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 By Neil B. Gailmard, OD, MBA, FAAO, Editor May 6, 2009 - Tip #378 
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Help with Staff Issues


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Staff management is always identified as one of the most challenging issues for practice owners and administrators. I'd like to use a recent email I received from a reader as a real world case study of a problem.

I would like some help with this situation. We have a staff of eight optometric assistants and two doctors. I am having great difficulty getting some of my wants and expectations across, accepted, and implemented. I have been extremely patient and understanding to the staff concerns, however whenever a new procedure or technique is brought up, it is either shot down, complained about, or just not done! I have tried several projects to build staff goodwill and several $$ rewards, but nothing seems to help. I need help. Should I keep trying or clean house? I generally have good staff members, but they just will not change or do what I would like. It seems the staff thinks this is all fun and games; actual work and follow through are no fun! PLEASE HELP with a TIP!!!

Office culture

I wish there was a quick and easy answer to the issue you face, but it generally runs deeper than that. Great staff attitudes are created by a positive organizational culture. The good news is that the culture in your practice can be improved and I will give you some practical insight here on how to begin the process.

In some ways, I would look within for some of the blame for creating the office culture that led to the poor attitudes. Perhaps you and your partner can sit down and discuss each of your roles with staff management. A great staff needs leadership and that should primarily come from the doctors and also from an office manager. We must inspire and motivate our staff members to understand that their careers will grow if they help the practice to grow.

With the current size of your practice, you may need to shift away from being an optometrist most of the time and becoming more of a CEO. I view this as a good thing. If you put more time into the management of your practice, it will grow even faster. If you currently have strong patient demand and don't want to lose the clinical productivity, consider yourself fortunate and hire an associate optometrist. Not every doctor in the practice needs to be an owner or partner.

Employee evaluations

Whether you do formal employment reviews or simply make a mental note of each employee's on the job performance, the attitude toward change and the support of new projects are big factors. I believe evaluating employees is a continuous process that we do every day. Rarely is a decision about an employee based on any one incident, but rather a collection of good and bad ratings over a wide range of factors. An employee may be very good with some aspects of the job and very poor in other areas. It is up to the owner and manager to weigh these factors.

Remember that your practice is the company your staff members work for. An employee who does not see the importance of helping his or her company grow is a weak employee. That is the consequence of the apathetic attitude that you describe. I would hope your employees realize that they have disappointed their boss. The owner of the company they work for now views them as not being team players. If it were my employee, I would view such a lack of support as a major factor and it would weigh heavily on his or her next review for a raise. It may even make me think about replacing him depending on the situation, the history and the other good and bad factors as mentioned above.

My response would be to let my disappointment be known. I would have some serious one-on-one discussions with these employees. I never display anger; there is never any yelling. I'm always respectful because I want to lead by example. But if I'm unhappy with behavior or performance, it's my duty to communicate that and to try to train the employee to do better.

Ideas to improve staff support

Here are some questions that may help you focus on ways to overcome your staff's resistance to new ideas

  • Do you have a true office manager? I have no doubt that you need one. A manager may improve the office culture and help with giving staff direction and supervision. Hiring or appointing a manager can be sensitive, but your practice will be better off in the long run.
  • Do you have staff meetings every week, blocking out about an hour of time? Your staff needs to communicate with you frequently. They need your leadership.
  • Do you need an additional employee? Many practices are understaffed but the owner wants to try to avoid an increase in payroll cost. What is often not realized is that an additional employee will improve productivity through better delegation and better customer service. It is very rare that the practice owner will notice a decrease in net income. It generally increases. And the behavior of a problem employee often improves!
  • When discussing change, do you allow the employees to be part of the process? I would avoid giving an edict (from now on we will...). Instead, start with a general business problem (we need to find ways to increase revenue...) and let the staff help you find the solutions. People support what they have helped to invent.
  • Do you pledge support? Look at the new plan from the employees' point of view. What might they fear? Possibly that they will have to work harder? Maybe that they won't be able to perform the new task? Maybe that they will have to answer to a new boss? If you know the fears, you can probably overcome them. You may ask them to try the new idea and if it works well, you can promise to hire additional staff, provide more training, buy additional equipment, develop additional tools and offer more resources.
  • I do not jump into giving a bonus as an incentive to tackle a project. I don't believe we should have to buy cooperation. I don't look to bonuses as a substitute for good management and leadership. If employees truly expand their responsibilities and if production increases, you will likely reward those achievements with raises. You need not be specific at the outset of the project.

I wish you the best with your new approach to staff management. Let me know how it goes.


Best wishes for continued success,

Read Past Tips Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week


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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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