Everyone Is Essential: Guest Author Bob Cooper

Obama Fist Bump with JanitorSome organizations will use the terms essential and non-essential workers as a way to distinguish between who needs to be on site in the event of an emergency, and who does not. I do understand the purpose of this distinction, however, it’s very important that businesses not give the impression that some employees are more important or valuable than others.

Have you ever thought about the importance of the Bank Teller’s role? Is this individual given the requisite respect they deserve? I once overheard a bank manager say the following – “She’s only a teller, you can’t expect her to know better.” Think about the responsibility of this role. The Teller helps to build the customer experience and is responsible for very important transactions. I don’t know about you, but I want the Tellers in my bank to be satisfied and maintain a good focus on their work.

How do you view each and every member of your team? Do you respect everyone as an important member of the team? How does each person on your team impact the internal and external customer experience?

Your employees are your most important asset, and you need to serve them. If you expect them to deliver exceptional service to others, you need to serve them first.

The following are a few suggestions to demonstrate that you view every member of your team as essential:

1) Show Respect at all Times – Never make the same mistake that the Bank Manager made by saying “She’s only a Teller, or clerk, or aide, or any other position. Sometimes the best ideas come from your front-line staff. They have dreams and aspirations and want to know that you value them for their contributions. They have feelings and want to know that you value them as professionals.

2) Engage their Hearts and Minds – Give every member of your team the opportunity to become involved in all aspects of the business. Show your staff how their work is integrated with other members of the team and is critical to the organization’s success. Find out what motivates team members, and wherever possible, allow them to become involved in initiatives that ignite their passion. They should become engaged in offering ideas to build the business and drive strategy.

3) Say Thank You – Show your gratitude for individual efforts buy expressing sincere thanks for a job well done. The key is your sincerity. If your thank you is half-hearted, don’t be shocked when one of your best performers leaves the organization because they don’t feel appreciated. You can’t fake sincerity.

4) Care About Them – Have you ever experienced a personal problem only to find your boss is only concerned with the project you are working on? I have heard bosses say – “Leave your personal issues at home.” Oh really? What if a staff member has a loved one who is very ill? Should this not matter? I have witnessed throughout my career many top performers change jobs because they felt their boss was totally insensitive to their personal concerns. When people come to work, they bring their whole selves to the office. Of course they need to perform their duties responsibly. As a leader, part of your job is to help staff keep their head in the game. You need to show empathy and assist the employee to effectively deal with their issues.

5) Bring Them Coffee – In my book “Heart and Soul in the Boardroom” I discuss a former boss named Warren. Although I have not seen Warren in over 25 years, I remember him as if it was yesterday. Warren would say – “Bob, can I bring you a cup of coffee back from the cafeteria?” He would make the same offer to every member of the team. Warren treated every member of the team with respect. What about the boss who asks his or her assistant to bring back a cup of coffee and never offers to do the same? What’s the message? This individual believes that others are there to serve them – WRONG! You are there to serve others. In turn, they will reciprocate and go the extra yard to help you win.

6) Care About Their Careers – Take the time to listen and understand your employee’s goals. Make every effort to help them to achieve their goals. The key here is to show the effort and desire to assist them to reach their full potential.

Great leaders treat every member of the team as essential. They realize that the receptionist or janitor make a huge impact on the customer experience. I will never forget what a former boss named Harry said many years ago during a meeting. Harry said – “Remember, the janitor may be at the bottom of our organization’s hierarchy, but is the CEO to his family.” I can still hear Harry’s voice. He was so right. Every human being deserves to be respected.

If you treat every member of your team as essential, and truly care about them, they will perform beyond your expectations. We must make sure the financial compensation is fair and competitive, but the differentiating factor is that staff know you care, and see them as essential to the organization’s success.

For a complete listing of our services, please visit us at www.rlcooperassoc.com or call (845) 639-1741.

