Keeping Medical Practice Staff on Task

August 29, 2012

Day-to-day operations at your practice can easily get derailed. Here's how to keep staff on track despite possible disruptions.

The modern day medical practice is nothing if not nimble. It must be to survive the onslaught of new technologies that permit greater efficiency, new ownership models that impact corporate culture, and the additional hiring necessary to sustain growth. Such change reflects progress, of course, but it also creates distraction, diverting the attention of your team away from the task at hand.

Whether implementing an EHR conversion or managing interruptions from mobile devices, it's your job to help your staff balance their workload as they adapt and evolve. "It's important for managers and staff to focus on both their day-to-day responsibilities and their new transitional responsibilities," says Jack Valancy, a practice management consultant in Cleveland Heights, Ohio. "It's your job to figure out how the staff will fulfill both sets of responsibilities." Failure to do so, he notes, increases the risk of lackluster results and could deal a devastating blow to morale. "Staff may lack the commitment to work for the project's success, and may compromise the project with passive aggressive behavior," says Valancy.

Set priorities

During times of transition, says Susan Childs, a practice management consultant with Evolution Healthcare Consulting in Rougemont, N.C., you should always clarify priorities and communicate them to your staff. Before you schedule a training session, for example, which will leave your practice temporarily short-staffed, meet with each employee to review their job responsibilities and identify those that take precedence when the office is operating with a skeleton crew. It'll take the pressure off your team, and ensure the office continues to function as seamlessly as possible. "They need to know what their roles are and what parts of their job are most important to you," says Childs. "Communication between employees and management is essential." All subsequent job responsibilities should be placed in order of importance, as well, so your staff knows what to tackle next when their workload permits.

Just make sure you get the employees' input throughout the process. "Sometimes managers sit down during a big project and they figure it all out on their own and say 'this is how we are going to do it,' but they may not have thought of the optimal way to implement," says Valancy. "We really want to be listening to the people who are actually doing the work and getting them involved in the process at every level." Ask them what they think and how it could be better, suggests Valancy. You may not follow every suggestion, but the mere act of soliciting their opinion shows you value their expertise, which encourages the staff to engage.

Similarly, says Valancy, it's important to set long-term goals for your practice and share them with your staff so everyone is playing for the same team. Perhaps you plan to become a Patient-Centered Medical Home in the coming year, or expand your patient base by 10 percent. Don't keep it a secret.

Training

When teaching your staff to operate new technology, such as an updated phone system or EHR, you should also make every effort to lighten their workload while they are in training by asking coworkers to pinch hit. This requires planning, says Deborah Walker Keegan, a medical practice consultant with Medical Practice Dimensions in Asheville, N.C., who advocates cross-training all staff members to perform multiple duties.

"If you know you're going to implement an EHR in six months, begin cross-training your employees now," says Keegan. "If Susie is off the phones for four and a half days for training, someone else has to be on them. Formalize your new job responsibilities for the interim period to permit training to occur." Cross-training will continue to be useful when someone gets sick or takes vacation. And, it's empowering for your employees, says Keegan, most of whom crave new challenges. While some jobs, like billing, require greater expertise, it may still be possible to train a front-desk clerk to do a single job - like respond to the most common type of claim denial. "It may not be the full complement of work, but you can teach them to do one or two things well," says Keegan.

In the case of EHR training, you can bring your staff up to speed fastest - and burden them with less backlog when they return to their seats - by designating blocks of time when they don't also have to juggle patients or phones, says Childs. After all, it's hard for team members to absorb the complexities of a new computer system if they're worrying about the e-mail piling up in their inbox.

Some practices ask their staff to come in on the weekend or before hours for training, but Childs says the most effective strategy is to close the practice for a few days or afternoons during the workweek. "Take the distraction away," she says. "Have at least a day and a half carved out for training where you close for patients and your staff can concentrate." The financial cost to your practice is more than offset by the benefit of getting your team trained faster and more effectively - without all the stress of falling behind on their regular work, says Childs.

Teach time management

You can also help your staff juggle their workload amid transition by showing them how to budget their time. Take e-mail, for example. If you don't set parameters, you could easily get sidetracked by every message (spam or personal) that comes along.

"Rather than checking their inboxes throughout the day and getting distracted constantly, teach them to check it twice in the morning and twice in the afternoon," says Keegan. Likewise, you should establish a policy to ensure your providers are only interrupted when the matter is urgent, enabling them to focus on patient care. "The physician should have the confidence that their team is working synchronously and that the nurses are only going to bring the abnormal lab results to him. He should know that the scheduler will be able to add in another patient without involving him."

Tame the mobile device

To that end, it may help to put a practice-wide policy in place to minimize digital distractions from social networking sites and mobile devices. It's easy enough to prohibit your staff from logging on to Facebook and Twitter during work hours, but the ubiquitous smartphone and tablet computer are another story. These days, there's almost universal adoption of such technology for both personal and professional use. Providers rely on mobile devices increasingly for instant access to patient data and reference tools.

