Three Simple Questions To Help You Manage Disruptive Employee Behavior

Guest post by Brenda S. Campbell

One of the most challenging aspects of practice management is managing the people within the business. It can feel overwhelming to manage employee attitude, behavior and performance, especially if confrontation doesn’t come naturally.

Screen Shot 2016-06-05 at 9.56.40 AMI have had the privilege of working for an amazing pediatrician for the last fifteen years. He’s been in practice for decades and has taught me so much about practice management, especially the “people” part.

He has helped me understand that it is possible to manage any employee behavior and expectations using a simple strategy.

When confronted with unsatisfactory employee behavior and performance, it is important to focus on three questions:

You send a message to the rest of the staff no matter how you handle the issue.

What’s the message you want to send?

If you choose to overlook the behavior, the message to your staff is that it is okay to continue this behavior and that it is acceptable.

If you address a behavior, it sends a message to everyone that the behavior is NOT okay and will not be tolerated. Often times, even though they may not say it, the staff appreciate that you address negative behavior.

For example, we had a telephone triage nurse who had a lot of experience, worked for us for several years and was solid in the advice she would give.

Her customer service skills, however, were lacking. I had to make a decision about the message I wanted to send to the rest of the staff.

What you allow is what will continue. Are you going to allow it to continue?

Make the decision to address the behavior and do it. Don’t put it off. Ask, “May I give you some feedback?” Let them know the problem with their behavior, set expectations and move on. They’ll either choose to correct their behavior or they won’t.

We’ve found that employees generally receive feedback in one of two ways. Some are completely unaware that their behavior was being perceived in a negative manner and are quick to ask how they can fix it.

The others become defensive and refuse to take ownership of the behavior often blaming external factors.

With our triage nurse, I knew that I needed to address her customer service problem, particularly her tone which could be perceived as condescending and snarky at times.

Her response fell in the defensive category and she said “somehow I get all the nasty parents on the phone.” I explained to her that she was the common denominator in each complaint and that her tone was the problem.

“Ma’am” is not necessarily respectful if delivered in a sarcastic manner. It was her behavior that made the parents become, in her eyes, “nasty”.

Are you better off with them or without them? Is it time to let them go?

If, after you’ve given the feedback and they have not changed their behavior, it’s time to make the decision about the employee’s future.

As you may have guessed, it didn’t take long for another parent to complain about the triage nurse and, at that point, we decided that even though we’d be down a phone triage nurse in a busy sick season, it wasn’t worth allowing negative behavior to continue thereby sending the wrong message to the staff.

We have found that when it comes to working with someone who behaves poorly or working short-staffed most employees would rather work a little harder until we find someone who is a good fit for our practice.

It’s certainly easier in the short term to ignore problematic employee behavior but it’s always costly in the end.

Allowing negative employee behavior to continue can hurt your employee morale, productivity and retention as well as cause you to lose patients. When we reflect on the occasions where we’ve had to let someone go after asking these three questions, we have yet to regret a single one.


Brenda Campbell is a practice administrator for The Pediatric Center at Frederick. You can check out her practice by clicking, here. She is a member of AAP’s subcommittee Pediatric Practice Management Alliance (PPMA). This article originally appeared in SOAPM’s Quarterly Newsletter.


 

4 Simple Questions That Will Make You A Better Manager To Your Employees

As practice managers and administrators of both large and small practices, we are wired not to see our failures but instead see the shortfall of our employees and attempt to correct them. Nothing wrong with that. It’s part of management.

But let me challenge you on this one. The next time you have difficulties with an employee, take a moment and reflect how you are interpreting the issue using the questions above. Consider where you are placing the blame. On people’s character or the circumstances?

As humans, we have an uncanny ability to justify and explain situations in ways that benefit us.  For example…

When we observe a father shouting, tugging or being overpowering towards their child, we raise an eyebrow and pass judgement on that parent’s poor parenting skills.

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If we lose our temper with our kids, we justify it by blaming the circumstances. We’ll say, “if you knew how challenging my children are, you would understand.”

In a medical practice environment, it may go something like this.

Julie: Nancy is late again.
Michelle: That’s the way she is. She’s so disorganized.
Julie: I know. And she doesn’t take her job seriously.
Michelle: Bill has given her so many opportunities, but she seems not to get the message in that thick head of hers.

