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.


 

The Secret That Is Helping Practice Managers Hire The Best Candidates

Foto Credit:  Blolg.eskill.com
Foto Credit: Blolg.eskill.com

When you are ready to hire your next doctor, what process do you follow? What steps does your practice take to ensure you are hiring the best candidate?

For many of us, the process begins with shifting through CVs looking for candidates that look good on paper. And once we find one that does, we invite them for an interview.

During the interview, we ask the candidate a series of questions with the intent to learn more about them professionally and personally. Some people come up with clever questions to see how the candidate responds. Others merely focus on the clinical knowledge.

Some practices bring in the candidate more than once, but for the most part, if the a candidate looks good on paper, interviews well, and most people in the practice likes the person, chances are the practice makes the hire.

Success!

But success doesn’t always come, does it? Sometimes, the opposite of success occurs. And many are left saying, but she looked good on paper; he interviewed really well; she seemed so nice. Patients loved him…

What in the world happened?

It is easy to blame the candidates saying it is a generational thing or a cultural thing or the training they received, but many times, it isn’t the candidate’s fault. But rather poor planning and execution on behalf of the practice.

My friend Susanne Madden from the Verden Group has helped many practices with their hiring process.

In her experience, she believes that the most important part of the interview is the work the practice does before they meet with the candidates. She says that practices don’t even know what they are looking for in their next employee, resulting in disastrous hires.

Susanne first recommendations is to get clear on your practice’s priority (and those of your partners too).

Baseline clinical skills aside, what is most important to YOU? Do you need someone with an easy-going manner who is most likely to ‘fit’ with your practice’s ‘personality’ or someone with a stronger constitution who can work tough cases, deal with demanding patients, and so on. 

Susanne makes it painfully clear that this initial process is more about the practice than it is about the candidate.

Take a good look at your practice first and leave your perceptions behind. What are the prevailing attitudes? What is the culture? What are the requirements for a new person to be able to be successful? 

One of the mistakes we made early on, was do a poor job of communicating our practice’s core values. I had the values in my mind, and from time-to-time described them, but I never took the time to gather my thoughts, write them down, and clearly communicate them to employees, let alone potential hires.

I wish we knew about Susanne’s next piece of advise sooner.

When you have that figured out, make sure that you can explain it well to potential candidates. Crossed expectations only result in losing a new doc (either they walk or you fire); a costly and painful experience all round!

Lastly, she adds this:

So figure it out, lay it out and then invite them to spend a couple of days on site shadowing you to see if this may be a good fit for BOTH of you.

I find this sort of framework interesting because it shatters the traditional way of doing things. It places the focus on the practice first, and then on the candidate. Whereas most people place the focus on the candidate first, and do little work aligning the practice’s culture and needs with the candidate’s strengths.

When we compare the traditional hiring process with Susanne’s more inward and introspective process, it is easy to see why the traditional process has less of a chance to succeed. 

What would you add to Susanne’s list? What are things that your practice has done that may help others hire their next physician?

How Do You Best Motivate Employees?

iStock_000004504118XSmall-423x281Despite our efforts to recognize staff members for their outstanding work, the feedback we often get is that employees don’t feel appreciated enough. In other words, we appreciate our practice’s team members, but they don’t feel we recognize their work enough.

Apparently, this is not something unique to our practice. I’ve read research that shows that most employee leave a company because they don’t feel their bosses appreciate their hard work, commitment or dedication.

Research has also shown that when employees leave a job, many times it isn’t the money. Workers reveal that raises and promotions are great, of course, but what they would really like, is to feel valued. And not feeling valued enough is what led them to leave the jobs.

At the bookstore the other day, I came across a book titled The 5 Languages of Appreciation in the Workplace by Gary Chapman and Paul White. If you ever have attended a marriage seminar, you may have heard of Gary Chapman before. He is the author of the popular book The 5 Love Languages.

The title intrigued me so I bought the book.

The authors of the book discuss that in the work place, people have different ways in which they feel appreciated. Some employees like it when their boss acknowledges them publicly for a job well done, while others would prefer a gesture of recognition done privately.

Others feel appreciated when co-workers or managers step in to ease the burden of their work load, while others feel special when they are able to spend time with their bosses and be heard.

Another example the authors illustrate is the employee that is publicly recognize in front of the entire company time and time again for his outstanding work. During the recognition, his boss goes on and on about how great the employee is and that if it weren’t for him, the company would have failed in that area.

Sounds like a great way to show appreciation, right?

As it turns out the employee feels uncomfortable having the spot light shining on him and receiving public praise. His appreciation language is actually what the authors describe as “acts of service” which is when the person feels appreciated when others recognize the overwhelming amount of work he does and offers to help him out.

Understanding how each of your co-workers, team members, employees or partners are wired in terms of how they feel appreciated, is just one of the many ways that can help an organization increase the level of job satisfaction.

It also increases employee engagement by making staff feel truly valued. Not to mention that it reduces cynicism which creates a positive work and productive working environment.

