Rheumatology Practice Management
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Rheumatology Practice Management February 2014 Vol 2 No 1 — February 28, 2014
Jay Salliotte
Managing Director
Advanced Rheumatology
Lansing, MI

Think back to a time when you had a bad work experience or left a job. What happened that made you miserable or made you leave? Of course, pay is important, as are other logistical items such as commute time and flexible work schedules for family obligations. But, when we say an employee has “left the company,” most likely it was because of a manager. You could work at the best Fortune 500 company, or at any other company voted as one of the best places to work, and still have a bad experience because of one manager. Thus, as practice managers, it behooves us to create great work environments so we do not lose talented employees. In addition, it is our job as practice managers to improve and maintain key performance metrics, including revenue, cost-containment, productivity, safety, patient satisfaction, etc. At first glance, it may seem these 2 directives are at odds with each other, but in reality, they can be quite closely related.

The Gallup Organization, famous for their opinion polling, has been studying businesses and managers for decades. One of their many important research topics is how great managers get great results from their teams. Gallup first presented their work to the masses in the 1999 best-selling book, First, Break All the Rules: What the World’s Greatest Managers Do Differently.1 In 2006 Gallup released a follow-up book, 12: The Elements of Great Managing.2 Since then Gallup has continued its research on an annual basis. According to the Gallup website, as of 2013 the company has surveyed more than 25 million employees.3 In addition to quantitative surveys, Gallup has conducted thousands of qualitative interviews with employees and managers to provide a deeper understanding of the topic.

Why Gallup? There must be thousands of new management books released every year. I have read my share, and they are all filled with commonsense wisdom and “how-to.” However, this series has caught my attention for very specific reasons; namely, it is truly universal and it is scientifically reproducible. The Q12 Meta-Analysis is based on quality data, has consistent findings and measurable outcomes, and is straightforward in implementation. After all, we work for physicians, and, in their world, the only way to prove worth is through solid data with measurable outcomes.

Although I strongly recommend that all managers read these books, the revelations can be summed up in just one statement: Great managers foster a work environment that engages their employees, and in turn, engaged employees produce positive results. In essence, this embodies the entire philosophy.

Engaging Your Employees
The evidence from analyzing the data speaks for itself. To summarize the data in terms that are meaningful to the everyday manager, Gallup parsed the data in the following manner. First, they looked at employee engagement scores across different business units, where a unit could be a team within a company, or the entire company itself. Based on the scores, the business units were grouped into quartiles. Then they cross-referenced the employee engagement scores for the business units against key performance metrics, such as revenue, profit, customer satisfaction, safety, quality, and employee retention. The most recent data are from 2012 and can be found on the Gallup website.4 Based on these 2012 data, compared with business units in the bottom quartile, the top quartile units have4:

  • 37% lower absenteeism
  • 25% lower turnover (in high-turnover industries, such as retail)
  • 65% lower turnover (in low-turnover industries, such as healthcare)
  • 28% less shrinkage (loss due to theft)
  • 48% fewer safety incidents
  • 41% fewer patient safety incidents
  • 41% fewer quality incidents (defects)
  • 10% higher customer metrics
  • 21% higher productivity
  • 22% higher profitability.

These results were nearly identical to those discussed in the 1999 and 2006 Gallup books.1,2 If you are a data geek like me, a full 32-page scientific description of the objectives, methods, results, and conclusions can be found under the “Outcomes” section of the Gallup website.5

The many years of research that Gallup conducted on this topic have culminated in a set of 12 questions that measure employee engagement. Gallup now refers to this set of questions as the Q12 Meta-Analysis. These 12 questions are the same 12 elements outlined in 12: The Elements of Great Managing. The answers are given on a scale of 1 to 5, where 1 is “strongly disagree” and 5 is “strongly agree.”

  • Q1: Do I know what is expected of me at work?
  • Q2: Do I have the materials and equipment I need to do my work right?
  • Q3: At work, do I have the opportunity to do what I do best every day?
  • Q4: In the last 7 days, have I received recognition or praise for good work?
  • Q5: Does my supervisor, or someone at work, seem to care about me as a person?
  • Q6: Is there someone at work who encourages my development?
  • Q7: At work, do my opinions seem to count?
  • Q8: Does the mission/purpose of my company make me feel like my work is important?
  • Q9: Are my coworkers committed to doing quality work?
  • Q10: Do I have a best friend at work?
  • Q11: In the past 6 months, have I talked with someone about my progress?
  • Q12: At work, have I had opportunities to learn and grow?

The order of the 12 questions is very intentional. In 12: The Elements of Great Managing, Wagner and Harter use the analogy of climbing a mountain (Figure).2


If an employee is struggling with Q1 and Q2 at “base camp,” their basic needs are not being met. How could they possibly worry about someone encouraging their development when they do not know what is expected of them? Similarly, if employees feel that their opinions do not matter (Q7), how could they be concerned with opportunities to learn and grow at work? Thus, followers of this system should be most concerned with consistently achieving high marks in the first few questions. If we do not, the entire effort will crumble.
In our practice, we conduct the Q12 Meta-Analysis once every quarter. The survey is intended to be completely anonymous; thus, we take great care in our methodology to safeguard that promise. We also remind the staff to be completely honest, because their candor will help us to understand where our practice can improve. I compile the results as soon as possible so I know if there are issues to address. At our next scheduled staff meeting, we publish and discuss the results with the entire team. The data from our last survey and the averages since inception are listed in the Table.


