During the many decades Silkin Management Group has been helping doctors take control of their practices, we have been asked to help out in many areas: finance, new patients, goal setting etc. What is interesting is that some of these areas have waxed and waned in terms of the owners’ concerns. During the last recession, a great worry was obviously the lack of growth. While this problem has remained important, as the economy recovered, it was less the singular point of concern.
Similarly, there will be years where the owners’ attention is on attracting more new clients, only to be followed by years where that concern has receded.
One area, though, has remained at the top of the list ever since Silkin Management Group opened it’s doors back in the early 1980s, and that is Personnel. No matter the decade, no matter the economy, no matter the completion or lack of it, this area of the practice has consistently been a very large source of difficulty for owners.
Year after year, it’s the same lament: “How do I find good people?”, “How can I insist things get done properly without coming across like a jerk?”, “How do I deal with the emotionalism in the workplace?” And one I particularly like, “This latest generation just doesn’t have a good work ethic.” It seems that every decade the practice owners feel like the upcoming generation is unique in their feeling of entitlement. The truth is that whether it’s the X generation, the Y generation, the Me generation or the millennials, owners have always had a difficult time creating the ideal staff.
The good news is that all problems with staff can be traced back to a breakdown or a flaw in the practice’s personnel system. Why is that good news? It’s good news because there are actual effective personnel systems that solve all these problems. All that is necessary is an understanding of the various parts of the system and training on how to implement the parts. In other words, there is no arcane voodoo to creating and developing personnel; there are just skill sets that can be learned. This article is written to lay out the main factors of a personnel system so that owners and practice managers can evaluate their problems to see what part of the system is broken, and to find out which tool can repair it.
The first order of business in a personnel system is the development of a job description. Several things go into this:
- An understanding of which functions belong in each role in the practice. You don’t hire a person because she (or he) is a good person; you hire her because you want her to fulfill a very specific role, for instance the receptionist role, or “hat”. But you need to know which functions belong in this hat.
- An understanding of how exactly each function is supposed to be done. For example, there are a myriad number of ways the phone can be answered. The owner has to determine how he wants it done in his practice.
- A detailed write-up of how the function is to be done. This write-up would be part of the overall job description for that particular hat. Given the daunting task of writing all the job descriptions, it is fair to ask why this particular tool is so needed.
The reality is that without putting down in writing how you want a task to be done, you leave the door open to misinterpretation by the staff member.
Any job has a lot of functions that need to be learned. Just take the receptionist hat. A receptionist needs to know how to schedule, how to answer the phones, how to check people in and out, etc. Each of these functions has a lot of moving parts to it. To expect someone to remember exactly how you told him a particular task needed to be done is to push the boundaries of naivety.
By way of example, go no further than the parlor game of telephone, or gossip. A phrase is whispered in one person’s ear and this, in turn, is passed on to another person. By the time that it gets to the last person, the original phrase has been greatly altered. And that was just a simple phrase. Imagine now that you whispered into that first person’s ear the entirety of how to schedule. How altered would that get by the end?
To put it differently, passing on complex data verbally virtually guarantees that various staff members will each do the same task differently. If you love chaos, teach people verbally. If you prefer uniformity and consistency, put the data in writing.
One other point: There is more to a job description than merely a written explanation of the functions. There needs to be a clarification of the purpose of the hat, its product, where it lies in the organization, and so on. There are actually nine parts to a job description, all of which need to be written up. Each of these elements are quite necessary in getting someone to really wear a hat.
Once the job description has been compiled, then there needs to be one or several statistics developed to objectively let the manager, as well as the staff member, know if the function is being performed well. This is actually one of the nine parts to the complete job description that was mentioned above. It is singled out here because its use is so vital.
One of the main reasons for upset staff is the disagreement between the staff member and the manager as to how well the job is being performed. Without recourse to some objective way of monitoring the performance, the evaluation is subjective. The manager feels the staff member isn’t performing up to snuff, while the staff member feels he/she is doing an admirable job. Lacking objective verification, it’s one person’s opinion versus another’s. Feelings then get hurt, morale drops and emotion reigns supreme.
