Last Tuesday, February 26, MCMS hosted a roundtable of thirty practice administrators and physicians, there to discuss the most pernicious, frustrating, and troublesome employment situations in their practices. Here are key strategies and best practices, organized by issue area, that our roundtable identified:

Working with Longtime Employees Nearing Retirement

Our roundtable participants agreed that the institutional knowledge offered by longtime, late career employees was invaluable to the practice. However, transitions in work tasks, practice workflows, and technological updates can require challenging adaptations for these employees. Our groups recommends:

• Assessing if there are mobility or technological competency issues associated with unfulfilled tasks. Consider providing additional training or altering task assignments accordingly.
• Before changing required tasks or responsibilities, clearly list them in a new position description, and request that the employee signs it.
• Create leadership or project-based opportunities for engagement.
• If appropriate, offer a severance package, and be sure to recognize the many contributions of the staff member.

Chronic Tardiness

If an employee presents as chronically tardy within the probationary period at the beginning of employment (usually three months or 90 days), it is grounds for dismissal. Some attendees begin with two to three counseling sessions regarding tardiness, escalate to placing an employee on probation, and then, finally, dismissal. If there is a reason given for chronic lateness, such as issues with childcare, explaining to the staff member why timeliness is an essential attribute for work performance may resolve the issue. As always, communication with practice owners about an upcoming dismissal is recommended. 

Family Members on Staff

Family members have often contributed to the founding and growth of a medical practice.  When the practice reaches a point where additional staff, particularly managerial staff, is necessary, smooth transitions in roles and responsibilities require clarity and courtesy from all parties. Roundtable participants recommended that other practice managers should have an understanding of family members currently on staff in a potential workplace, ask that the practice owners provide written roles and responsibilities for them and other staff, and that practice managers should provide support for transitions into special projects or reduced hours as aligns with the best interests of the practice. 

Perfectionism

Perfectionists can be particularly complicated to manage, as their drive and dedication can lead to dissatisfaction with the work product or time management of coworkers. Our group suggested providing additional opportunities to communicate with direct managers such as an open door policy, increasing structured communication on collaborative team work, encouraging self-reflection, and considering a personality training such as Meyer Briggs, which helps individuals understand strengths and weaknesses they may have in working with other personality traits.

Unpleasant Demeanor

While unpleasant demeanor (to coworkers, management, or patients) can be difficult to document, participants agreed that this step is essential. Consider speaking with clinicians in the practice, or those the employee works most closely with to gain a better understanding of what may be driving problematic behavior. Finally, don't be afraid to address it. A simple, compassionate "what's going on?" can often be enough to diffuse an individual whose unpleasantness is a symptom of distress.

Avoid Issues at Point of Hire

Having an updated position description and a one page summary of benefits for every position on staff can help to expedite the hiring process. Large hiring websites such as Indeed can rapidly pull in large numbers of applications, but most practice administrators agreed that only 10% of applicants were qualified for the position they applied for.

Always do a background check, call references, and anticipate that during a staff transition in which you are given two weeks notice, there will be a two week shortfall in coverage. Most hiring processes take four weeks, minimum.

PTO vs. Sick/Vacation Time

One of the issues brought to the roundtable was abuse of sick time.  Some practices deal with this by requiring a "sick note" from a health care professional for an absence of more than three days. Others explained that they had moved away from the sick/vacation time model to an all encompassing paid time off (PTO) model that combined previously allocated sick/vacation time. PTO could also be taken as family sick time during this model. Those using the PTO model reported fewer instances of employees calling in sick. 

Trauma & Grief

Medical practice employees often witness patients and their families during the most traumatic, grief-stricken periods of their lives.  This is particularly true of clinical staff, but can also wear on administrative staff over time.  Attendees emphasized the importance of providing support to staff members, in the form of team building or other wellbeing programs. It reduced instances of employment challenges and staff turnover.

Recurring Best Practices

All of our attendees emphasized the importance of documentation, insurance coverage, consultation with an attorney in certain circumstances, self-care for practice administrators, managers, clinicians, and physicians, and a solid foundation of support from practice owners.