RL Cooper Associates’ book Heart and Soul in the Boardroom outlines suggestions for leaders to develop highly respectful and ethical work cultures and is available in the Manage My Practice Store. For additional information about their services, please visit www.rlcooperassoc.com.

Guest Author Donald “Tex” Bryant: Good Communications Equals Good Outcomes

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.

Poor outcomes for patients and doctors are found in many other medical settings besides surgeries, although these seem to get the most attention in the press. Consider the following scenario, for instance. A family physician during a well baby visit was looking for a pediatric stethoscope. It was not in her office. She excused herself from the exam room and went searching for it in the office. It took her 5 minutes to find it. The incident was very annoying to her and the mother of the child. She had to hurry through the exam and did not have as much time as she needed to talk to the mother. There were no serious consequences from this visit but the outcomes were not optimal either. The mother lost a bit of trust in the doctor that day.

Besides the failure to communicate adequately with the mother, the misplaced stethoscope is also a failure to communicate with staff. With good communication habits at the ambulatory site there likely be good organization too: a place for everything and everything in its place. Good routines and habits would emerge and time spent with patients would improve. Outcomes would improve. Doctors and staff would be more satisfied with their work.

What, then, are some characteristics of good communication? One is that each staff member has the opportunity in the right setting to express his or her opinion about how a particular process could be improved or how patient safety could be improved. Being able to express oneself is not enough, though. Leadership must make sure that good ideas for improvement and safety are implemented in a timely manner. The person who made the suggestion should be recognized.

Another characteristic of quality communication is that time is set aside for staff meetings to address suggestions brought to the attention of leaders at the site. For instance, in the ambulatory setting described above, the physician can suggest to the office staff director that something should be done about making sure that physicians need not leave their office during a patient encounter to look for missing supplies or the physician as leader in the office can call the meeting. Meetings such as these should be scheduled regularly; other issues other than processes and safety can be addressed. For instance, meetings can be used for training, such as for EMR implementation.

Team meetings are a good place for problem solving using effective communication. To be effective they must be well organized and run. Based upon my experience in working with a variety of teams in a variety of settings and based upon discussions with colleagues along with research, I believe that there are several elements that are necessary for effective team meetings. These are:

  • Strong leadership
  • Preparation
  • An agenda
  • Staying focused
  • Participation by all members
  • Decision rules
  • A time limit

Keeping focused is not always easy. There can be staff members who distract or disturb the meeting. Team leaders should be alert for distractors and quickly refocus the group. The Wall Street Journal listed a few of the types of distractors recently in an article titled “Meet the Meeting Slayers”. One is the “know-it-all”. This person keeps promoting his own ideas and will not consider the ideas of others. There is also the “naysayer”; this person tends to shoot down most ideas. Another is team member who tends to drift off to other topics, such as the birth of a child or grandchild.

As you can see there are many skills required of a team leader. Besides controlling disruptions, he must also encourage all to participate. Someone who may be timid to speak should be encouraged; his or her idea may be one of the most innovative and important. When I am leading a meeting before I close discussion of a topic I make sure that I personally address any who have been quiet and ask if they have any comments. If not, I may ask them to summarize the previous discussion so that they will be involved.

As you can tell, communication is very important at medical sites. There are many benefits to effective and ongoing communication—optimal outcomes for patients, satisfaction among staff that they are delivering quality care in a culture that supports them and improved income. While I believe that most recognize that effective communication is necessary for these outcomes, achieving it takes a lot of effort.

On another note, I suggest that you read Power of Habit. It has many good ideas that you can apply to your patient encounters. The second section of the book also describes in detail ways to become an effective organization.

Headshot of Guest Author Donald "Tex" Bryant

Bryant’s Healthcare Solutions offers training and advice for helping you achieve optimal patient or client outcomes while improving the bottom line.
(www.bryantsstatisticalconsulting.com). If you want to discuss more about good communication contact Bryant’s Healthcare Solutions. Mr. Bryant is certified by the University of Michigan as a Lean Healthcare facilitator.

