Getting Medical Practice Staff to Work Together

September 10, 2014

Even dedicated staff can sometimes have tunnel vision. But unless team members work together to achieve practice-wide goals, productivity suffers.

Practices are like families; some are closely united and support each other in both big and small ways. Others just seem to be fractured and don't get along, or just do their own thing and ignore the problems they see within the family - nothing gets better and the dysfunction continues. This same type of division can happen in a medical practice. When it does, it hurts morale, impacts productivity (including the physicians'), and compromises profitability.

I recently worked with a mid-size medical group that struggled with this issue. The front office worked like a fine-tuned clock, but there was no sharing practice workload within the nursing staff. Each nurse served a single physician - not the practice as a whole. Even when they had idle time they turned a blind eye to the needs of other nurses.

Busy physicians buried in their work were just glad when their nurses provided the help they needed to get them through their day. They did not realize the cost to the practice when the nurses didn't offer to help others with their workload.

The nursing supervisor was promoted to her position because she was smart, hardworking, and conscientious. However, she had no prior supervisory experience. She openly discussed her frustration and concern about how hard it was to supervise nurses who had been her peers in the past. She asked the office manager if she could attend a management course or get other help in gaining much-needed management skills, but it seemed to always be at the bottom of the manager's to-do list. Because the nursing supervisor didn't have a job description and was not given the guidance she felt she needed to succeed, she was largely ineffective. The monthly nurses' meetings were anything but productive; they were unplanned and often became dreaded gripe sessions.

The first step to resolving this issue was defining the nursing supervisor's job description and giving her the authority she needed. The organization chart was revised to include her position, and was announced at a full staff meeting. The physicians agreed that nurses would report directly to the supervisor, not the physician they served.

The nursing supervisor was enrolled in online webinars and scheduled dedicated time each week for supervisory responsibilities. She met with the office manager regularly for guidance and support. She then met with each nurse and gave explicit instructions for when and how they would be expected to assist the other nurses. The manager and nursing supervisor agreed on measurable goals to improve the nursing department's performance.

The nursing supervisor monitored performance, provided support to the nurses, and held them accountable to specific performance standards. Nurse meetings were renamed team meetings; they became constructive and energizing. Working together and sharing the workload resulted in higher productivity and improved morale.

Within three months this was a well-functioning team that respected their supervisor. With the extra nursing support, physicians were staying on schedule and work was finished at the end of the day. Patient services improved, overtime costs disappeared, and the nursing supervisor became the supervisor she aspired to be.