Article Date: 8/1/2006

Set a for Your Staff

You have a bigger role than you think in your staff's performance.
BY GARY GERBER, O.D., Franklin Lakes, N.J.

"Can't live with them, can't live without them." "My practice would be so much easier to run — if I didn't have any staff." "My staff is great — when they show up for work." These and similar enigmatic phrases describe the relationship most O.D.-business owners have with their staff.  

To show how pervasive staff management challenges are, our consulting company conducted a study in 2003. You may recall a large management challenge that started in April of 2003: HIPAA. To help us better service our clients, our study set out to determine which areas of management clients were most in need of assistance with. We did this by categorizing every incoming e-mail we received for 12 months. We had categories for marketing, billing and coding questions, fees, and of course, HIPAA. As newsworthy and confusing as HIPAA was, it turned out that more than 80% of the questions we received were focused on staff management challenges.

"How do I fire someone?" "What should I do about personal phone call abuse and Internet/ e-mail abuse?" "If New Year's falls on a Sunday, what do I do about paying my staff?" Our study showed, across the broad spectrum of management tasks and challenges O.D.s face, dealing with staff issues is by far the most time- and emotionally-consuming task. Here are some guidelines you can use to reduce the stress of this crucial job.

1: Staff are the ambassadors of your practice

Your staff — be it one person or 40 — are the life-blood of your practice. You have to realize that they are the ambassadors of your practice and poorly trained or surly staff members will torpedo your best management efforts. Doctors who think their patients' worlds revolve around the care they provide are in for a shock when they learn that world revolves around the complete experience they receive in the office. Clinical care is only one part of that world — usually a small part. Staff interaction is the largest chunk. Until you come to internalize and honestly believe your team is vital to your success and actually do something about it, you really won't succeed. Jack Welch, the former CEO of General Electric summed it up well when he said, "The team with the best players wins."

2: Paint the Big Picture ... Clearly

Unfortunately, many of us hire fast and fire slow. We typically wait to make a hiring decision and start the process only when someone quits or is fired. Since we hire under stress, our criteria to fill a job vacancy can be as vague as, "If you speak the same language as most of our patients and have a pulse, you're hired!" We then hire this person and train them by saying, "Do what that employee does." This "training" leads to staff answering the phone and saying things such as, "Astigmatism? I don't think the doctor has medicine for that." "No, we don't treat glaucoma. Only real eye doctors can do that." "Yes, we have indivisible bifocal contact lenses that get darker when you go outside."

Beyond these finer educational points and semantics, however, most staff are mismanaged because no one delineated the practice's reason for existence. Is your practice about low fees, speedy service, specialty glaucoma care, high-technology, customer service or pediatrics? If you had to sum up your practice's personality in one sentence, what would it be? More importantly, does your staff understand that message and can they convey it to your patients? Unfortunately, in most offices, the answers are "no."

Here's a sports example to illustrate this core understanding of what your practice stands for. The New York Yankees aren't just a baseball team: They are the most winning team in sports history. Every Yankee and Yankee fan knows that. The essence of being a Yankee is understood and internalized by every player who runs onto the field for each game as he sees a small wooden plaque with the famous Joe DiMaggio quote, "I want to thank the Good Lord for making me a Yankee." Your staff must have a sense of what it means to work in a unique office like yours and they must get it from you. Your leadership skills will set the tone for how your staff ultimately reacts with your patients. If you sweat the little details, so will they. If you continually reinforce your big picture, your staff will do the same.

3: How staff management imitates horse play

Early in the 1900s there was a horse named Clever Hans. He was able to respond to arithmetic questions by tapping his hoof. "Clever Hans, how much is two plus three?" Onlookers were astounded as he tapped his hoof five times. In fact, two researchers studying Clever Hans discovered that he could answer very complex questions — provided the person asking the question knew the answer and was visible to the horse.

They went on to determine that as the horse's tapping approached the correct answer, the questioners had a detectable increase in heart rate, their eyebrows raised a bit and their nostrils slightly flared. It was these subtle cues that Clever Hans was responding to, as he had no innate mathematical abilities. In short, Hans was Clever when the questioner thought he was.

This thinking goes on to explain what is now referred to as the Pygmalion effect or the self-fulfilling prophecy. Commonly referenced by educators, the effect states that teachers interact differently with students who they believe are top performers. When teachers are told a student is superior, even if they have no other evidence to support that statement, they call on these students more often. They give these students more time to answer questions and then support their answers with more positive feedback than those students described as lower performers. When these alleged top performers receive this positive feedback, they in turn perform better and complete the teacher's self-fulfilling prophecy.

And so it goes with staff management. We all have certain preconceived notions of various staff members. "Bill is a great frame seller." "Wendy is a very compassionate contact lens technician." "Mary is a superstar on the telephone." And these perceptions affect the way we interact with and manage our staff.

Take the example of a patient who is on the verge of purchasing six pairs of glasses but can't quite make up his mind. We try our best to have Bill work with that patient. After all, he is the great frame seller. But if Bill is with another patient and Mary, our phone superstar is available, we might approach her with less enthusiasm and tell her, "Mary, I know you're not comfortable helping patients choose eyeglasses and this person is likely to get six pairs if you don't blow it." When Mary "fails" because the patient only gets three pairs, your premonition is fulfilled and you assume you are correct, "Mary really can't sell glasses and should therefore be handcuffed to the telephone."

Of course, you can and should use the power of the Pygmalion effect to your advantage. Pre-emptive positive praise can transform moderate performers into stellar ones. You can use preemptive positive praise to turn moderate performers into stellar ones. Challenging staff to continually grow and expand their skills, while offering enthusiastic encouragement and praise, is incredibly effective. However, in my experience as a consultant, optometrists rarely use it. Rather, doctors are quick to pounce on an erring staff member and criticize caustically (and often do so in front of a patient).

4: Respond in the moment

The key to putting positive praise to work is to use the system put in place by Hewlett Packard, referred to as Management By Walking Around, or MBWA. Instead of waiting for formal reviews to discuss with staff how their behaviors are syncing up with the big picture, do it as it happens. For example, if your practice's mantra is one of exquisite customer service, then approach and praise a staff member the instant he or she does something that supports that doctrine. "Janet, the way you handled that last patient was absolutely perfect and totally in line with what our practice is all about. Great job!"

The odds of Janet repeating this behavior are greater than if you waited six months (and probably forgot the incident) for Janet's staff review. Similarly, when things don't go as they should, you should inform staff immediately, out of earshot of patients. When doing so, make sure to again reference how the behavior relates to your practice goals. "The reason we can't have discussions like that on the phone, Amy, is because our practice is all about a high level of service. Telling patients they can't have their glasses in a brown eyeglass case doesn't support the level of service we're trying to attain." Note how this is different than, "Amy, you should have just given her the black case. You blew it."

Your take-away lesson

There are three main areas to enhance staff management. First, you must truly believe and act on the importance of a well-managed staff. Just acknowledging, "Yeah, I know good staff is important," and not acting, falls short. Next, you should set clear and concrete goals for what you expect from your staff. Finally, you must support and encourage staff as they work on these goals. If you follow these steps you'll be on the road to a higher and more productive level of staff management.

Dr. Gerber is president of The Power Practice, a company specializing in making doctors more profitable. You can reach him at (800) 867-9303 or at

Optometric Management, Issue: August 2006