Speed Training

Your practice is a busy one. Your office manager sprints around collecting copayments, answering phones, filing claims, and doing the work of three employees. Finally (and just in the nick of time before she goes absolutely crazy) you hire someone perfect to fill the front desk position that’s been open seemingly forever. Hooray! Help is on the way! But … wait.

“I always like to remind people that even though [they’ve] hired this person, it’s not over,” says Carolyn Pickles, an independent practice management consultant. “Even if they came from another practice, every practice is different, and there’s a huge learning curve.”

Yes, someone has to train the new hire. And who on earth has time to do that?

It’s a common dilemma with any business: While there can be a lot of focus on hiring the right people, finding time to train them can often be an afterthought. Your reason for hiring someone in the first place was to lighten staff workload, yet the new hire’s arrival is no magic bullet. On the contrary, it will likely add to the burden, at least in the early going. And if you rush through those first weeks and train the newbie insufficiently, then his “rookie mistakes” will become chronic - maybe even permanent.

“A lot of people don’t realize the message they are sending when they don’t have a structured training program,” says Cindy Dunn, senior consultant from MGMA Health Care Consulting Group. “The quality of your orientation training speaks to your practice’s culture. Employees will work hard for you when you show them you care.”

Among the most common training pitfalls are:

• Rushing the process. By not taking enough time to teach a skill, you don’t allow a new employee to show competency.

• Not explaining the big picture. By not demonstrating how a task or job function fits in with the overall work flow of the office, a new employee may not appreciate the importance of performing it correctly and efficiently.

• Not sharing the mission. By failing to orient a new employee to the practice’s mission and culture, you don’t provide a proper beginning or frame of reference.

So how do you effectively train a newbie while keeping the office’s work flow on track? Start by remaining calm and patient. Remember that you were once a new employee, too, and that he is probably eager to please and even a little nervous.

Next, make sure you have a plan. Don’t wait until you have a new employee standing there watching as you get organized - do that ahead of time. The best time to create and document a training strategy is while the office is fully staffed and you’re not in hiring mode. Four key tasks you can do in advance are:

• Make sure your practice has a written job description for each position that lists all the necessary skills and duties. List each duty in order of importance to the position.

• Create a written outline of what each department does.

• Identify employees with good skills (and attitudes) who are willing to work with new employees to get them up to speed. To sweeten the deal for these superstar helpers, offer incentives to let them know their help is appreciated. “It could be a small stipend, a gas card - whatever. Just some acknowledgement,” says Dunn.

• Make sure all your training materials are organized and located where everyone has access to them.

With this basic foundation in place, the moment the new employee comes through the door on his first day, you will be ready to roll. And the best place to start?

The beginning, of course.

Orientation

Before jumping into the specifics of the new employee’s job, take some time to get him oriented to the practice. This means sharing the practice’s mission statement, the big picture, and where he fits in.

Pickles suggests setting aside the first day or so (depending on the size of your practice) to have the employee spend time in each area and work through the practice the same way a patient would flow through. This way he will meet all (or at least most) of his new coworkers, and get a sense of what part each department plays in the patient’s experience.

“Start with appointment scheduling and work your way through to billing,” says Pickles. “This will provide a solid understanding of how the practice’s work gets done.”

Even better, use your written department outline to help a new hire better understand what he is seeing.

This is what Kentucky-based Family Practice Associates of Lexington did when it developed its “Walk a Mile” program. As part of the program, all new employees are required to spend part of their first few days in each department, learning what their new coworkers do. The practice had been providing this great birds-eye view to their student interns for years, before realizing its power as a staff orientation method and making it a formal part of its employee training. They even cycled their own current employees through the process to ensure everyone had a turn.

“We feel like it’s a real eye-opener because a lot of the time you know how to check in a patient, but you don’t know what happens to the patient after that,” explains Susan Miller, practice administrator.

Other information that should be covered in the practice-wide training includes some human resource basics: What are the practice’s hours? What is the dress code? How do you call in sick? When does everyone get paid?

Even though you are ready for this new hire to be able to pitch in and help as soon as possible, he needs to get his land legs underneath him - kind of like warming up before you go running, answering questions like this are imperative to getting him acclimated.

Practice-wide training

Once the big picture is established, you can start to insert some specific knowledge and skills. Dunn recommends starting with a baseline (or practice-wide) checklist with information that applies to every employee and every position.

“It’s not uncommon for employees not to know the names of the doctors in the practice,” says Dunn. “You really have to start with the basics.”

Baseline checklists should include:

• Name of the practice;

• Names of the doctors and midlevel providers;

• The practice’s addresses and directions;

• The location of workstations;

• Office emergency procedures; and

• HIPAA and OSHA training.

While these might seem very elementary, having this information on a universal checklist - that everyone knows and has been trained on - is not only vital, it ensures that everyone starts with the same knowledge base and allows more established staff members to help with this part of the training.

But remember, not all of this training must be done one on one. These days, training programs can be found electronically or online, allowing an employee to train independently. Here are some important areas that lend themselves to hands-off training:

Computer skills. It’s a good idea to give all new employees a computer-skills assessment. Even though they may have worked on similar software before, you want to know exactly how skilled they are on your software and determine what further training they may need.

“You don’t want to give them a software package, a logon, and password just yet,” says Dunn. “Otherwise you might have a situation where they can’t use [the computer program] and there’s a patient standing there waiting and they have to say, ‘Um, I’ll have to get her to help me when she’s off the phone.’”