I would encourage you to pick up the book. It was a very easy read and I’ve even started implementing some of the things I learned with great results. The book even offers a questionnaire for employees so that you can find out what is each employee’s appreciation language.

To learn more about this book, check out the link below:

http://www.appreciationatwork.com/

Hiring Stars: 8 Steps to Help You Through the Process

Interview

Not long ago, I was asked if I could provide some insight into hiring competent staff. I told the person that we were embarking on a similar journey to find top notch employees and the best that I could do, was share the steps that we’ve taken so far. Below is what I shared with the gentlemen that asked the question:

Define Improvements

Jot down, on a piece of paper, areas in your practice you need improvements. Don’t just say, I need administrative oversight, but rather, dig deeper in your assessment. For example, one area in my practice that needs improvement  is with follow-through. We have good ideas, but don’t have staff that picks up the vision, makes it their own, and sees it though.

Ponder… what is it that your practice needs exactly (ie. improve marketing, start an asthma clinic, improve budgeting, implement clinical work-flows, increase the number of patients, pay the bills on time, etc.).

In our practice, one of the things that didn’t meet our expectations, was the handling of chronically ill patients. Thus by determining areas of improvement, we decided we wanted someone that could help us manage chronic patients. For this role, we needed an experienced RN (or an exceptional MA, although that is less likely, but still an option if somebody were to show up) to take charge of a project like this.

Define Candidate

Next, sit down with a pen and paper and jot down what would your perfect candidate look like. That is, what skills should the person have, character, work ethic and of course experience.

I particularly put a lot of emphasis on the character and work ethic description. Some people have the gift of leadership, others have the gift of administration while others are very good soldiers (the kind that follow orders very well, but don’t always have initiative).

In our chronic care management position, we knew that any nurse would not fit the bill. So we wrote down what were the character traits the person needed to fill this position like a glove.

Remember, you may not get it all in one person, but that is why this exercise is of value. Because by jotting all “wants” you start to get a better picture of the person you are looking for.

Create a Job Description

Then, you are ready to create a job description that goes beyond the regular blah, blah, blah of the common job description.

For example, for our chronic care coordinator position, we wanted somebody that had implemented something similar on their own, from scratch and little direction or oversight. Why? Because we never have had a position like this before, so we don’t know exactly what needs to be done. At that point, we only had the vision for the position.

Therefore the person not only had to be experienced in chronic care coordination, but also demonstrate the ability to implement processes and find answers to questions that we may not have, go the extra mile as well as embrace the position with the understanding that we wanted somebody to implement a vision

Our job description was worded to address that the person needed to have certain qualities.

Interview Process (Cross interview)

After advertising the job description, you’ll begin the interview process. In this process, I interview the candidate first. If I think they are good enough, I have them interview with 2 or 3 of my top staff members. It doesn’t matter if not all the interviewers  work in the discipline the candidate works in. I’ll have a clinical RN interview a front desk position or vice-versa. The point of the exercise is for you to have a complete understanding of the candidate. An office manager may pick up different things from the interview than the MA will, for example.

By the way, I also wanted to share that doing the cross-interview process has also shed light on my employees’ ability to identify the better candidates. Some of them have surprised me with their knack to read candidates’ verbal and physical cues.

Meet with Providers

Then, I have the candidate interview with my providers. These are short interviews (20 minutes). If you have a lot of providers, this may not want to have them interview with all of them.

But having the candidate meet the provider and the provider meet the candidate is, I believe, an important part of the process. One additional piece that helps complete the puzzle.

Interview Questions

The interview process is more about finding character traits than anything else. Of course experience is important, but we want know what the person is made of. Not how well they can talk up their resume.

Thus, the questions we ask the candidate are two-fold. One, does the candidate have the skills for the job that we outlined. And second, does the candidate have the character traits we want.

Here are 100 potential questions to help you get started:

http://career-advice.monster.com/job-interview/interview-questions/100-potential-interview-questions/article.aspx

Personality Test

After the interview process is complete, and we are in agreement the candidate is a strong candidate, we have the candidate perform a personality assessment test. This helps us identify personal characteristics that would otherwise be hidden in an interview settings.

We use a personality assesment test called DiSC. You can find it by going here: http://www.yourlifespath.com/

It is helpful if your entire staff has done the personality test because then you are able to identify where the candidate fits in. It also provides context. When I receive a candidates results, I see their placement and compare it to the rest of the employee’s results giving me a different kind of glimpse into the candidate’s personality.

Shadowing

Lastly, we have the candidate spend an entire day with the staff shadowing them. Naturally, if you are hiring an admin or manager, you are not going to have them sit with the triage nurse, but it would be beneficial for the candidate to sit with the front desk staff to see how they work, handle phone calls and treat patients among other things.

This phase also has several intentions. I’m looking for the type of questions the candiate is asking, how they are interacting with the staff and their demeanor (bored, interested, etc). This also gives an opportunity for the candidate to see the working conditions. It is one thing to say you like kids and it is an entirely different thing to work in a place where there are crying kids, temper tantrums, angry and frustrated parents all over.