Let’s look at it from another viewpoint.

Julie: I’m sorry I’m late. It’s just that my car has been acting up. And with my husband being out of town, I have to get the 3-kids ready, drop them off at my mother-in-law’s house – you know she is still upset about that thing – and just as my luck will have it, there was a fender bender on Route 95 and traffic was backed up all the way to the freeway.

CHARACTER VS CIRCUMSTANCES

Medical practice managers and administrators tend to make similar judgements.

When we have an under-performing staff member, we question their work ethic, make claims about their lack of motivation, engagement or lack of interest. Simply put, we tend to judge their character.

When we fall short, we don’t dare blame our work ethic, lack of motivation or lack of interest. Instead we blame the circumstances.

For example, we’ll blame our underperforming employees, unreasonable parents, the healthcare system, insurance companies, the printer, the network, being overworked and our boss. She’s too demanding and has unrealistic expectations.

REVERSE

What if we reverse the tendency to blame circumstances when we fall short and blame people’s character faults when they make a mistake or underperform? What would it look like if you looked at your character when employees in your practice fall short?

To help you put all of this into perspective, think about a time in the practice when an employee was underperforming. Using that situation in mind, read and think about the four questions I’ve listed below.

1.- Am I measuring a fish by its ability to walk?

Everybody has their strengths, but if you place someone in an environment that is counter to their strengths, they will undoubtedly fail.

Before rushing to judgement, ask this question first. Have I done a disservice to the employee by placing them in a position that they are not naturally good at doing?

2.- Am I telling them instead of leading them?

The best leaders are not the best because of their title. The best leaders are remarkable because they have distinctive character traits. Thus, asking employees to think and see the way you think and see things is often unfair.

Instead of saying, why can’t they just… (they being employees) ask, have I led them?

Consider putting more efforts towards helping them understand – leading them – rather than expecting them to know.

3. – Am I assuming employees remember?

Just because you said it once, doesn’t mean it was heard or retained.

If an employee keeps overlooking necessary task for example, take pause and consider if the reason is that you have not made clear the importance of the tasks.

One important distinction to have present when reminding employees. It is more important to tell employees why their jobs matter than remind them how to do their jobs.

4. – What am I doing about it?

Some hires simply are not a good fit. Others don’t work out. You know that. The entire staff also knows that.

Keeping an employee around that doesn’t fit well into the culture, is disruptive, consistently underperforms, and makes mistakes despite coaching, is a failure of leadership.

In other words, an employee that is out of line is not necessarily your fault, but it is on you if they remain an employee of the practice.

As practice managers and administrators of both large and small practices, we are wired not to see our failures but instead see the shortfall of our employees and attempt to correct them. Nothing wrong with that. It’s part of management.

But let me challenge you on this one. The next time you have difficulties with an employee, take a moment and reflect how you are interpreting the issue using the questions above. Consider where you are placing the blame. On people’s character or the circumstances?

 

Simple Yet Effective Leadership Lesson You Must Learn If You Are A Practice Administrator

Medical practices don’t sell products, transport goods, develop software or produce widgets in a factory. Our businesses are all about people. Consequently, the only way to improve productivity or enhance performance is by getting better at managing people.

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One day, his wife complained that in their 25 years of marriage, he had never told her that he loved her.

“I told you when we got married. I’ll let you know if it changes,” he replied.

Acknowledging staff members or affirming employees for a job well done doesn’t come naturally to me. I’m the kind of person that believes recognition isn’t necessary when someone does as expected.

YOU’RE SUPPOSED TO WORK HARD

For example, I’ve heard employees say, I worked hard for this company. This comment doesn’t deserve affirmation.

Why? Because the expectations is not to barely do mediocre average work. The expectation is that people work hard. Pronouncing you work hard is like a father publicly declaring he takes care of his kids.

WHEN IS TOO MUCH, TOO MUCH?

I also feel that if you praise a person for their good job often, the praise eventually loses value. Like the word thanks. It’s polite, but is one thankful every time we say thanks? So when I acknowledge someone’s behavior, character, work ethic, etc. it is because it truly exceeded expectation.

WHAT IS THAT ABOUT?

Here is the thing. As a member of the team (as opposed to the boss) I like to receive positive feedback. I like to get recognition, have someone acknowledge my work and accomplishments.

