Article Date: 12/1/2005

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What To Do When Staff Says No
Communication is key to keep employees and your practice up to standard.
MICHELLE BOYLES, Managing Editor

Most successful optometrists credit a portion of their accomplishments to their staff. But what do you do when a staff member isn't performing to standards? It can often be difficult to admonish people you rely on and value so heavily. "Optometric practices are often small and have a family-like atmosphere. It's hard to give negative feedback to someone you feel close to," says consultant Marilee Blackwell, president of Blackwell Consulting.

Dealing with staff issues before they become a significant problem, however, can help assure your practice runs smoothly. Here, veteran managers offer tips on resolving conflict within your staff.

Starting on the right foot

The best way to avoid serious problems with staff members is to keep potentially troublesome employees from entering the office in the first place, says Andrew Gurwood, O.D., Associate Professor of Clinical Sciences at Pennsylvania College of Optometry in Philadelphia. "Call all references before making a decision to hire a job candidate. A hasty or wrong decision will cost time, materials and patients," he says.

An accurate job description is necessary for your staff members. Bob Levoy, O.D. of Rosyln, N.Y., author of "201 Secrets of a High Performance Optometric Practice," says the most common complaint he hears from optometric staff is that the job is not what it was described to be upon hiring. "At the root of the problem is a failure to have a written job description," says Dr. Levoy. He suggests asking current employees to make a list of all the tasks for which they are responsible. Next, ask them to rank those tasks in order of importance. "Then, compare each list to a list of your own for the same job. A high percentage of such lists that I have seen differ from each other, from mildly to profoundly," he says.

It's also good to note that each employees' job description has the potential to change. Optom-etrist Milton Hom of Azusa, Calif., suggests telling staff, "This is your job description, but it can change in the future. We do appreciate employees that are flexible." He adds, "Employees actually like to hear these things at the outset." 

Heading them off at the pass

Orientation and training can also make or break a staff member's level of performance. Make sure all staff receives a copy of your employee handbook. Dr. Gurwood says this should contain the employee's job description, review periods, dress code, expectations, violations and consequences. Give new staff members some time to review the office policies and go over anything that's unclear so that all questions are answered during the honeymoon period.

Also make sure that staff receive adequate training. "Staff need to know how something is done properly to establish a baseline of competence," says Dr. Gurwood. "An employee cannot be held accountable to a standard they have not been shown."

Minor issues

Even with the best interview, training and orientation procedures in place, you may still encounter issues. This happens for myriad reasons, and must be dealt with on an individual basis. Some examples include:

Tardiness. Optometrist Jay Petersma of Johnston, Iowa, recommends using time clock software that requires employees to log in and onto the PC. Keep accurate records to address problems in this area.

Hygiene. This can be a tough issue to address, but it can also have a significant impact on how patients view your practice. "Hold a staff meeting devoted to image so no one feels singled out," says Dr. Petersma. "Affirm expectations like aroma, dress code, breath, etc. and tell employees you and/or the manager will be particular and point out all infractions for a few weeks until it's ingrained."

Personal Internet and phone use. Your office policies should clearly address this issue so there is no confusion. "Set up web browsers' parental control options to only allow users to visit Web sites the office needs for business purposes," says Dr. Petersma. You can add a supervisor password to allow new sites on a case-by-case basis until they are added to the approved list. Remove e-mail clients and instant messenger capabilities from all PCs in the office. Dr. Petersma also suggests setting-up a PC and telephone in the break area where employees can surf the web or make personal calls during breaks and at lunchtime.

Vendor incentives. Be sure all sales representatives know to confirm distribution of all complimentary merchandise or incentives with you and/or the office manager.

Provide feedback

It's likely that most of your staff will never create serious performance issues, but there are those employees whose performance and attitude can impact your whole practice. (For more on the effects of negative staff behavior, see "Fix This Practice," page 26.) Evaluate all staff issues in context, says Jerry Hayes, O.D. owner and president of Hayes Consulting. Is the problem occurring with a new employee or a long-time staff member? Is his or her job description clear? Is the manager doing an adequate job? These are all things you must take into consideration.

Repeated mistakes can affect business and must be addressed. Positive and negative feedback are key to helping staff improve. "Many employers make the mistake of only telling people the good things or only the bad things. It's imperative to do both," says Ms. Blackwell. Many managers are concerned, however, that too much negative feedback can result in staff feeling unappreciated. Combat this by trying to balance the positive with the negative. When you must point out a staff member's mistake, try also to point out something he or she has done well.

Ms. Blackwell also says it's important to give feedback on the same day the behavior occurred so that it's fresh on everyone's minds. Dr. Gurwood agrees, "Waiting too long after an incident or avoiding conflict in hopes an undesirable behavior will somehow just evaporate are common mistakes. Time simply clouds the record and sends an implicit message that the offense was not severe enough to warrant immediate action."

Consultant Gary Gerber, O.D., president of the Power Practice, employs the concept of positive reinforcement we all learned about in Psych 101. When you catch a staff member doing something well, immediately praise (reward) him or her for doing so. For example, one of your technicians writes a lab order incorrectly. If this was a one-time thing and not a repetitive problem, Dr. Gerber suggests taking the employee aside to quietly discuss the problem. First, let the staff member know mistakes are human. Then, point out the error and explain why it's important to do it right the first time. In this case, "If the order had been sent to the lab as is, the patient would have suffered a needless delay and inconvenience in waiting for her glasses."

In the future, when the employee performs the task as you requested, affirm the changed behavior, says Dr. Gerber. "After she writes up the next lab order correctly, tell her so. 'Lisa, that's exactly what I was referring to this morning. That helps me so much.'" Thank employees for their help to let them know that you value their participation.

Dr. Hayes notes that some employees act out when harboring resentment towards the owner/manager. Their passive/ aggressive behavior is a way to express dissatisfaction with something about their job. "This could be an otherwise good worker who just doesn't know how to confront the boss on an issue that's really bothersome," says Dr. Hayes. This kind of resentful behavior often stems from unfulfilled promises on the part of the employer, such as being passed over for a raise or promotion. "In a case like this, the employee is trying to bring things to a head so they will have a chance to clear the air with their employer. Try to win this employee's confidence and discover what's bothering him or her," he suggests.

Broken record

While most staff members will respond and improve with good training and positive reinforcement, you may occasionally encounter resistance. For extreme circumstances where a staff member's behavior has a major impact, Ms. Blackwell advises going through the counseling process with staff. "This means that you give a verbal warning and you and the employee agree on the date the problem will be resolved. A second warning is written and signed by the employee," she says.

Document warnings during an employee's performance review, or at any time you feel it's warranted. Keep in mind, also, that should you decide to let an employee go, this kind of documentation can protect you from legal action. "Firing for cause requires documentation, especially because disgruntled employees can claim harassment, ignorance, discrimination and other offenses," warns Dr. Gurwood.

We hope most of your staff says "yes" on a regular basis. But if and when they don't, try employing these techniques for managing difficult moments. OM


Optometric Management, Issue: December 2005