Time

This process takes a long time. And although you may have an urge to skip some steps because of the pressing need to fill the vacancy, I would encourage you to exercise extreme patience. I have to remind myself of this too. Especially when we are short staffed.

However, When we’ve rushed to place a warm body without doing the due diligence, we have regretted it almost every time.

The long process also test the patience of the candidate. Which can be very reveling as well.

Lastly, I’ll share that all my research in this regard has pointed me towards creating a comprehensive interviewing process that helps us identify who is truly the best candidate for the position. If you look at something like navy seal training, or anything that is high stakes, you’ll notice that they too have an arduous process. And the best companies are not exception to this.

Good luck

What is your hiring process like? What are some of the lessons you’ve learned over the years ? Does your hiring process rock solid or does it need improvements. Explain it what what ways.

How To Take Care of Your Most Valuable Assets

Organizations often talk about how their employees are the company’s strongest assets. Which is absolutely true.

But very few actually take the time to ensure that their most valuable assets have what they need to perform their best. We believe they have what they need; we think they are comfortable; we assume they are happy, but how do we really know?

We have a small group in our office that has been with us for a long time and for the most part, I have always assumed I have a good understanding of how they feel about their jobs, their coworkers and the company in general.

But then I realized, I’ve always assumed. Never have I asked direct questions about  how they truly feel about me (as their leader, boss, or manager) or the medical practice.

So I decided to change that.

I drafted a series of questions to ask our employees. The questions were designed to  get a better understanding of their feelings about me as their manager, the office, their co-workers and the company in general. I also wanted to determine if our most valuable assets have what they need to continue being our most valuable assets.

And here is what I asked them to complete:

  1. What is most satisfying thing about your job?
  2. What is the least satisfying thing about your job?
  3. Do you receive enough training to do your job effectively?
  4. Do you receive adequate support to do your job?
  5. Are you satisfied with this company’s merit review process?
  6. Does this company help you to fulfill your career goals?
  7. What can we do to make your position better?
  8. If you could define our practice philosophy in one sentence, what would you say?
  9. How does the management do at treating you and others employees as their first customers?
  10. Has management been fair and consistent when dealings with employees? I not, explain why not.
  11. What could management do better to express loyalty to the staff and to gain loyalty from the staff?
  12. Do you feel you are adequately informed ahead of time about changes?
  13. Do you feel in control of your workload?
  14. Do you feel your bosses are open and honest in dealing with employees?
  15. Do you have a clear understanding of what is expected of you?
  16. Do you dread coming to work everyday? If so, why?
  17. Is the office environment between employees and physicians comfortable?
  18. Name 3 things your boss could do better to serve team members.

I asked the staff to answer the questions to the best of their abilities. I told them that the more they shared with us, the better. Not only will the responses give me an idea of areas where we can improve on, but it also is a way to gauge how satisfied they were with their job; which is crucial in helping us achieve our mission at the practice.

I could tell they were a little hesitant to fill it out the questionnaire. They wanted to know if it was anonymous and if their would be consequences if we didn’t like the answers.

I explained that it was not anonymous. Second, I told them that this was an opportunity to tell me what I could do better as their boss. And lastly, I told them that if they weren’t truthful, the exercise was worthless.

I did get very interesting responses. I’m still going over them, but some of the things that jumped out was how we/I reprimanded the staff. They don’t appreciate it when one of them screws up and all of them get reprimanded.

I’ll have to reassess this issues as it conflicts with my all for one, one for all management philosophy (if one fails, we all fail; if one succeeds, we all succeed).

They also pointed out that we/I did not do a good job of letting the staff know of changes within a reasonable time frame. So now, I know to announce things sooner rather than later.

I still need to go over them in detail, but overall, the feedback went well I think. I learned there are areas I need to work on and I also got to know my staff a little better.

Do you think this is a valuable exercise you could do in your practice?

Exit Interviews Before They Exit

Exit interviews are done when an employee is leaving the organization. The intent of the interview is for the employer to gather data for improving working conditions and retaining employees. Theoretically, I understand why one would want to do exit interview. But I don’t understand why one would wait until the employee is leaving to ask their opinion. Seems to me that at that point, it is too late.

Asking employees exit interview type questions while employees are working at your practice can also be a good tool to gather employees’ feedback on their work experience in and effort to improve working conditions and retain employees.

Examples of exit interview type questions that can help one get a sense of how employee perceive working at your practice. For example:

What is most satisfying about your job?

What is the least satisfying thing about your job?

Do you receive enough training to do your job effectively?

Do you receive adequate support to do your job?

Are you satisfied with this company’s merit review process?

Does this company help you to fulfill your career goals?

Performing exit interview type question to employees on a regular bases gives employers an opportunity to learn the same things one would learn from a traditional exit interview process but only this time, the employees has not left yet. Consequently, as a manager or employer, one is able to address issues with the employees as well as learn ways one can improve the working environment.

The process is actually quite simple. Just jot down those 6 questions above and either print them up for the staff to respond or send them an email. I’ll bet you will gain really good insight.