WE ALL NEED TO HEAR IT

I’m sure the wife in the story knew the husband loved her, but she needed to hear it from him. And just like the wife, people too need to hear from the person in charge words of appreciation even though they heard it once before.

The affirmation, praise, recognition, pat on the back (how ever you want to describe it) isn’t only for those in charge to give to their reports. This also applies to colleagues and peers.

Furthermore, I’d challenge those of you that have bosses, supervisors or managers to share words of encouragement as well. They need it just as much as you need it too.

HAS BRANDON GONE SOFT?

You may be wondering what this has to do with practice management, business, revenue, CPT codes or ICD10? A lot!

Medical practices don’t sell products, transport goods, develop software or produce widgets in a factory. Our businesses are all about people. Consequently, the only way to improve productivity or enhance performance is by getting better at managing people. And frequent reminders that show appreciation is one of the best way to become a great practice manager.

As it turns out, people that are recognized, appreciated and affirmed are far more productive, far more efficient, and far more happy than those that are not.

 


Do you regularly provide positive feedback to your employees? Do you provide positive feedback to your boss, manager or supervisor? If so, how do you prefer to affirm or show appreciation to the staff? A note by email, a handwritten note, publicly? I’d love to hear ways your practice engages employee.


 

Can A Mechanic Shop Teach Us Anything About Managing A Pediatric Practice?

I was reminded that to keep Salud Pediatrics focused, on task, an aligned towards our objectives, it is my responsibility to remind, affirm, correct and make adjustments (sometimes this process includes “changing” old worn out parts for new ones that perform better) to ensure the practice performs at its best.

I took my car in for alignment the other day. As I was waiting for the car, I thought about why the car needed alignment in the first place. If the car’s tires were aligned once, why the need for realignment?

My guess is that the car gets misaligned when something happens to it. For example, the car is jolted by a pot hole. I guessed road conditions, weather, vibrations or simply usage tend to mis-align a vehicle as well.

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Regardless of the reason, one thing is for sure; alignment brings a lot of value. Not only does it keep the car from veering off, but it’s also a preventive measure (kind of like a wellness visas). If you don’t care of your car’s alignment, the misalignment can create bigger problems in the future.

You know what else needs alignment?

You and the employees of your practice.

Why?

For the same reasons your car needs alignment.

There are things that cause us to veer off the path. Just like a car, your practice may have been jolted by an event. When this happens, we start to pull a little left. We tend to forget, lose focus or start heading down a path we weren’t intending on going down.

The jolt may have been a big change or a transition that occurred in the practice. But it could have also been subtle, barely noticeable. Anything from an important team member leaving the practice, to opening a new location to hiring a new provider.

Perhaps it was none of those things, but time.

That day at the mechanic shop I said to myself, just because I’ve aligned the staff towards our objectives, our purpose, our goal once, doesn’t mean that the alignment remains. 

I was reminded that to keep Salud Pediatrics focused, on task, an aligned towards our objectives, it is my responsibility to remind, affirm, correct and make adjustments (sometimes this process includes “changing” old worn out parts for new ones that perform better) to ensure the practice performs at its best.

And sometimes, that alignment begins with me.

What needs to be aligned?

I don’t know what those things are for your practice, but for me, areas in which we need to be frequently aligned are: our practice mission and core values.

I always go back to the core values and our mission because in it, I find reminders on why Salud Pediatrics exist in the first place; what’s are purpose as a practice; why do we come to work; who are we there for?

Once those things are in perspective, I know what needs to be done.

What about you?

What are the areas in your practice that need to be realign? Where have you or your staff veered off? Is the  practice pulling to one side more than it should? Has it been a while since you “aligned” the practice?

If so, it may be time to bring it in to the mechanic shop.


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Do You Have We Employees or They Employees?

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Next time you are in a meeting with your staff, or you are conversing with them, try to determine which employee say “we” and which employees say “they” when they are referring to the company, the management or the leadership of the practice.

What is the difference between the ones that use “we” and the ones that use “they,” and why does it matter?

The “we” are high performing employees. The employees that use the word “they” are the ones that are alienated.

Understanding where each employee stands goes a long way in helping you lead better. That is why I think there is great value is working with the “they” to convert them in to “we” employees.

But don’t neglect the “we.” Our jobs with them is to empower them.