According to Charles Duhigg in his newly released book, The Power of Habit, Rhode Island Hospital was one of the nation’s leading medical institutions. It was the teaching hospital for Brown University and the only Level I trauma center in southeastern New England. Rhode Island Hospital also had a reputation as “a place riven by internal tensions”. In one surgery for instance, a neurosurgeon was preparing an emergency surgery for an elderly gentleman with a critical subdural hematoma. Just before the surgery a surgical nurse noticed that the medical chart and other paper work did not indicate the location of the hematoma. The nurse cautioned that the surgeon should wait until the needed paper work was seen. The surgeon yelled at her that he had seen the cranial scan and said he knew where to operate. He didn’t. He opened the skull on the wrong side. Although he corrected his mistake quickly, the patient died soon thereafter. Such errors are not foreign to most hospitals but the number of errors at this hospital due to poor communication, especially between nurses and physicians who overpowered them with their authority, eventually created a culture of high tension and anxiety.
As Manage My Practice just passed the two-year mark, it seems like an excellent time to hear what’s on your mind. Please take 2 minutes or so and answer my 5-question survey.
I don’t often find articles that reflect my own views as closely as the article “10 Ways to Keep Employees Happy” from HowStuffWorks by Cristen Conger does. Not only does Ms. Conger hit the list with 10 strong concepts, but she also gives great sources to back up her points. Here are her 10 points – click each one to go to the page for more information.
10. Offer Flexible Work Options Some jobs in medical practices are ideal for flexible work options, but most are not. Any position that requires face-time with the patient will likely need to adhere to appointment hours. My question: is it “fair” to allow some positions to have flex-time and others not? If you have a group of people all doing the same general job, letting some people have flex-time and others not may lead to a mutiny. Consider carefully the precedent you are setting when allowing flex-time, and make sure employees understand that as the needs of the organization change, work arrangements may need to change.
9. Practice Open Communication I couldn’t agree with this one more. Communicate, communicate, communicate. One-on-one, in departments, in all-staff meetings, in all-organization meetings. I typically send out an electronic newsletter every Friday (an idea from my mentor, Tom Girton) that announces/reminds people of events, clarifies policies and acknowledges achievements. Oh, and don’t forget to make sure that people are understanding what you’re trying to communicate. Touch base every once in awhile to make sure the message you’re sending is the one they’re receiving.
8. Pencil In Face Time When beginning a new job I often meet with every employee who reports to me (and sometimes meet with everyone in the organization in a smaller practice) for at least an hour to learn a bit about them and hear what they think the practice is doing well, and what the practice could be doing better. Yes, it takes a lot of time, but it starts to form a bond with individuals and it gives me more information that anything else I could do to start to learn about my new group. People are fascinating and I really enjoy an uninterrupted hour with someone – it’s almost a luxury in this day and age. Once you’ve established that bond, make sure to nourish it by connecting with individuals on a regular basis. Letting people know you truly care about them as individuals is how dynamite teams are created. And the karma ain’t bad either.
7. Recognize Success and don’t save it all up! Recognizing efforts, going the extra mile, dealing with a difficult patient, all deserve a pat on the back in front of other employees. Remember to always praise in public and counsel in private. Share the joy of something well done, and let the employee have the privacy of a critique.
6. Set Goals I like to establish individual goals every six months during the annual performance review and six months later during a less-formal touch base. 12 months is a long time to keep a goal in mind, so I prefer to deal with 6-month goals. Performance evaluations should not be a rehash of what was done right and wrong over the year, but rather should be a time to review the goals from the last six months and see what wasn’t accomplished and why, as well as celebrating the goals that were accomplished. See my simple evaluation for more information.
5. Explain the Big Picture I’m often surprised how many medical practice employees don’t understand how their job (especially done well) contributes to the big picture. Check-in staff might not understand how their job impacts billing. Scheduling might not understand how their job impacts the nurses. Nurses might not understand how their job impacts the check-out. No one may understand what their efforts mean to the financial viability of the practice. If all the staff know that they haven’t had raises for two years yet new medical equipment is being purchased for a new service line, they need to have some insight into why a decision was made and what potential it may have for keeping the practice viable.
4. Provide Career Growth Opportunities This fits in well with the 6-month performance evaluation when you set goals with your employees. Goals may include projects, new skills, improved skills, shadowing other jobs, cross-training on other jobs, conferences and workshops, and online or classroom training. Never think that someone can’t do something as predicting success is one of the hardest things in the world. Encourage everyone!
3. Give Employees Respect Give everyone respect. Know that every single person is much deeper than you will ever know and more fragile that you would ever expect. Never forget that you can make someone’s day and break someone’s day. Being a manager is making a choice to care for and respect the people who have chosen to work with you. In many ways, management is the most powerless job (next to parenting) there is.
2. Provide Consistent Feedback For you to effectively provide feedback, positive or negative, the employee must have been trained, must have resources to help them do their job and must understand the expectations of the job. Do not take for granted that your front desk person knows instinctively that your expectation is to have the day’s charges posted and reconciled before the end of the day. Have written performance expectations for each person, then explore the reasons why those expectations are not being met (communication, misunderstanding, workload, etc.)
1. Build Trust I’m so glad Ms. Conger put this as #1 -I agree! Here’s how I build trust: Keep confidences. Follow the same rules I set for the staff (if they can’t eat at their desks, neither can I.) Make promises sparingly and fulfill all promises. Don’t mess up peoples’ payroll or their time off. Understand the details of their job. Don’t allow the doctors or the patients to abuse them.
I am about to use SurveyMonkeyagain. The first time I used SurveyMonkey was to ask the staff questions about benefits. I knew that we were facing some big health insurance premium increases and I wanted to know what employees’ priorities were. SurveyMonkey walked me through the process of designing a simple survey (10 questions) and compiled the results for me.
I presented the results of the survey at my first quarterly staff meeting and discussed what my challenges were in trying to meet the needs of the employees and the needs of the organization in choosing a health plan. The use of the survey tool and my discussion of the results let the staff know that their feedback counts.
Now, we’re designing a new office and I am soliciting information (not anonymous this time) about what people value in a workspace and what their needs are for technology and comfort. Feedback from the staff is that they like being asked what they think and enjoy the surveys. Feedback from me is that SurveyMonkey is easy to use and at $20.00 per month for unlimited surveys, it’s a tool that delivers the value.
Here are some other ways you might use surveys:
Put a survey on your practice website.
Put a survey on a computer monitor or tablet in your reception area.
Send a survey to patients via email.
Ask the staff or docs at referring physician practices to complete a quick survey about the service you provide to their patients.
If you’ve sent patients for tests, therapy or surgery, have them complete a survey about their experiences.
Have a computer for surveys at health fairs asking visitors to participate for a chance to win a prize.
Add a link on all marketing materials to a community survey.
I don’t often find articles that reflect my own views as closely as the article 
