Analyze Staff Mistakes, Improve Medical Practice Performance

February 13, 2013
Carol Stryker

Repetitive mistakes made by medical practice staff members are often not their fault.

Many physicians are frustrated with a staff member who persistently makes the same mistakes. More often than not, the employee's performance is the collateral damage of forces beyond her control. In any case, it is up to management to find and correct the root cause of the poor performance.

Is it the staff member's fault?
Two common assumptions are that the staff member is simply not committed to high performance or is not bright enough to perform well. The first step in addressing the performance issues is to test those assumptions:

• Does the staff member otherwise demonstrate a good work ethic? Is she faithful and timely in attendance?
• Is the staff person able to communicate adequately? Can she express herself clearly, and does she perform any similar tasks well?
• Is anyone else in the office having the same problems?
If the answer to most or all of these questions is no, the employee probably should be terminated and the office needs to review its hiring practices. If the answer to these questions is yes, it is highly unlikely that the fault is with the employee.

Has there been adequate training and education?
Another question actually precedes these two: "Is there an acknowledged right way to perform the activity?" In many medical offices there are no explicit standards as to what constitutes a good job. Staff members are left to try to figure it out, and they often guess wrong.

If explicit standards exist, has the employee had adequate instruction in the standards and how the activity is to be performed? This is training.

Has the employee been told why it is important to execute the task, and to execute it in the prescribed way? This is education, which can be even more important than training because it focuses on what is to be accomplished, instead of what is to be done.

If any of the answer to any of these three questions is negative, the solutions are self-evident, although finding the resources to develop them can be a challenge. If the responses are all positive, the root problem is systemic.

Ask the employee why she thinks she has so much trouble performing reliably.
An employee's reasons will tend to fall into one or more of the following categories:
• Inadequate equipment;
• Disjointed or cramped workspaces;
• Regular interruptions of work that requires concentration;
• Not enough time to perform the task
• Forms or electronic systems that do not match the work

Listen carefully and take the feedback seriously.
It is a bad idea to accept the explanations at face value, because the employee may not have the perspective to adequately describe the difficulties. At the same time, management should be aware that the employee is a treasure trove of information about how things actually work, as opposed to what management assumes.

Work together with staff to address the systemic problems
The process begins with brainstorming and progresses to proposed solutions that must be analyzed for effectiveness and feasibility. Evaluating feasibility often involves negotiation, because a proposed solution may not be economically viable. Significant operational improvements are always available, even if the ideal solution is not.

Persistent errors almost always result from inadequate definition, training, education, infrastructure, systems and/or processes. The most talented employee will perform poorly without appropriate operational infrastructure.