Once you know where your new employee falls, you’ll know better how to proceed with the rest of his training and can take advantage of some hands-off tools. Expect your software packages - billing, scheduling, and the like - to come with Web-based or CD or DVD training.

Customer service. Training everyone in customer service is important, but don’t let the training itself slow down your practice. Consultant Meryl Luallin of Sullivan/Luallin, Inc., says that after years of going into practices as an on-site consultant, more and more practices were asking for online training so their employees could train independently. As a result, the firm now offers “Spotlight on Service,” Web-based customer service videos. The training is comprised of four, approximately 15-minute segments that employees watch and then take an online quiz.

“With these videos, employees can do one over lunch, on their break or if there’s a no-show, or even at home,” says Luallin. “It’s totally at their convenience.”

Office communication. Pickles recommends that practices make a point of compiling all the practice-wide procedures (again, during times when the practice is fully staffed) into online or written manuals and have them ready when new employees come on board. Although it takes more advanced preparation, these manuals can save valuable training time.

“All practices communicate in different ways - some may have different policies and procedures on everything from e-mail to voicemail,” says Pickles. “Practices that take the time to compile all of this information in a way to share it provide a great tool for new employees and a great reference for established employees.”

That’s what the Orthopedic Group, Inc., in Pawtucket, R.I., found to be true. The 12-physician practice started the slow and daunting process of documenting its procedures in 2004, and today has approximately 10 to12 manuals that cover all departments - everything from front desk to billing - as well as practice-wide manuals that outline basic communication procedures. Most of the manuals exist online (with paper backup for convenience and emergencies) and have been described as a “work in progress.”

“They’re very dynamic,” says CEO Phil Rhoades. “They’re never really complete because everything keeps changing - the technology and our needs, [and] how we use them really evolves.”

Rhoades points out the manuals have been helpful in recruiting as well as training.

“It’s especially helpful when we’re trying to attract high-end recruits because they see these manuals and are attracted to how organized we are,” he says. “They know they aren’t walking into a situation where they’re going to have to figure it all out on their own.”

The nitty-gritty

Now it’s time to get down to the specifics of the position. Make sure you have a written job description that includes all of the position’s duties. Even if the new employee came from being a front-desk clerk at another practice, he still needs to be shown what a front-desk clerk does in your practice.

“If you’ve seen one medical practice, you’ve seen one medical practice; they’re all different,” says Dunn. “It’s important to establish your expectations. If there’s a job duty they can’t perform, you need to know about it now, rather than later.”

While the practice-wide training and orientation can be handled by many people (because everyone has received the same training), the best person for job-specific training is an employee who does the job or task every day - sometimes it’s the person one workstation over, sometimes it’s the person the new employee will replace. Whoever it is, Pickles recommends the teaching method that you may have followed in medical school: The EDIP (explain, demonstrate, imitate, and practice) approach. This method essentially means that once you show the new employee the task, you allow her to practice it under supervision until she has it.

“It provides an opportunity for the employee to demonstrate competency,” she says. “And performing it with supervision can be done as many times as necessary until you - and they - are comfortable.”

Jeffrey Denning, president of the Practice Performance Group, is surprised at how often practice managers just assume a new employee’s competence without seeing it for themselves. This is a big mistake, he says. “They could be very proficient in a poorly-designed work flow, for all you know.”

After you have reviewed all the tasks related to the position and feel confident your new staffer knows the ropes, offer lots of praise and encourage him to ask questions. Also make sure he knows where all the training resources - books, manuals, DVDs - are, in case he has questions at times when you are unavailable.

Finally, cross-train new employees in another position, but only after they’ve learned their own jobs.

The extras

While getting new employees up to speed as fast as possible is paramount, don’t forget they are people, too, and people like to be treated nicely. It makes them feel good and, more importantly, they feel like staying. Starting a new job is stressful enough as it is, but having a good first few days can pay dividends in productivity and longevity. Take time to:

• Be friendly and take breaks. There will be a lot of information in the first few days and it can be difficult to absorb it all without some well-timed breaks.

• Be social. Take your new hire out to lunch or go get some coffee together. Don’t assume he knows where the local deli is or that he has plans for lunch. Show him that his new coworkers are friendly, interested, and ready to help him get rolling.

• Speak the unspoken. Do you like to be called “Dr. So-and-so” or do you go by your first name? What is the protocol for lunches and breaks? How do you feel about personal phone calls? Every practice is different; a little heads-up is always appreciated.

• Don’t underestimate the power of a name tag. Dunn advises to keep it simple. “Use large print and no decorations. It’s not a piece of jewelry and people just need to know names,” says Dunn.

Going forward

The initial training an employee receives on the job is crucial and it’s important to keep the momentum going. As policies change and technology is introduced into the practice, all employees should undergo periodic checkups. Every six months (especially after the first six months in a position), it’s a good idea to get together and see how things are going, what questions have arisen, and what goals there might be for the future.

If you approach training with a solid plan and the willingness to be patient, your work flow will be minimally interrupted and you will end up with a competent and happy new coworker who is ready to roll up his sleeves and help you fight the good fight.

“A good training program makes a new employee say, ‘I’ve joined a practice that’s organized, clearly focused, and my contribution is important,’” says Dunn. “They wrote it down - it’s important.”

Kellie Rowden-Racette is an associate editor for Physicians Practice. She can be reached at kellie.rowden-racette@cmpmedica.com.

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