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Physicians Practice Pearls: The Perils of Cross-Training


Watch out for these common cross-training missteps.

Many practices tout their teamwork and the fact that everyone pitches in for the good of the practice during a staff shortage or a super-busy period, like flu season. That’s great, but when such cross-work happens on a regular basis, inefficiencies and compromised outcomes can abound. And while cross-training and supporting fellow team members is a good idea, sometimes people pitch in at the cost of completing their own duties. The result? When a problem emerges, it’s hard to pinpoint who did what.

I like to call this Everyone’s-Job-But-No-One’s-Responsibility Syndrome, and it’s a major contributor to medical office inefficiency.

Does your office clearly define the responsibilities for which each individual is held accountable? For example, if Mark is helping Jessica manage a sudden spike in billing calls, but his real responsibility is data entry and electronic claims submission, you must ask yourself if he is the right one to assist her. Does he have the skill, the time, and a sufficient level of self-accountability? Can you track it? Some other tips:

  • Clearly define the primary tasks for each position. Assign a back-up for each position, and be sure that person is well-trained to deliver a consistent outcome as a substitute without compromising regularly assigned work. Be careful here. How you distribute the workload in your office is critical to efficiency and profitability. Mismanaging these assignments can lead to frustration, errors, uncertain outcomes, a never-ending stockpile of work, poor accountability, and a loss of supervisory control - not a pretty picture.

  • Follow the 10 percent rule. Coworkers shouldn’t be called away from their full-time duties to assist others more than 10 percent of the time. Otherwise, you’re asking for trouble. The exception is when a new employee starts or you have an unexpected absence, but the disruption should be temporary and its impact closely monitored.

  • Re-evaluate your office processes to determine if each step is truly necessary and whether such steps are performed consistently, regardless of who is doing the work. Perhaps you’ll find tasks you can eliminate, refine, or automate. Indeed, one of the best ways to streamline paper processes and obtain reliable, consistent, and trackable outcomes is, without a doubt, through automation. Explore opportunities to refine processes through automation or perhaps additional training. The investment will result in more efficiency and long-term cost savings.

  • Delineate time demands to accomplish the primary tasks for each position when developing job descriptions and assigning tasks; that way you’ll ensure that you’re being realistic in your work distribution and expectations for each staff member.

  • Re-examine job descriptions during annual performance reviews, and proactively discuss the description with the employee. Find out if she is struggling with workload issues and if the job description and distribution of the workload needs to be further evaluated.

Evaluating the essential tasks in your office, distributing the workload evenly, and ensuring tasks are performed consistently among staff will promote teamwork in a way that makes sense.

Judy Capko, owner of practice management consulting firm Capko & Company (, is a seasoned healthcare consultant, speaker, and author. She can be reached at

This article originally appeared in the January 2009 issue of Physicians Practice.

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