Contact Mr. Bryant at t.Bryant@alumni.utexas.net or call 616-826-1699 if you need more information. With my help, I promise that we can meet your needs. Would love to chat over a cup of coffee or over the phone. Looking forward to hearing from you. If you need a speaker to present at a meeting or conference, please contact me and I will consider doing so.

What Does a Medical Practice Manager Do?

clockWhether the title is manager, medical practice manager, physician practice manager, administrator, practice administrator, executive director, office manager, CEO, COO, director, division manager, department manager, or any combination thereof, with some exceptions, people who manage physician practices do some combination of the responsibilities listed here or manage people who do.

Human Resources: Hire, fire, counsel, discipline, evaluate, train, orient, coach, mentor and schedule staff. Shop, negotiate and administer benefits. Develop, maintain and administer personnel policies, wellness programs, pay scales, and job descriptions. Resolve conflicts. Maintain personnel files.  Document Worker’s Compensation injuries.  Address unemployment inquiries.  Acknowledge joyful events and sorrowful events in the practice and the lives of employees. Stay late to listen to someone who needs to talk.

Facilities and Machines: Shop for, negotiate, recommend, and maintain buildings or suites, telephones, hand-held dictation devices, copiers, computers, pagers, furniture, scanners, postage machines, specimen refrigerators, injection refrigerators, patient refreshment refrigerators, staff lunch refrigerators, medical equipment, printers, coffee machines, alarm systems, signage and cell phones.

Ordering and Expense Management: Shop for, negotiate and recommend suppliers for medical consumables, office supplies, kitchen supplies, magazines, printed forms, business insurance, and malpractice insurance as well as services such as transcription, x-ray reads/over-reads, consultants, CPAs, lawyers, lawn and snow service, benefit administrators, answering service, water service, courier service, plant service, housekeeping, aquarium service, linen service, bio-hazardous waste removal, shredding service, off-site storage and caterers.

Legal: Comply with all local, state and federal laws and guidelines including OSHA, ADA, EOE, FMLA, CLIA, COLA, JCAHO, FACTA, HIPAA, Stark I, II & III, fire safety, crash carts and defibrillators, disaster communication, sexual harrassment, universal precautions, MSDS hazards, confidentiality, security and privacy, and provide staff with documentation and training in same.  Make sure all clinical staff are current on licenses and CPR.  Have downtime procedures for loss of computer accessibility.  Make sure risk management policies are being followed.  Alert malpractice carrier to any potential liability issues immediately.  Make sure medical records are being stored and released appropriately.

Accounting: Pay bills, produce payroll, prepare compensation schedules for physicians, prepare and pay taxes, prepare budget and monthly variance reports, make deposits, reconcile bank statements, reconcile merchant accounts, prepare Profit & Loss statements, prepare refunds to payers and patients, and file lots and lots of paperwork.

clockBilling, Claims and Accounts Receivable: Perform eligibility searches on all scheduled patients.  Ensure that all dictation is complete and all encounters (office, hospital, nursing home, ASC, satellite office, home visits and legal work (depositions, etc.) are charged and all payments, denials and adjustments are posted within pre-determined amount of time.  Transmit electronic claims daily.  Send patient statements daily or weekly. Negotiate payer contracts and ensure payers are complying with contract terms.  Appeal denials. Have staff collect deductibles, co-pays and co-insurance and have financial counselors meet with patients scheduling surgery, those with an outstanding balance, or those patients with high deductibles or healthcare savings plans.  Make sure scheduling staff know which payers the practice does not contract with.  Liaison with billing service if billing is outsourced.  Credential care providers with all payers.  Perform internal compliance audits.  Load new RBRVS values, new CPTs and new ICD-9s annually.  Run monthly reports for physician production, aged accounts receivable, net collection percentage and cost and collections per RVU. Attach appropriate codes to claims for e-prescribing and PQRI.  Have plan in place for receipt of Recovery Audit Contractor (RAC) letters.  Make friends and meet regularly with the provider reps for your largest payers.