Right along with developing a statistic(s) is a determination of what range the statistic needs to be in to qualify as “job being done well.” Let us say that one of the statistics for the receptionist hat is “Percentage of Kept Appointments” (a way of monitoring if there are too many cancelations). Well, what is an acceptable amount? If you set the bar to an unobtainable level, you destroy the morale of the receptionist. Set the bar too low and you cut into the viability of the practice. So, identifying the correct range is important in developing an objective way of evaluating performance.
Finding the Right Person
Once you have figured out what goes into the hat, then you have to find the correct person for the job. Most managers’ problems in hiring are either a) when they go to hire, the talent pool seems very limited or b) they get fooled, meaning they hire someone who appears to be good in the interview, only to later discover they made a mistake. These are such problems for executives that most of them, even when they have good staff, start the conversation off with “I have great staff, but I got lucky.” Obviously, any system that depends on luck to succeed is a fragile system indeed.
A lot of the complexity in hiring can be stripped away by identifying the most basic quality for which one is looking. When hiring, the ideal candidate would be one who has a lot of experience and is high-toned. We will say someone is high-toned if: a) what motivates him to work is the work itself, b) he has a good attitude, c) he is solution-oriented and d) he is responsible. Low-toned people, by contrast, a) always seem to have drama about them, b) they don’t solve problems and c) their attitudes aren’t that great.
The problem is that you rarely get both qualities and so you have to choose. Do you prefer the high-toned one without experience, or the experienced person who is low-toned? In our 33 years of asking this question, the answer everyone gives is that they would take the high-toned person. You can train the skill set; you can’t train the attitude.
While we completely agree with this choice, it does clarify what the main problem is in hiring: there are more low-toned people in society than there are high-toned. So, hiring is a numbers game. Like winning the lottery, to improve your odds you must buy more than one lottery ticket. For hiring, this means you must interview a sufficient number of people so that the odds are good that at least one of them will be high-toned. From experience, that means you must interview 15 to 20 people.
And herein lies the two problems with most hiring systems: either they can’t attract enough applicants to have good odds that someone will be high-toned, or they don’t know how to interview 15 to 20 people in a reasonable amount of time. In the hiring system we designed, we teach people how to attract a lot of applicants and then we have a special hiring system that enables a manager to interview 15 to 20 people all within one hour.
Done in this fashion, one is able to take luck out of the process of hiring.
Alright, now that you have hired the right person and you have figured exactly what you want him to do, the next step is to train him. Training is crucial at any time, but most especially if we are sincere when we say that we prefer attitude over experience. Ideally, the new staff member will possess both these traits. But as we discussed above, the most important of the two is the attitude. This means it’s conceivable that you have just hired someone with a great temperament, but not much experience. Now you really better have a great training program.
What do we mean when we say a great training program? We mean a process by which the new staff member can swiftly and accurately be trained with minimal time spent by the manager. These three qualifiers are why people hate to train; they are worried the new person will make too many mistakes, or that the process will take too long or will take up too much of the manager’s time. In fact, these concerns have often kept managers from dismissing staff members who should be let go. Not wanting to put in the time to train, or being worried about the plethora of mistakes that the new staff member will make while learning the ropes, these concerns sometimes result in managers retaining staff members they shouldn’t.
For all these reasons, it is imperative for the practice to have a very effective methodology of training. Sadly, what passes in most practices as a training system is to grab a staff member and have her teach the new person. The problem with this approach is that it may have been some time since the veteran staff member taught this job (and so her approach will be quite convoluted, ineffective and will result in parts of the hat never getting taught) and the manager will have no great certainty that the information is being passed on correctly.
The alternative is to construct an actual training program; a series of steps you want the new person to do to get trained. These steps would include such things as reading assignments, tests to assess comprehension, demonstration by the veteran staff member and roleplaying on the part of the new staff member.
What would a training program look like?
Let’s simplify the receptionist position to examine this. We will pretend that there are only two things to teach: how to answer the phones and how to schedule. So, the training program would have two sections in it: one section devoted to teaching how to schedule and the other to phone etiquette. Within each section there would be four or five steps we would want the trainee to do. By way of example, we will take up using the scheduling section to teach the new staff member.
