'Oops, I Hired a Nightmare Employee'

August 18, 2010

Here’s how to skip the drama and hire right the next time at your medical practice.

The trouble with Mary Pat Whaley’s new hire started almost immediately. In her first few days on the job, the new receptionist was already missing work. Whaley, a long-time administrator who hired the employee many years ago at the first practice she managed, remembers that there was a string of excuses - the new hire was sick, then she had car trouble, then her son had an accident on the playground at school.

“This was pretty bad. I haven’t had anyone quite that blatant since that time,” says Whaley, who adds she’s not sure the employee even had a son. “But my ears always perk up if somebody, especially in their first week or two, can’t come to work.”

After she let her go (over voice mail, because she couldn’t be reached), Whaley found out from coworkers that this same absentee receptionist actually carried a gun to work in her purse. “I was totally weirded out,” says Whaley, administrator for Halifax Regional Medical Center in Roanoke Rapids, N.C., where she manages four clinics, a billing office, and a hospitalist service.

Needless to say, Whaley learned several lessons from that nightmare hiring experience, among them the need to run background checks and check references.

But during the interview, Whaley says, the applicant seemed perfect for the front-desk job. She was personable, knowledgeable, and a great interviewer - but as Whaley puts it, “Everything sort of fell apart.”

This gun-toting no-shower might be an extreme, but every office has at some point faced the reality of hiring the wrong person. Whether it’s someone who turns out to be embezzling from the practice or just someone whose work ethic doesn’t line up with yours, a poor hire can turn into a nightmare for your practice.

So how can you see through the interview pleasantries and make sure to hire right? Here are some pointers from the experts:

Don’t settle. Practices often find themselves with a desperate and immediate need to fill a vacancy. “When you’re short staffed, it just truly creates a burden on the rest of the staff,” says Maureen Waddle, senior consultant at BSM Consulting in Incline Village, Nev. “So often [the practice] will hire the first warm body that appears to be OK.”

This leads to one of the most common hiring mistakes: settling. The mediocre employee is likely a more common ill than the nightmare hire. The slumping economy has flooded the applicant pool with talented and qualified prospects, so now more than ever, practices should avoid settling out of desperation.

Remember, hiring any employee takes time, especially if you want the relationship to last. It’s more than placing an ad in the paper, picking out a few resumes, meeting a couple applicants, and then making the hire. “All positions require a little bit more time,” Waddle says.

Bob Levoy, author of “222 Secrets of Hiring, Managing and Retaining Great Employees in Healthcare Practices,” agrees that the No. 1 mistake is hiring under pressure. When your staff is stretched thin, you can be anxious to get some help. But lowering your standards and hiring a bad fit can lead to costly errors in the practice, poor office morale, or even a loss of patients, he says. “Don’t compromise your standards for the sake of expediency,” he says.

An employment agency might be able to help fill the position temporarily, or a former or current cross-trained employee can step up while you’re hiring.

Define the job. Before casting the net, take a look at the job description. Is it time to redefine the duties? Consider what should be added or amended, Waddle says, such as updating the description based on work flow changes since implementing an EHR.

Also take into account what skills and attributes you’re looking for in a job candidate. “The first thing you need to know is who you are looking for and what you are looking for,” says consultant Donna Weinstock, president of Northbrook, Ill.-based Office Management Solution.

When it does come time to meet applicants, make sure you and your prospects have the same expectations of the job, Levoy says. You should consider going over some elements that might not be on this updated job description, such as salary increases, promotion opportunities, and vacation time - upfront. It’s best to make sure you and the applicants are on the same page from the get-go.

Ask better questions. When you do sit down for the interview, get a little creative with your questions. Every well-prepared applicant has planned her response for questions about her strengths and weaknesses, or where she sees herself in five years. Try a series of questions that can be a little more revealing, Levoy says. “Today there are so many books on doing interviews, people know how to ace the interviews, and so people learn how to answer these standard interview questions,” he says. “I think the challenge is to come up with questions people aren’t prepared to answer. They don’t know what you are looking for.” For example, you can ask what he did or didn’t like about a past job, or what traits his favorite boss had. Against the backdrop of the current opening, his answers may offer some insight into his expectations and compatibility with the practice.

Take a case study from your practice, sans patient names or identifying information of course, and see how your prospective staffer would handle it, Waddle recommends. This will give you a glimpse of his decision making and logic in certain situations.

For her part, Whaley likes to relate a personal workplace story and then ask if the applicant has faced a similar situation. She says she prefers to slip this in while she’s explaining the job description in painstaking detail, so the applicant doesn’t realize it is part of the interview and may be more honest about his answer. “The bottom line is getting to see who they are, getting to see the real them, something that isn’t rehearsed,” says Whaley, who also writes and edits the blog ManageMyPractice.com where she offers 101 interview questions.

Meet twice - or more. How can you really tell if the candidate is the right fit in just one hour-long meeting? Instead, consider a couple of interviews, Waddle says. “It’s good to have them come in once in the morning, then come back at a different time of the day, in a different setting where they might let their guard down,” she says. “You can observe the fit of the personality a bit better.”

You may consider having another person in your office conduct a second interview, Weinstock suggests. Also, ask your receptionist what she thought of the candidate when he walked in the office. Was he personable, and did he engage in chit-chat with other staffers before the interview started? This can offer some revealing clues about your applicant’s personality.

If your applicant makes the cut, have her come in for a test day. Here you can observe the prospective hire in the role and interacting with other staff members, Waddle says. Your staff will undoubtedly give you valuable feedback.

Whaley says she’s also a big fan of pre-employment testing for certain positions, such as a proofreading quiz or even a simple math quiz. “I like to know if people can add numbers together, and what their handwriting looks like, and if they have control and can hear a message on the phone and can actually translate it to a message that’s readable,” she says. Although you don’t base your decision on the test results alone, she adds, the tests are one element in the process that “will tell you a lot.”

Check it out. Performing background checks aren’t always easy, but they are necessary, experts say. A surprising number of people fudge on their resumes, Levoy says, lying about places they’ve worked or certifications they’ve earned. Practices should take the time to confirm employment - which can be hampered by lawsuit-wary former employers - and check references. You should also consider credit, motor vehicle, and criminal record checks. “Anyone who avoids checking employees does so at his or her own peril,” Levoy says. Not sure how to check out all that information? Weinstock says she frequently uses a background-check service, chalking the cost up as a necessary part of the hiring process.

Whaley concedes that even when you do everything right, “it’s still the toss of the dice. You’re taking a chance every single time that somebody is a really good interviewer, very personable and knowledgeable, and yet they still have a gun in their purse,” she says. There may be a couple bad hires here and there, she adds, but following smart recruitment practices “definitely increases your chances of making a good hire.”

Sara Michael is senior editor at Physicians Practice. She can be reached at sara.michael@ubm.com.

This article originally appeared in the September 2010 issue of Physicians Practice.