Marketing: Introduce new physicians, new locations and new services to the community.  Recommend sponsorship of appropriate charities, sports and events in the community. Recommend sponsorship of patient support groups and keep physicians giving talks and appearing at events.  Thank patients for referring other patients.  Track referral sources.  Recommend use of Yellow Pages, billboards, radio, television, newspaper, magazine, direct mail, newsletters, email, website, blog, and other social media. Prepare press releases on practice events and physicians awards and activities.  Recommend practice physicians for television health spots.

Strategic Planning: Prepare ROIs (Return on Investment) and pro formas for new physicians, new services, and new locations.  Forecast potential effect of Medicare cuts, contracts in negotiation or over-dependence on one payer.  Discuss 5-year plans for capital expenditures such as EMR, ancillary services, physician recruitment, and replacement equipment.  Explore outsourcing office functions or having staff telecommute.  Always look for technology that can make the practice more efficient or productive.

Day-to-day Operations: Make the rounds of the practice at least twice a day to observe and be available for questions.  Arrange for temporary staff or rearrange staff schedules for shortages, meet or speak with patients with complaints, and meet with vendors, physicians and staff.  Open mail and recycle most of it.  Unplug toilet(s).

Stay Current in Healthcare: Attend continuing education sessions via face-to-face conferences, webinars, podcasts and online classes.  Maintain membership in professional organizations.  Pursue certification in medical practice management.  Network with community and same specialty colleagues.  Participate in listservs, LinkedIn and Twitter.

What did I leave out?  Take a lunch?

Read my post on “How Much Do Medical Practice Managers Make?” here.

Monday Special: Use BNET and CNET to Find Information on Business, Management and Healthcare

BNET is Business Network and CNET is Computing Network and both sites are owned by CBS.

BNET is a great one-stop shop for information on business and management, and now the site has a category for healthcare described as:

…daily industry news coverage and insights for managers and executives, focusing on the major health care providers, hospitals and facilities, insurance companies, and medical device manufacturers. In addition to detailed company profiles, we bring you critical analysis on new alliances and partnerships, new products, health care cost control, partnerships and alliances, management and board changes, and a host of other important business issues.

That may be a bit much to consume on a daily basis, but don’t forget, information is a buffet, and you don’t have to eat everything!

Here are a few BNET goodies you might like to check out:

Marketing Secrets from Campaign ’08 (if you are in a competitive market, read this and think about your maketing!)

Finding Opportunity in Upheaval (if everyone at your practice is stressed and cranky, it’s a perfect time for you to think differently. Patients need healthcare – what are you going to do about it?)

And don’t forget to check out BNET’s Business Library and Videos (including “Motivating a Stressed-Out Staff” during an economic downturn – very solid advice – I give it 5 stars!)

CNET is all about cell phones, computers, audio, video, etc., and has the latest on gadgets, including reviews and prices.  It’s also a great site to find software to download.  This site might not be as appealing as BNET, unless you’re as geeky as I am, and the longer I write this blog, the geekier I get.  One of my favorites on CNET is Tips & Forums.

And just in case you are geeky, check out Woot, the site I check daily for great geeky deals.

Monday Special: One Big Gift Box with One Big Resource Website for Healthcare Managers

Okay, this is a big one!  This one website is like a big gift box that has another box inside and another box inside, and so on.  The health100.com site has links to over 800 of the top English-language health blogs.  You can search on site names or search on content.  There are clinical blogs, research blogs, hospital blogs, and management blogs. You can find information, opinions, news, webcasts, and podcasts. You can find lawyers, doctors, nurses and patients.  And pretty soon, you’ll be able to find me!

Happy hunting, and let me know what you find.