Trouble is, it can be hard to tune out the unrelenting assault of alerts and notifications that come with the territory. "Health professionals are using mobile devices, such as smartphones and tablet computers, at increasing rates," says Jon White, director of health information technology for the Agency for Healthcare Research and Quality's Health IT Portfolio. "Because they can be used in conjunction with EHRs, they can enhance quality, safety, and efficiency. However, there have been instances when their use has had unintended consequences."

Indeed, a growing contingent of patient advocates is concerned about "distracted doctoring," in which providers focus more on data entry or personal text messages than the patient on the exam table. Physicians who go to write an electronic prescription, for example, can easily lose their train of thought when they address an urgent text message waiting on their screen.

To combat the problem, physicians should maintain a separate phone for professional use, disengage pop-up alerts when they're in the office, and exercise proper electronic etiquette, says Peter Papadakos, director of critical care medicine and professor of anesthesiology, surgery, and neurosurgery at the University of Rochester Medical Center. "The most important thing for health professionals to realize is that they should keep a separate device for their professional life," says Papadakos, who has written on the topic of distracted doctoring. "Your device for receiving e-mail and text messages should be sacred for patient care." When using handheld devices during patient encounters, he adds, physicians should also explain to patients what they're doing and why so they don't feel marginalized.

Staff for the work

As your practice tackles new projects and technological upgrades, it's equally important to recognize the limitations of your staff, says Keegan. Employees can only be stretched so thin before performance starts to slide. A receptionist who is already overwhelmed with the phones and patient volume, for example, can't also be expected to monitor secure e-mail messaging or virtual visits via your EHR.

To do it right, you may need to add another person to the payroll. "Instead of piling the work on higher and higher, look at her volume of inbound phone calls to see if that's appropriate," says Keegan. "In many practices, I will add some clinical staff to be sure we're staffing these patient access channels appropriately. You need to staff for the work."

Consider first, though, whether you may be able to redistribute job responsibilities among the employees you already have. "In terms of your EHR, there may be an opportunity to deploy the medical records staff in a different way," says Keegan. "We still need to scan records into the EHR and monitor inboxes, but there may be a way to retool the staff" when some of their paper-based job responsibilities disappear.

And don't forget to be flexible. In their zeal to get the job done, managers sometimes get too hung up on self-imposed deadlines, says Valancy. "You can do all the planning you want, but Murphy's Law is always in effect: If something can go wrong, it will," he says. "If people are straining to get it done by your completion date, be flexible and don't beat your staff up over it." It'll only breed resentment and result in increased errors as your staff struggles to get their work completed on time.

Manage sentiment

As your office reinvents itself, one of the best ways you can help your staff remain productive is to exude an aura of calm. It'll make the process seem less overwhelming and remind your team that it's still business as usual.

"Help your staff juggle priorities, while doing it in a way where you don't seem frantic like you're running around like a chicken with its head cut off," says Keegan. During the process, you'll get better buy-in from your staff if you highlight the benefit to them, adds Valancy. "Acknowledge that this conversion to the new EHR may be really tedious, but once we get it in place it'll be easier for them because we won't have lost charts or have to keep running back and forth to get paper charts," he says. "Help them stay focused on the upside." For long-term projects, like certification to become a Patient-Centered Medical Home or EHR conversion, he says, you can encourage your troops to carry on by posting a progress report in the break room. "If your project is a five-part process, do a chart that shows they've completed steps one and two already, like a fundraising thermometer," says Valancy, noting a catered lunch or Starbucks run now and again shows your staff their hard work is appreciated.

But be honest, too, about the challenges that lie ahead, says Valancy. If a change in ownership is pending or the practice is experiencing financial problems, address any concerns quickly and candidly. In short, stay ahead of the rumor mill, the ultimate distraction that forces employees to take their eyes off the ball. "When people learn of changes, especially changes that have the potential to threaten their job or income security, they often anticipate the worst-case scenario," says Valancy. "Anticipate such a reaction, and be prepared to clearly explain how the transition will affect each employee.

Office distractions come in many forms - mergers, EHR conversions, mobile devices - but it doesn't have to sabotage productivity. If your team is losing focus or showing signs of fatigue, it may be because you haven't given them the tools to succeed. Help them set priorities, organize their workday, and limit interruptions to bring the focus back to the patients.

"Management is like gardening," says Valancy. "You have to cultivate a positive organization culture. That makes employees feel good about themselves and their jobs, increasing the likelihood that they will rise to the occasion - and demands - of a special project."

In Summary

There are several ways to help your medical practice staff balance their routine workload in the face of possible distractions:

• Review priorities with each employee, so expectations are clear.

• Training sessions should be held when employees are not distracted by patients or phones.

• Set policies that limit interruption from mobile devices.

• Teach time management skills to help them do more in less time.

• Stay flexible and don't push your team too hard.

Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.

This article originally appeared in the September 2012 issue of Physicians Practice.