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Building Office Unity


In times when medical reimbursements are dropping and pressures are increasing for physicians, the need for a well-functioning office is greater than ever.

In times when medical reimbursements are dropping and pressures are increasing for physicians, the need for a well-functioning office is greater than ever. Sadly, many offices spend so much time dealing with office problems that promoting unity is nearly impossible. Don’t make the mistake of thinking that disunity’s effect is only limited to your support staff; physician disunity is far more disruptive to the efficient and effective functioning of your medical office.

Unity does not happen without effort: Like entropy pushes things to disorder, the tendency of an office atmosphere will always be toward disruption. Our office has been through times of major disruption, but we are presently seeing the benefits of our work to achieve a unified practice environment. Here are the most important steps we took:

1. Start from the top
If there is more than one physician in a practice, the first effort should be aimed at getting all the physicians on the same page in as many ways as possible. Because of the independent nature inherent in the way physicians work, they often find this difficult to do, but agreement on both clinical and procedural work flow will help a practice function much better.

For example, the four physicians in our office have agreed on phone protocols for handling the most common calls we get. This has allowed us to centralize the job of answering phone questions (using our EHR) and make that process much less of a burden. If something new comes up that we know we will face repeatedly (such as a drug recall or new recommendation), we get together and discuss what our policy will be. We have also worked with our nurses to standardize their role as much as possible, regardless of which physician they work for. This allows us to more easily reallocate our nursing staff when someone is out.

2. Trickle down
When I was just starting in practice, I was given the following sage advice, “Your staff will only treat your patients as well as you treat your staff.” Physicians and administrators need to set the standard of behavior before they try to enforce rules. Nothing breaks morale more than hypocrisy among leaders, and disillusioned staff will not be motivated to serve patients. This means that leaders should not:

  • Gossip;

  • Talk negatively about patients; or

  • Ask their staff to work harder than they themselves are willing to work.

This is not just the ethical thing to do, it is better business as well. Negative attitudes suck up time and resources.

3. Cultivate community
People work better when they feel that they are part of something important - they want to feel that what they do really matters. Physicians get regular encouragement from patients, often getting the credit for things their staff have done. To have a well-functioning office, it is essential that credit goes to the whole office and everyone feels appreciated.

This can be achieved in several ways. First, leaders should never assume people know they are appreciated - they need to hear it. Bonuses and raises are one form of appreciation, but it is at least as important to thank your staff in other, less material ways. We hold an office party in December, but also close the office for one day in June and treat our staff to a day of fun. The value of this office appreciation day is tremendous: our staff members learn more about each other while having fun together outside of work.

4. Deal with problems
Not confronting problem employees will undermine everything else you do for office unity. There must be a well-enforced discipline policy, and office leadership must be willing to fire employees if they don’t respond to that discipline. Yes, there are times when firing someone will cause more work for other staff members, but I have found that getting rid of problem employees eventually improves office morale.

There is no way to have perfect unity in an office - we are human beings, after all - but finding ways to minimize problems will not only make a happier workplace, it will make a more productive workplace as well. That harmony doesn’t simply come by hiring the right people; it takes a conscious effort on the part of leadership, starting with you, the physician.

Robert Lamberts, MD, who is board-certified in internal medicine and pediatrics, practices in Augusta, Ga. His practice won the 2003 Davies Award for outstanding application of IT in a primary-care setting, and he has lectured extensively on EHR. He also writes the popular medical blog "Musings of a Distractible Mind" ( Dr. Lamberts can be reached at

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