The Great Practice Makeover: Taking Care of Business Associates

April 1, 2008

After their entire staff left town in the wake of Hurricane Katrina, a Louisiana endocrinologist and his office manager/wife want to make sure the new employees stay happy. We can’t keep hurricanes away. But staff retention? We can handle that.


To the average hourly medical practice worker, office manager Baishali Mallik probably sounds like a dream boss: Her chief concern at the moment is the staff’s happiness. “I’m fortunate and blessed to have these good employees,” she says. “But how do I keep them and motivate them and make them feel that their teamwork is valuable?”

An excellent question, and all the more impressive because Mallik has thought to ask it now, before trouble strikes. Or at least, trouble she can control. The practice has already weathered a major disaster of another sort: Hurricane Katrina. Based in Marrero, La., just 10 miles south of New Orleans proper, Mallik’s husband, Tilak Mallik, is the only endocrinologist for miles around thanks to the hurricane.

In fact, Dr. Mallik’s entire staff dispersed with the über-storm, including one-and-a-half providers who shared the practice’s clinical load. “You can imagine with the population here in New Orleans - he’s swamped,” says Mrs. Mallik. Imagine, too, how frustrating the practice’s recruitment efforts must be. “No one actually wants to come to New Orleans,” she says.

Mrs. Mallik is grateful she even has a staff, and she’d like to know not only how to keep them but also how to help them coalesce into a high-functioning, supportive team.

What do they care?

Even before Katrina, the staff was in flux: Dr. Mallik’s nurse of 20 years retired, and he has been unable to secure a replacement he finds 100 percent satisfactory. After all, the long-time nurse “knew if he moved his finger, what he wanted,” says Mrs. Mallik. “Cindy was like that - very dedicated.”

Between Cindy’s 2002 retirement and the August 2005 hurricane, Mrs. Mallik tried out nurse after nurse, finally shifting to lower-cost medical assistants, as they seemed to serve the practice’s needs as well as or better than RNs or LPNs. Today, in addition to the Malliks, the practice staff consists of two front-desk workers, one biller, and two MAs - all full time - and one part-time clerk who assists with filing, answering calls, and so on. A new nurse practitioner is scheduled to start soon, too. Finally, a physician assistant came on board in January 2006, but health issues preclude her from working at present.

Mrs. Mallik says that the “Cindy Replacement” MA has potential, but she is “still on the superficial level. Anything demanded of her, she’ll do it, but she doesn’t understand why.” This seeming lack of initiative could be evidence that a staffer feels little or no personal investment in her place of work beyond a paycheck, which begs the question: Are there opportunities available for employees to embrace the underlying mission, values, and goals of their employer? In short, what’s in it for them?

Speaking of mission, values, and goals, what are these? The Malliks should make sure they have spent time carefully developing these three critical entities, as they are essentially a practice’s raison d’être - a written manifesto of why the practice exists.

Lots of specifics are needed here. Of course you want to make money and take care of people in need, but how much money? How many people? What about next year? Five years from now? What is most important to you? Growing your patient base? Instituting technology? Expanding your clinical offerings? And how can your staff help the practice get there? What reward do you offer if they make the practice’s goals their own goals?

Which brings us full circle: When you define your mission, values, and goals, it becomes obvious that you can’t do it alone. And because you need help, you agree to divvy up the spoils.

Money talks

You can’t get anywhere if you don’t know where you are right now. So take a snapshot of various aspects of your practice to establish some benchmarks, such as the percentage of revenue consumed by overhead, average length of time accounts languish in A/R, percentage of patient copays collected at time of service, patient wait times, patient compliments and complaints, and more.

Some of this info can be culled from your practice management system - a “days in A/R” report, for example, is pretty standard stuff. Poke around the other available reports, too. What information can you pull out to help establish benchmarks?

Collecting other stats, such as patient wait times or feedback, will require the involvement of your staff. Mrs. Mallik admits that the practice’s schedule is a slave to Dr. Mallik’s dedication to his patients, as he will spend the time he thinks is necessary for each case - sometimes at the expense of the practice’s schedule. “If he’s supposed to see 18 patients [in a day], we are blessed,” says Mrs. Mallik. “If it’s 21, we are doomed.”

But we’re just gathering data at this point - for now, no judgment.


The next step is to set specific goals, using your stated mission and values to interpret those benchmarks. This part is actually sort of fun. What do you want to do? Decrease your billing errors by, say, 20 percent? Get your A/R down by half? Increase time-of-service copay collection to 90+ percent?

After you decide your focus (don’t try to take on too much at once), then establish the rewards. To make sure the goal/bonus resonates with her administrative staff, Mrs. Mallik could choose to focus on ramping up patient copays, as those folks are largely responsible for collecting them. Reducing claims denials, of course, should become the biller’s bailiwick. And so on.

Tell your staff that achieving a specific goal will produce a specific monetary bonus. Make the bonus multi-tiered. For example, reward each percentage increase/decrease with a corresponding dollar amount (i.e., a 10 percent increase in copay collection warrants $10, a 20 percent decrease in claims denials yields $20).

