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