Lipton-Dibner calls "relative deprivation." "Basically it means that I was perfectly happy with what I had until I saw what you had," she explains. "The staff sit in the lunch room and instead of doing what they need to be doing they're talking about Dr. X's new car and how they could feed their kids for a year on what he paid for it," she says. "They can't help but notice what they don't have when it's in their face every day." Ultimately, the resentment that builds translates into an unwillingness to go the extra mile.

The cure? Lipton-Dibner suggests reminding your staff (delicately) that they do have choices. They don't have to work at the practice. "There are a world of choices out there, but they get so caught up in their little box of saying 'I am a victim,' which makes them 100 percent ineffective," says Lipton-Dibner. Legitimate concerns about their job, of course, should not be dismissed. It's your role to create a work environment conducive to success, and ensure each team member has the tools they need to do their job effectively. But chronic complainers often benefit from a dose of tough love, argues Lipton-Dibner: Sit down with the staff member one-on-one and ask her what she needs from you. Then ask what she likes about working in healthcare and why she chose it to begin with. Remind her that she controls her own career, and that she owes it to herself to pursue a line of work that she loves. "As soon as they start to realize that they're not a victim everything turns around," says Lipton-Dibner. "Self esteem improves and the next thing you know they're making some realistic suggestions on how you could be more efficient."

5. Ineffective workspace

Does your front desk staff have to schlep to the back of the office each time they send a fax? Is there never copy paper where you need it? How far are your exam rooms from the waiting area?

Dick Haines, president of Medical Design International in Atlanta, which helps physician practices optimize productivity, said in an interview that many practices' poorly designed offices costs them time every day, which adds up to many hours of lost productivity as the months pass. "I worked with one practice where it took the medical assistant five full minutes to go get the patient and escort them to their exam room," he says. "Do that 40 times a day and they're spending 25 percent of their day just walking, which is not only a waste of their time but renders them unavailable to help the doctors." Be sure your layout isn't slowing your staff and always provide the equipment they need to work effectively (ergonomic keyboards, comfortable chairs, updated software) and the space they require to work uninterrupted.

6. Limited sick leave policy

Many practices have poorly designed sick leave policies that inadvertently encourage staff members to show up when they're under the weather to save their sick days in case they get "really" ill later on or have to be home with sick kids. Other practices allow employees to carry over unused sick leave to the following year, which also encourages them to come to work when ill and infect their coworkers, potentially putting the entire office out of commission.

Tell sick employees to stay home, says Sylada, noting they're not performing at the top of their game anyway and they're far more likely to commit costly mistakes. Many consultants say the best policy is to offer unlimited sick leave, which empowers your workers to use their judgment. Plus, it can be a valuable recruiting tool. The concern, of course, is that employees might abuse the policy to start their summer weekends early, but it happens less often than you'd think, says Sylada. The few who take advantage don't take responsibility seriously to begin with and chances are their performance reviews reflect it. If they're not contributing to the team, cut them loose. You could also consider retaining your limited sick leave, and building into your paid-time-off benefits so-called "earned leave," says Sylada, which gives employees extra time off for use at their discretion based on tenure. For example, they might earn one additional day off for each year of service, up to a maximum of, say, five days.{C}

7. Unclear expectations

If you haven't told your employees what you expect from them, then you can't complain when they don't measure up. All new employees should be given a copy of their job description and performance goals. It should then be revisited each year during their annual review. "The vast majority of managers do not set expectations clearly at the start of each year and provide clear, continuous feedback to employees," says Greene. "This leaves employees in the dark as to what is expected and how they are doing, as well as how they could do better."

Capko agrees, noting job descriptions make employees more accountable and thus better performers. "I do an exercise at my clients' offices where I ask the staff members to write down their top five primary tasks and when I compare them I'm amazed at how much crossover there is," she says. "It's nice to have them cross-trained, but they need to understand what their primary role is."

8. Poor communication

Good communication between management and staff builds trust, motivates, and fosters an all-for-one mentality. A lack of communication does just the opposite. In addition to regular staff meetings (the productive version), try sending out weekly e-mails or newsletters that keep staff informed of important happenings - and of individual achievements by their coworkers. Always practice an open door policy, where staff members can feel free to voice concerns and suggest new ideas, and don't forget the importance of less-formal meetings with your team.

"Managers should have coffee with each employee on his or her team one-on-one, every month or so, so they get to know the employee better and understand what's going on in their life," says Sylada. Perhaps they're suddenly caring for an aging parent, or going through a divorce. You may be able to offer more flexible hours to help them achieve better work-life balance. Ask, too, for their insight on what the practice is doing well and how it could do better.

Above all else, never leave employees in the dark. If changes are in store for your practice, level with them as soon as possible. "If a new employee comes on board, someone is getting laid off, or there's talk of a merger that all leads to uncertainty and unproductive gossip," says Sylada.

9. Letting poor performance slide

While positive reinforcement is paramount, you will at times be forced to discipline staff members for poor performance or bad behavior. Failure to do so can contaminate morale, and send the wrong message to the team, says Jaklich, noting your best and brightest will quickly tire of pulling their coworker's weight and they'll start to resent management for letting it slide. Your employee handbook should include a written policy for professional conduct and outline the disciplinary procedure for infractions such as regular tardiness (more than once a week), says Jaklich. The mere act of having a policy will help prevent most problems to begin with, but when you do need to use it, be consistent so there's no perceived favoritism, he says.

10. The wrong people for the job

Letting staff members perform tasks that are below their level of training is a great way to waste their skills - yet it happens all the time. While all employees should be cross-trained for flexibility, it's up to you to ensure they're not spending their day doing work that a lesser-trained coworker could handle, says Orrick.

That goes double for physicians. No one but physicians are trained to treat patients at their level, and treating patients is the reason practices exist. Physicians should never spend their time filling out paperwork or making copies. Likewise, let your physician assistants and nurse practitioners treat routine care patients and free your doctors to focus on more complex cases, he says.

In the quest for productivity, medical practices often miss the forest for the trees. Managers are so busy benchmarking their expenses and accounts receivable that they forget to equip employees with the tools they need for success - including clear policies, effective workspaces, and consistent performance feedback. By taking the time to revisit your HR policies, however, you can make your practice healthier and more productive. And the best part is it doesn't cost a thing.

In Summary

How do you make sure operations run smoothly? Start by avoiding these serious blunders:

• Ineffective meetings are costly and frustrating to employees

• Layoffs marginalize the contribution of those who remain

• Make sure your office is designed and stocked to set your staff up for success

• Unlimited sick leave is often the best policy to maintain productivity

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 2011 issue of Physicians Practice.

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