As the beginning step, the trainer would simply give the staff member her training program, point to the scheduling section and to the first step on it which would instruct: “Read pages 88-102 on how to schedule.” The trainer would give the staff member the write-up and tell her to get with him after she has read it.
Note something right at the start: for the trainer, look how little time was involved. Instead of spending several hours explaining how to do the scheduling, this step took all of a few seconds. For the new person, rather than try to write down all the points the trainer verbally discusses, she instead can read the salient points.
Upon reading the material, the staff member reports back to the trainer and that step is checked off. The next step would be to take a test that covers the material. If the staff member doesn’t pass the test, she would restudy the material and retest. Note that if the staff member has to keep retesting, it is a possible signal that the wrong person was hired.
Once the test is passed, the third step would involve the trainer grabbing a blank appointment page and a list of procedures, and then filling out the appointment page while the new staff member observes. Again, the point is that by having read and understood the theory behind scheduling, the staff member far better tracks with the trainer’s demonstration.
The fourth step would be a place where the new staff member could practice the skill—roleplaying, if you will. She would be given a blank appointment page, a list of procedures and the write-up describing scheduling; she would fill out the appointment page. She would then give the page to the trainer for correction. This step would be repeated again and again, until the new staff member demonstrates that she quickly and effectively can schedule.
Note that throughout this process, very little of the trainer’s time was taken up. The bulk of the work was done through the reading of the job descriptions and the roleplaying exercises. And the benefit to the new staff member is the ability to read and reread the written material (not her scribbled notes) and the luxury of practicing the skill set before she is thrown into the swimming pool.
So, a very important part of the personnel system are these training programs set up for each position. These tools, implemented into a practice, will speed up the training process for new staff and save the trainer/manager countless hours.
Apprenticing someone onto the job is an oft omitted step, much to the detriment of virtually every practice. What do we mean by apprenticing? Training is being taught the skill. But there is a learning curve when it comes to implementing that training. What seems logical in the job description and in the roleplaying drills, may not seem so when the person actually performs the task. Rarely do things play out exactly as they were taught. Someone needs to work with the staff to help them learn how to apply what they have been trained on. This action is called apprenticing. Sadly, most of the time, new staff members are just thrown into the pool to sink or swim on their own.
To ensure the apprenticing actually gets done, apprenticeship programs need to be constructed for each position. These are similar to the initial training programs describe above, except they are now directed to speeding up the new staff member’s learning curve in applying the material on which he/she was trained.
One of the important parts of a personnel system is the performance evaluation. These are done to give feedback to staff members as to how they are doing on their jobs. The purpose of a performance evaluation is multifold:
- First, it helps the manager keep a broader perspective of the staff member’s job. What often gets lost in the day-to-day management of the staff member is the longer-term view. Yes, he might have made a mistake or two this week, but overall, how is he doing? Understanding this helps to give the manager perspective.
- It creates an opportunity to assess strengths and weaknesses and devise additional training for each staff member; this can’t be stressed enough. Managers are forever asking how to get the staff to have the same enthusiasm as they, themselves, have. One of the answers to this is found in the very nature of work. When one has mastered his/her job and the challenge is no longer really there, there must be a new game to play. Just notice the exuberance new staff have for their jobs. They are trying on new skills to solve problems. As long as they are given the skills to succeed, this time period is exhilarating. But as their mastery improves, the challenges diminish and the day becomes routine. To throw excitement back into the job, teach them new skills and give them new mountains to climb. This actually is one of the key roles of any executive—creating a new game for the staff. During the yearly evaluations, one can assess whether the staff member is ready for new challenges or is still working through what he/she has already learned.
- It gives affirmation to the staff member. We all want staff who work for something more than just a paycheck. We want those people whom the mission statement of the practice actually motivates. But those people need feedback from management; they need the affirmation that their work is good and that they are contributing. The good staff nourish themselves on this feedback. It is not uncommon to find staff holding on to written commendations like money. They will pull out those commendations to read again and again.
