How to Effectively Manage Medical Practice Staff

December 19, 2012

Three elements of effective staff management that can lead to increased productivity and profitability and happier patients at your practice.

How can a physician improve productivity and reliability, mitigate legal and financial risks, improve patient satisfaction and quality of care, and get home at a decent hour? An essential part of the answer is effective staff management, which is a big challenge in any business.

It is even more challenging for physicians because:
• A provider is generally either out of the office or in an exam room with the door shut, so she has limited opportunity to observe office/clinic operations.
• There is a wide gap between physicians and staff in regards to education, training, perspective, and job function.
• Physicians would much rather focus all their attention on patient care.

Here are three elements of effective staff management. Each requires time and energy. Some require financial expenditures. Well done, however, they yield high returns - like any good investment.

1. Training
Inform staff of expectations and standards. Tell them what you want them to do, and how to do it. Equip them to do the job. As intuitively obvious as everything may seem to practice leadership, it is not.

2. Direct supervision and leadership
Provide staff with references that help them stay on track. An operations manual, checklists, and forms help standardize routine activities.

Observe and comment upon behaviors and results. Most employees want to do a good job. Even with good training, it can take a long time for staff to internalize what that means in a particular office. Compliment the good and inventive. Provide instruction and context when unusual situations come up. When errors occur, supply correction aimed at avoiding subsequent errors.

An ancillary benefit to regular observation and comment is that it makes it clear to staff that someone is aware of what they are doing.

3. Management by systems
Management by systems is a way to leverage time and attention.  Spreadsheets and EHRs are often used but there is no requirement that the systems be computerized. The systems have three primary purposes: avoid, detect, and warn of problems.

An avoidance system can be very low-tech. An example is having the person responsible for taking the mail or bank deposit leave her car keys in a special place where it is impossible for her to leave the office without being reminded of the task.
A common detection system requires the initials of the person completing a form. If information is omitted, it is immediately clear who is responsible. (An added benefit is that people are much more careful when they must sign their work.)

Warning systems typically report symptoms to be investigated as potential problems. One useful warning system is the pattern of staff absences. (I once had a secretary who was only sick on Mondays.)  Others relate to trends in office supply costs, equipment repair costs, patient scheduling, and productivity measures. The idea is to avoid looking over shoulders and appearing to be distrustful: It is demoralizing for staff and a waste of the physician's time. The necessary information appears essentially automatically as needed, and supports corrective action.

Easier said than done – but doable:
You may have noticed that there is a lot of overlap in the suggestions. The overlap is a very good thing. It means that, done intentionally, everything done to enhance one capacity enhances at least one more. For instance, an operations manual supports training, operational consistency, and management by system. In terms of cost, an operations manual can be expensive. In terms of value, it is a big bargain. Here are some tips for developing an operations manual for your practice.

The physician does not need to provide this management directly, but she must provide for it and require it. Training, tools and systems can develop organically or with the help of a consultant. A nurse or medical assistant can provide most of the direct supervision and leadership, provided she is visible, actively engaged, and respected.

Not all of this can or should be developed and implemented at once. Attack the most critical areas first and build on successes. The truth is that the support for effective management is always a work in progress.