Rheumatology Practice Management February 2014 Vol 2 No 1 — February 28, 2014

San Diego, CA—A customer service–oriented practice in which staff members work as a team to increase productivity will enhance your practice’s profitability now and in the future, said Audrey E. Coaxum, CHI, CMCO, CMC, CMIS, CMOM, faculty consultant at the Practice Management Institute in San Antonio, TX, at the 2013 meeting of the American College of Rheumatology. Ms Coaxum offered advice on staff management and development for high performance.

“We in healthcare don’t always think of ourselves as having to be customer service–oriented. What’s important to keep in mind is that the patients are our customers,” Ms Coaxum said. “Each patient is our source of revenue. If we’re not conscious about customer service, then we don’t have patients, and we don’t have a business.”

Leaders versus Managers
Identifying the leaders on your staff and offering them encouragement can help in goal achievement. Leaders are not always staff managers or practice administrators, and the 2 often have different characteristics. Managers establish and implement procedures to ensure smooth functioning, whereas leaders motivate others to act in order to help achieve the practice’s goals. Leaders look to the future and chart the course for the organization, said Ms Coaxum.

“Leaders are typically self-appointed,” she elaborated. “Because of the skill sets they possess and their interest in a project, they’re motivated to want to lead the project and provide oversight. If you’re a manager, you are appointed to oversee the project, whereas a leader inspires others to go through and change or improve the work environment.”

The 6 traits of effective leaders are:

  • Job-relevant knowledge
  • Intelligence
  • Self-confidence
  • Desire to lead
  • Integrity
  • Drive.

Leaders must be aware of how a particular project can potentially affect the practice. People are motivated to follow leaders, Ms Coaxum explained. Whatever a leader’s platform or objective, if people are inspired by a leader’s charisma, personality, eagerness to complete a task, and desire to want to achieve and be successful, they will assist a leader in achieving a goal.

“If you’ve identified a person that has these characteristics, even though he may not be in a managerial position, you definitely want to encourage him by giving him the ability to do oversight and management of a task,” she said. “Give him the resources and tools needed to accomplish tasks. If additional education and training are needed to ensure success, make that available. You always want to encourage and nurture those characteristics.”

One of the most important elements of a leader is trust. “If people don’t trust your judgment or insight, then they are not going to want to follow you,” Ms Coaxum warned. “The whole crux of being a leader is having a team of people you’re working with.”

Leaders create the desire for continuous improvement. They create an environment that nurtures mutual respect among people, provides encouragement, and promotes cooperation. Most of all, they lead by example and demonstration. “Modeling what you want from others is one of the most important responsibilities of being a leader,” she said.

Developing Your Staff
Staff development is an essential element of a successful practice. Your philosophies for development should be shared with the staff, employee development plans should be created, and resources to assist in development should be identified. These resources can be new software programs to help process claims more efficiently. Share what you know of the organization’s future needs, Ms Coaxum advised. The staff should be involved in planning and team-building meetings.

“Sometimes the managerial staff doesn’t always focus on development when doing performance reviews and staff evaluations,” she said. “You need to understand the vision of your practice and the goals, but you do need to talk to your employees and find out what their positions are as far as working with your practice as well as personally wanting to grow and develop themselves, because you may be able to nurture and encourage that type of relationship so that you can have another leader coming through the ranks.”

Ms Coaxum gave the example of a front desk specialist who had a thorough understanding of the operation of the practice, and after gaining an appreciation for clinical care, wanted to go to nursing school. Once she shared that vision with the administration, her schedule was altered to allow her to attend classes. The opportunity to eventually return to the practice in a different capacity was one that could enhance the practice’s goals.

Development plans should be monitored regularly. In the example cited, practice administrators were able to monitor the employee’s progress in completing her curriculum.

Employee Motivation and Morale
Motivation starts with good employee morale, which is the mental attitude of employees toward their employer and jobs, Ms Coaxum said. High morale is the sign of a well-managed organization. Poor morale may show up as absenteeism, employee turnover, decreased productivity, and employee grievances.

“Be honest with your employees about the position of your practice, which is especially important during a time of many transitions in healthcare in general,” she advised. “Reassure your employees that you are going to stay open, you are not going to close your doors, or that you’re staying as an independent practice instead of consolidating with another facility. Share the goals of the practice—where you plan to be for the next 10 or 15 years.”

There are times when you may not be able to financially reward employees for the job they’re doing, but they can still be recognized for their efforts.

“One of the clinics I worked with had a computer glitch and we lost 3 months worth of data in our system,” Ms Coaxum shared. “We had to have the staff come in on the weekend and input 3 months worth of data in 2 days. The staff successfully completed the task. I purchased thank you cards for all of the employees and the physicians signed them, and we put $25 gift cards in them. It was important that it come not just from me as a practice administrator but from the physicians.”

It’s Not “Us” and “Them,” It’s “We”
The entire staff must have the mind-set that it is working together as a team for the sake of the patient. “If I’m working at the front desk, I’m receiving patients, I am trying to get everything prepared so the patient can be transitioned to the back office area and the phones are ringing off the hook, there’s nothing wrong with a clinical staff or managerial person pitching in and answering the phones and trying to help get the patient through the process,” Ms Coaxum said. “It’s not ‘us’ and ‘them,’ it’s ‘we,’” she added.

A practice that is not customer service–oriented or cognizant won’t make for a good patient experience. The first opportunity to make a positive impression is the reception at the front desk, and the final encounter is equally important.

Every person involved in the patient’s experience can make or break a practice. Ms Coaxum related the story of a patient who had a wonderful experience with the reception and the clinician, “but on her way out, she asked the checkout person where the exit was. Instead of telling the patient the correct door, she was directed to use a closet door. The front desk staff person thought it was funny but the patient was embarrassed and humiliated, and she said that she was never coming back to that practice again,” she said. “The practice administrator unfortunately was not there at the time, but in finding out about the patient’s experience and how it ended, personally called the patient and apologized for the behavior of the front desk.”

Evaluating and Rewarding Performance
Performance evaluations should not necessarily be tied to a financial review, Ms Coaxum said. The performance evaluation starts with reviewing the employee’s job description, and based on that description, a determination of whether he or she is successfully completing the task. If you identify an employee who is excelling, provide some type of reward system. “It could be that the person has the opportunity to take time off from work because she successfully completed a task in a short amount of time,” Ms Coaxum said. “One facility had a bonus opportunity. They received customer service buttons from other staff members or patients, and their buttons were put into a bowl. At the end of the year, employees with more buttons in the bowl had a greater chance of winning a pot that was established. The practice gave a $500 end-of-year bonus to the staff person who was most customer service oriented based on those buttons.”

To ensure profitability, practices need volume, but patients should never feel as though they are being rushed through the system. Take personal notes from encounters with established patients and bring up any tidbits at the next visit, Ms Coaxum advised. For example, if a particular patient noted that he or she was taking a vacation soon, ask about that vacation at the next appointment.

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