Achieving the numbers shown in the Table was no easy task. I worked very hard, along with the other practice leadership, to build and maintain our results. Our ongoing goal is to have all averages (individual questions and total) at 4.0 or above with a stretch goal of 4.5. Anything below 4.0 means there is serious work to be done.

The Results
We implemented this system in our practice a little more than 2 years ago. At the time, our practice was still in its infancy, so I do not have a “before and after” picture from which to draw a contrast. However, I believe to my core that this system has strengthened our work environment, and I can share some of the observable benefits with you.

Staff Appreciation
The staff knows exactly why we conduct this survey, they understand the implications, and they share their appreciation with us on a regular basis for striving to make our practice the best place to work.

Track Trends over Time
Looking at the data over time reveals patterns where we are strong and places where we are slipping. Thus far, there has always been a clear explanation for the trends, and it has helped our management team to maintain the correct focus.

Identify Red Flags
We normally get great marks on Q9, coworkers committed to doing quality work. However, during one survey we had a drastic drop in responses for Q9, but only from a handful of staff members. This raised a red flag for us. After some further analysis and pumping my trusted sources for information, we identified a problem within our patient services team. We had 1 employee who was careless with the work and, after being confronted by team members, showed no interest in changing. No one told our leadership of the situation, because we are a loyal and tight-knit team. But, clearly, it was causing resentment. This employee was promptly coached and placed on a generous performance improvement plan, which ultimately failed, and the employee was terminated. It was a difficult situation, but we are now a stronger team for it.

Improvement That Is Relatively Cheap
This system helps you to focus your efforts and communications as a manager. With so many responsibilities competing for your attention, it helps to remind you of the importance of employee engagement and the 12 essentials of great management. Committing to this philosophy will certainly cost you time, but in all honesty, you will see such great results in the key performance metrics that the benefits far outweigh the costs.

Avoiding the Pay/Benefits Fallacy
Good pay and good benefits are crucial in recruitment. Good pay, good raises, and good benefits play a role in keeping good staff members; it is an ongoing cost of business that you cannot avoid. However, it is so easy to assume that if we pay employees well and offer great benefits, we will get great performance. After all, they are lucky to have a good- paying job and should work hard for us in return, right? Wrong. Pay and benefits alone will keep employees showing up for work, but rarely will they motivate them to do more than the bare minimum. If your goal is to engage employees and improve key performance metrics for your practice, simply throwing money at your team is not the answer.

Things to Consider Before Implementation
If you are considering implementing this system, and I highly recommend you do, here are a few tips from someone who has been down this road.

Frequent and Consistent Praise Is Hard
Q4 sets the expectation that employees should be praised at least once every 7 days. This will be a challenge for you and your management team. Weeks can pass since you last praised an employee and it will feel like just a few days. It can be mentally exhausting some days, so dig deep to find that commitment, because your employees are not mind readers. Once you start making this element a habit, you will see how just a few simple words can brighten someone’s day and build a loyalty that will pay endless dividends.

A Best Friend at Work
Really? Seriously? That was my first reaction. But, when you really dwell on it and read what the Gallup authors say on the topic, it is an important element. It is essential that each employee has one person who makes them feel like they belong. The trouble is you cannot force it. These relationships must happen naturally, and all you can do to foster them is create opportunities for your teams to bond socially. Also, make sure from the outset that your employees understand what this question is really asking.

I found out months into surveying that some employees thought the question was asking if their absolute closest friend in the entire world happened to be someone at work. That is not the point of this question. Rather, the question is asking if they have a work best friend. In other words, someone at work who they trust, can confide in, and would consider a good friend.

Essentially, that is it. This system as laid out by Gallup’s Q12 Meta-Analysis is quite straightforward and is not terribly convoluted. It will take buy-in and commitment from your leadership and effort on your part as a manager, but it is well worth the endeavor. I can practically guarantee your employees will appreciate it. In addition, if you track your practice’s key performance metrics alongside this effort, you will be able to demonstrate real value. What do you have to lose?


  1. Buckingham M, Coffman C. First, Break All the Rules: What the World’s Greatest Managers Do Differently. New York, NY: Gallup Press; 1999.
  2. Wagner R, Harter JK. 12: The Elements of Great Managing. New York, NY: Gallup Press; 2006.
  3. Gallup Employee Engagement Center. The only 12 questions that matter. 2013. https://q12.gallup.com/Public/en-us/Features?ref=homepage#sectionAct. Accessed January 17, 2014.
  4. Gallup Employee Engagement Center. Engagement at work: its effect on performance continues in tough economic times. 2013. www.gallup.com/file/strategicconsulting/161459/2012%20Q12%20Meta-Analysis%20Summary%20of%20Findings.pdf. Accessed January 17, 2014.
  5. Gallup Employee Engagement Center. The relationship between engagement at work and organ­izational outcomes. 2012. www.gallup.com/file/strategicconsulting/126806/2012%20Q12%20Meta-Analysis%20Research%20Paper.pdf. Accessed January 17, 2014.


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