A good personnel system has an evaluation process that is based on objective measures, so that both the manager and the staff member can come to agreement about his/her level of performance. Notice the role that statistics can play in creating this objective feedback. The stats don’t lie; they tell whether the staff member is actually becoming more effective or is just coasting.
A good personnel system obviously needs a method to deal with discipline. If you have done a good job hiring staff, then rarely is more than a nudge needed to get someone back on the rails. Someone shows up late. Yes, you must discipline her; but if she is a good staff member, that discipline need never be harsh.
But there are two other purposes to discipline: a) to reveal if you accidentally hired a bad staff member and b) to give you legal protection against the bad staff member whom you had to let go and who is now suing you.
The tools for discipline are basically twofold: have your policies in writing, and when you discipline someone, document it.
The policies by which the practice abides must be laid out in writing for the same reason the job descriptions need to be written up: if something isn’t in writing, the staff member will come to his own conclusion of what the policy is. And his policy might not be the same as yours. This is your show. One of the perks of ownership is that you get to decide what the rules of the game are.
The reason for documenting disciplinary issues is that it forms a written record of what you’ve done to solve the problem. If you ever get sued by a staff member, you need to have written documentation of what happened if you seek protection by the courts. And each document must be signed by the staff member to be valid. Without documentation, the vengeful staff member could claim that these disciplinary meetings never occurred.
Compliance reports are crucial to a personnel system. Oftentimes, the executive’s job is to predict the future and work out plans to avoid potential problems or to do actions that will result in an improvement in the practice. It is one thing to have the plans written out, but if you can’t get the staff educated, then the plans are just wasted paper. The first action is to issue one of the planning steps to a particular staff member to do.
As there might be many steps going on simultaneously, it is foolhardy to keep all of them in your head. Having the steps issued as orders allows for the use of a system called Compliance Reports, which tracks whether the order was complied with or is still outstanding. This sort of a system is far preferable than the one of mentally trying to remember everything you asked each staff member to do.
Compliance reports are basically attestations that the order has been complied with. In this fashion, the manager can track the success of the overall plan by just following up on undone compliance reports.
Staff reports are basically a way to keep communication about important issues in writing. Too often, crucial information is verbally given from the staff/management to the staff/management. If there were only one or two issues per month that needed to be reported, it is conceivable that the people could store that in their heads (but even then, verbal passage of data leads to misunderstandings as to exactly what was said). But in most practices, there are a lot of things going on. Trying to juggle all this data in your head is simply not a workable solution; important things will be forgotten. Having a system by which data can be communicated in writing is an important part of any personnel system.
Staff meetings are an important tool in any personnel system. Sadly, most executives conduct these meetings incorrectly, if they do them at all. The result of this is that managers stop doing it, as they see no value in the meetings and, in fact, rail against them as they take staff away from valuable production time.
However, staff meetings do have merit. Their main purpose is to keep everyone on the same page so that all the staff, both lay and professional, can operate as a team. So, statistics of the practice are reviewed so that everyone can see objectively how the various areas of the practice are doing and what the weekly (or monthly) plans are. Broad issues common to all staff can be discussed. Basically, this is just an orientation meeting, the product of which is that the staff understand how the practice is doing and what is being worked on to accomplish the goals.
Common mistakes related to staff meetings are:
- Using the staff meetings to correct staff. Correction can be humbling even when done well. Basically, the staff member is being told that he is doing something wrong and this must be corrected. It’s hard enough to hear that one-on-one with the executive. To correct a staff member publicly is to ensure that he will get defensive or confrontational as his failings are being aired in front of the entire team.
- Using the meeting to get to the bottom of problems. Various parts of the practice have their own unique challenges. To spend time trying to sort out a problem that is really only germane to one section of the practice is to waste the time of the other staff.
- Using the meeting to train personnel. There is nothing wrong with group training, but again, unless it is something that, in truth, all staff need to work on, it can serve as a waste of time to other staff.
What is important in a personnel system is to have a specific agenda that can be run each week (or month) and that creates enough value in the practice so as to justify the loss of production.