Pay out these bonuses quarterly, which is far enough out to allow for real improvement and close enough that your staff will stay motivated. The nice part here is if you’ve accomplished your goal, you’ll have the needed revenue to pay out the reward.

Other rewards talk, too

Cash rewards are great, and certainly they help ramp up an employee’s interest in the practice performing well. But Paul McCartney nailed the limits of such thinking when he sang, back in 1964, “money can’t buy me love.” So what else can you do? Plenty:

Feed them - How about an extended catered lunch party if you make your quarterly goals? If mornings would work better, make it a brunch.

Bestow gifts - Consider handing out nominal goodie bags as a thank you to your staff. Fill them with candy, low-cost trinkets, gift cards, etc., and distribute them at a quarterly party or some other appropriate event.

Promote teamwork through clothing - Mrs. Mallik already has a good suggestion here: Supply the staff with lab coats that are custom-embroidered with a pertinent slogan, such as “Diabetes Lifecare.” Great idea, with a cautionary note: Some experts assert that administrative staff should project a more businesslike image to promote professionalism within the office. A possible compromise is to have the clinical staff wear lab coats and the admin staff wear polos (in styles cut properly for the wearer’s gender) - both embroidered with the same slogan. (Although it’s not a particular issue for the Malliks, this suggestion may not do if you’re one of the many practices fighting a front/back culture war.)

Develop a branded look - This proven marketing principle can also be used to encourage a more cohesive, dedicated staff. You don’t have to spend a lot of money, either. Simply voting on a “brand” color (e.g., “Physicians Practice Orange”) and carrying it throughout the practice will offer a springboard for many events and decisions. Consider painting some of the walls, wearing scrubs or the above-mentioned polos in “your” color, or declaring the first Monday of each month Teal Day. Challenge your staff to come up with fun ways to celebrate and promote your brand.

Say “please” and “thank you” - You just cannot use these little helpers too much, and they don’t cost a thing. Encourage employees to engage in such behavior, too, peer-to-peer. You can even take this a step further: Decorate and hang up a piece of foam board (just a couple of dollars in an office supply store) in a public place, and supply heart- and/or star-shaped sticky notes (purchased at the same store) so employees can write notes of appreciation to one another. Remember that day when a patient yelled at your receptionist, and he handled it with maturity and panache? Write him a note! Whenever people do favors for each other or go above and beyond, direct the recipient or witness to the “Thank You!” board. Soon, it’ll become habit.

One-on-one

Group solidarity is critical to building a strong office culture, but it doesn’t cover individual performance.

Here, the keys are recognizing a specific person’s work and achievements and offering a custom-fit incentive. For example, Mrs. Mallik is concerned about her biller’s 60-mile roundtrip commute, saying, “She’s a very good employee; I don’t want to lose her.”

Surprise her with a gift card from a local gas station, and say how much you value her contributions and that you appreciate that she makes the trek to the office every day.


If you notice a certain employee working extra hard to achieve the practice’s goal numbers, crown her “Queen for the Day” (or week), complete with tiara, fluffy slippers (in your brand color, of course), flowers on her desk, a manicure certificate, whatever - use your imagination. Naturally, you’ll come up with more masculine alternatives for any male employees working hard in your office.

An alternate plan might be a “Get Out of the Office Early” pass. Simply create a coupon that states the bearer can leave an hour (or two, or half a day - you decide) early, with the rest of the staff picking up the slack for her that day.

You might want to require that this be pre-arranged, so you don’t get caught short on a particularly busy day, and make clear the reasoning behind the reward: It’s not that the practice is a place to be “escaped,” but that you also value your employees’ lives outside it. This suggestion may work especially well for Dr. Mallik’s practice, as its employees receive no vacation time until they have been on staff for at least one year.

Here’s one last suggestion that not only recognizes an individual, but it also gives staff the power to award the incentive themselves. Here’s how it works:

The practice manager starts the program by purchasing some sort of trophy that can sit at a desk, such as a stuffed animal or relevant fast-food toy. Give your selection a catchy name. Top Dog? Shining Star? Top Turtle? Bzzzziest Bee? You get the idea. Then, bestow this trophy upon someone you catch doing something right or going beyond her normal duties. That person becomes the Top Dog (or Turtle or Bee) for a week, winning the honor of displaying the prize on her desk or clipped to her clothes. All the while, she must be on the lookout for the next worthy recipient. And on it goes. The practice manager need not lift a finger to keep this perk going once it’s been rolled out.

Does the whole thing sound a bit silly? It is. But such team-building games add fun to what can be a stressful place to work, and the ensuing friendly competition will promote an invaluable sense of camaraderie.

Mrs. Mallik already recognizes that her staff “spends more time in the office than at home.” By keeping this wise observation in mind and implementing a few of the suggestions above, hopefully she can make a successful pre-emptive strike at staff retention by encouraging a tightly knit office culture where loyal staff sticks around.

Shirley Grace is senior writer for Physicians Practice. She can be reached at sgrace@physicianspractice.com.

This article originally appeared in the April 2008 issue of Physicians Practice.