The Perfect Staff
by William D. Esteb
Probably the most telling aspects of a doctor's relationship with patients is his or her relationship with their staff. Staff relationships reveal a lot about the doctor's communication skills, management savvy and personality defects. Doctors who are most successful in growing long-term relationships with patients, seem adroit in their relationships with staff members. Yet, there is a fundamental difference: patients pay the doctor, but the doctor pays the staff. So staff members are more likely to put up with a doctor's shortcomings than patients. Conversely, because staff members know that it is impolite to bite the hand that feeds them, they are reluctant to criticize or "tell the emperor that he's not wearing any clothes." Dysfunctional doctor/staff relationships continue to blunt the impact of many chiropractic offices.
In Hal Rosenbluth's book, The Customer Comes Second, this issue is addressed in the context of one of the world's largest travel agencies. Mr. Rosenbluth's perspective that the needs of the staff come before the needs of the customer (patient), flies in the face of conventional wisdom. It is tempting to look past the staff and focus entirely on the patient, the patient's spine, the patient's form of payment and the patient's likes and dislikes. And while it's important in this age of "consumerism" to be responsive to the needs of patients, bypassing the staff can sabotage everything.
Yet, because staff hiring, training and management are not taught in chiropractic college, this void is filled by entrepreneurial forces who often teach a form of staff management based on fear and intimidation. A style that is more ineffective and out of touch than it was in the 1950s when used by General Motors, IBM and other corporate behemoths.
Based on the conversations I've had with staff members when the doctor is out of earshot, an interesting profile emerges.
No training. It's astonishing, that with the critical role staff members play in the service to patients that they are so poorly trained. When I ask staff members on the telephone what adjusting techniques the doctor uses, many who answer the telephone act as if I've suddenly broken into an esoteric dialect of Portuguese! Basic issues like adjusting technique, which chiropractic college the doctor attended (and when), special training, awards, specialties, financial policies and other fundamentals should be part of every staff person's understanding. Unfortunately, doctors are rarely in a position to observe staff members fumbling these topics, nor is there a ledger entry that records the loss of patient confidence and practice income these gaffs cause. Apparently, staff training, when it does occur, is the result of occasional management seminars or conducted in the heat of battle while the doctor is distracted by the demands of patient care.
Action steps: Reserve a consistent time each week, maybe a Tuesday or Thursday morning, for staff training and rehearsal. Yes, rehearsal. Remember, products are manufactured, and services like chiropractic are performed. An effective rush hour is as much a performance as it is an issue of being a traffic cop. Practice when the office is empty. Role play at the front desk. Call into the office from the second line and pretend you're a new patient calling 10 minutes before closing time. Ask about fees, appointment times and generally push the limits. Practice with the actual forms, questions and environment your staff will encounter on a busy Wednesday evening!
Staff in fear. It's still amazing that there are doctors who think the best way to get staff members to perform is by intimidation and a fear-based management style. This approach may purchase their bodies, but it ignores their minds. So while staff members dutifully show up one minute before starting time and leave within one minute after closing time, their emotional commitment is missing. They do as they are told, but contribute little else. They offer few suggestions for improvement. They are afraid to approach the doctor or, the doctor's spouse with a problem or concern for fear of being reprimanded. Little problems fester. The staff is always looking for another job. Staff turnover is epidemic under these conditions.
Action steps: The most contemporary, mainstream management style teaches the importance of empowering the people actually doing the work to help shape the nature of their work. I'm not suggesting turning the asylum over to the inmates! Create an environment where staff members feel comfortable continually rethinking their job responsibilities and looking for ways to improve them. Imagine the countless offices still using the same procedures as they did six years ago before the decay of indemnity insurance and the emergence of managed care! Institute a policy that invites a continual questioning of the status quo. Reward staff members who are good at asking "why?" and who look for ways to enhance, streamline or discard inefficiencies and needless effort. The only thing to fear from this management posture is that you may find yourself having to defend procedures whose purpose you've neglected to explain, or discard policies that give you a false sense of security. Get real!
Staff excluded from clinical concerns. Without some knowledge and appreciation for your clinical approaches, not only do you exclude your staff from the joys and fulfillment you experience, but you've tricked them into a boring, dead end job. How well do you think you'd last where the pinnacle of achievement is keeping patient files in alphabetical order, and supervising an appointment book in which the objective is to get patients to show up in an order previously scheduled.
Action steps: Involve your staff in the clinical picture of each new patient. Explain how you approach each case. Reveal the concerns you have. Share your frustrations. Bring your staff into the "inner circle." Sure, they may never fully appreciate the mind-numbing training and classroom work you've had to put up with to get to this place, but try.
Certainly there are issues of patient confidentiality here, but if your staff is too immature to understand and respect these dynamics, you may have the wrong staff. No wonder so many doctors feel isolated in their practices--they haven't groomed any teammates!
Staff given the dirty work. The mark of good leadership is to never assign a task to a subordinate that you wouldn't be willing to do yourself. Yet, all too often, staff members are asked to lie ("He's with patients right now...") or to badger patients to return for care they don't understand or want ("Yeah, the doctor found something on your X-rays he wants to talk to you about...") or perform personal errands that would make even an indentured servant feel uncomfortable. Interestingly, these tasks are rarely discussed during the interview process before staff members are hired.
Action steps: Create some clear job descriptions at your next staff meeting. Outline job functions which are considered daily duties, weekly responsibilities and occasional tasks. If you're expecting staff members to entertain young children, vacuum the office and pick up your laundry, let them know in advance. Lots of qualified staff members would be delighted to perform these chores--if your expectations are outlined in advance!
The promise of change. Doctors would be surprised how many staff members dread attending chiropractic seminars. And it's not for the reasons that many doctors think. Many staff members look forward to a little vacation away from their families in a swanky hotel with room service. What they hate is being exposed to lots of great ideas that are never acted upon.
What is so disappointing is watching the doctor spend thousands of dollars on management services, only to ignore the advice, or giving up after only half-heartedly trying a new procedure for a week or so. After a couple of rah-rah sessions at the Hyatt, in which the promise of change is made, but not acted upon, staff members see what a wimp their doctor is and would rather stay home and do laundry.
Action steps: Make up your mind. Decide. Focus. If your management firm doesn't reflect your values or you're not inclined to act upon the suggestions presented at the next seminar, don't go! If you bring your staff, have every one contribute to a "to do" list when you return, before even the most obvious idea is newly implemented. As a team, decide which ideas have merit and how much time will be needed to confirm their value. Then, implement them with complete and total commitment. Holding back almost assures failure.
Not only do staff members spend more time with patients than the doctor, they make the most enduring, first and last impressions. They set the tone of the office and supervise its environment. They can make patients feel they are either a source of joy, or an irritating, schedule-busting inconvenience. They can spearhead office growth, or they can serve as a governor, regulating practice volume. Besides the ability to adjust patients, there may be no other more important aspect of practice than a nurturing a great staff.
Excerpted from
Chiropractic Patientology
Originally published in 1996
240 Pages
US $24.95
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