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Keep Today's Practice Staff Tomorrow


Looking for the keys to job satisfaction for your employees? Look no further than autonomy, action, and assessment.

There is no doubt that the salary your staff receives keeps them reporting for work at your practice each day, but there are other factors that are equally as important to keeping talented employees as a part of your team.

"It is not about the money and that is a hard thing to say," says Patricia Raymond, a Virginia-based gastroenterologist and healthcare speaker and author. "You won't cause retention with a better Christmas bonus. Yes, it is important to pay to the work level … but retention is about enjoying being at work, enjoying the colleagues you work with, and enjoying what you need to do to get the work done."

Raymond, who visits practices, hospitals, and other healthcare facilities nationwide through her "Rx for Sanity" speaking program, says physicians and practice administrators need to get past the thought that good pay equals a long-term stay for their employees. If you really want to keep good employees around, you need to look at three non-fiscal factors: autonomy, action, and a simple assessment, she says.


Raymond says a key factor in gauging staff satisfaction with their jobs is first determining how much autonomy you give employees. Are they allowed to make decisions on their own or do they first have to consult with a physician or other administrator before making a decision?
For example, if a patient calls in with an emergency, can the staff person fill an open slot or must they check first to see if the emergency is a valid one?

"Give your front desk staff the ability to listen to people in need and service those people to get them in," she says.

Raymond says one thing practices can do is to pencil in a couple of free schedule spots 24 hours in advance, such as right before lunch and at the end of the day, for staff to use if they feel a patient is in immediate need of attention. Rather than have the staff member sympathize and then explain that they need authorization for a same-day visit, have that employee schedule the patient in the open slot right away.

"A lot of doctors will worry that they may not have a full schedule [under this plan], but once patients are aware that they can get in to see you when they are sick, these spots will be filled," she says.

Raymond joined a group practice in 2009 and is still trying to get her staff comfortable with the way she used to run her solo practice: "I say [to staff] bring 'em on in," she says.

"I don't think any doctor would really say 'no' to seeing a really sick patient," Raymond adds. "I'm working on trying to get my staff to know that I'll never say 'no' and frankly, I'd rather they not even ask me. I'd rather they just do it."

Raymond says that giving autonomy also means a willingness to accept mistakes - such as if that "sick" patient is not so ill after all. That then presents physicians and practices the chance to offer feedback for the future for staff to perfect their performance.

Taking action

Working hand-in-hand with autonomy, it can be a good thing for a member of your practice staff to take action when the situation calls for it, rather than first seeking approval.

"Is your staff acting like the offensive line in football, protecting the physician from patients or are they actually having some of the fun of medicine, which is assisting people? They should get that chance to assist others and make things right," she says.

One strategy is giving staff up to $20 per person to help a patient they see in need. For example, if a patient is delayed for their scheduled procedure, let a staff member go next door to a store or down to the gift shop for a small token of appreciation for their patience. Is a family member waiting for someone during a lengthy visit? How about getting them a hot cup of coffee or issuing a gift certificate at the cafeteria for a small bite to eat while they wait?

"It comes down to how much is it worth to keep the patient happy and keep the patient in your practice or your hospital," she says. "I'm pretty sure it is worth a lot more than that $20."

12-step assessment

Raymond is a big fan of one of the most widely used employment engagement tools used in numerous fields, including healthcare: Gallup's Q12. The assessment tool features 12 core elements that serve as a good predictor to employee and workgroup performance.

Among the questions on the Q12 are:

• In the last seven days, have you received recognition or praise for doing good work?

• At work, do your opinions seem to count?

• Does your supervisor, or someone at work, seem to care about you as a person?

Raymond says the Q12 puts staff satisfaction and retention goals "in a beautiful nutshell." She points to the question "Is there someone at work who encourages your development?" as an example of how keeping a staff member engaged and growing professionally can actually serve as a deterrent to retention - in a good way.

"I'm glad when staff outgrows me," she says. "It is sad to see them leave, but you've let someone grow and develop professionally and you can get someone else who can become extraordinary."

Raymond notes that the more questions in the Q12 you can reply "yes" to, the better, and none have to do with salary.

"Pay them fairly, but don't forget about the intangibles," she says. "The more of the Q12 that is positive, the more likely that staff member is to stay with you … and I think it is worthwhile to run through the Q12 regularly to see how to make a person's job better and sometimes easier."

*Wondering what other practices are paying their staff? Check out our 2011 Staff Salary Survey.

Keith L. Martin is the managing editor of Physicians Practice. He can be reached at

This article originally appeared in the May 2011 issue of Physicians Practice.


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