The Cost of Ownership

by William D. Esteb

A crucial link in having patients fully experience your educational program is an enthusiastic and committed staff. Yet, high staff turnover within chiropractic interferes with this critical procedure. Sadly, staff turnover is so widespread, many doctors accept it or merely shrug it off as the cost of doing business. And it's a very high cost.

The subject comes up in patient focus groups I've held for offices that have experienced high turnover. It's demoralizing for patients to see a new face behind the front desk, and it raises questions about behind-the-scenes working conditions and the doctor's management abilities. It lowers the image of the office and the credibility of the entire staff. As in other businesses with high turnover-fast food restaurants, car washes, or convenience stores-it's expensive, disruptive, and redirects large amounts of energy away from serving your patients.

If you have the wrong people or have harnessed their potential incorrectly, get on with the inevitable! You're doing them, the office, and the future of chiropractic a disservice by unnecessarily prolonging a doomed relationship.

A job versus a career

For many, the selection, hiring, training, and nurturing of staff members is the most challenging aspect of running a chiropractic office. If success has been spotty, it may require a shift in attitude and approach. Without change, your practice and profession stand to be hurt in the future as members of the baby boom generation become fully integrated into the work force. As the number of available workers diminishes, chiropractic will have to face up to salaries that ignore the realities of an increasingly competitive marketplace, a professional reputation tarnished by furniture store advertising tactics, and training programs that limit staff positions to narrowly-defined, repetitious, task-oriented, burnout-producing jobs.

Pay more?

But is the solution more money, more benefits, and more, more, more? No. No. And no. How do the best run companies avoid expensive staff turnover and create career positions? Ownership.

Not literal ownership. Not co-signing your bank loan. Not putting their name on the clinic sign. Not a bigger desk in the corner office. Not even a raise. Psychic ownership. A sense of belonging. A real feeling that it's "our" practice. If you have the right staff and you want to keep them, here are some ways to help nurture a sense of psychic ownership in your practice.

Team linguists

The first involves semantics; how the doctor uses language to describe office activities. Most small business owners work very hard to build their businesses. Almost single-handedly they've kept the bill collectors at bay during the early days. It's their vision and their name on the sign out front. Naturally there's the tendency to call it "my business" or "my practice." If you're interested in remaining the Lone Ranger, stunting the commitment of those around you, continue to call it such. But the most successful business leaders recognize the contributions of their staffs and refer to their business as "our business" or "our practice." It seems such a small thing, but employees are sensitive to it, and swell with pride when they hear it.

A corollary of the my/our practice is the "my girl" reference so often heard in chiropractic circles, as in, "I'll have my insurance girl call you..." Besides being sexist, it's demeaning, it's dictatorial, and it's out of touch with the language that motivates and inspires team support in the 1990s.

Another way to build psychic ownership is to involve the staff more closely in patient care. Doctors are in the enviable position of experiencing a sense of progress with patients. Patients enter the practice almost desperate, and over a period of days, weeks, or months, regain their health. Sure, it's fulfilling. Yet, for the staff insulated from this primary source of inspiration, progress is measured in less satisfying terms: kept appointments, running on time, and other mundane interactions. Staff members can feel a sense of psychic ownership when they are kept up to date on the clinical progress patients experience, feeling a vicarious sense of participation in the caregiving process.

Promoting a sense of psychic ownership requires a sense of team. Building a successful team, whether in sports, politics, or health care, requires these six ingredients:

1. A common purpose. Is there a statement of purpose that everyone understands, supports, and aspires to? Does the staff know the long- and short-range goals of the doctor? Must staff members derive intentions solely by the doctor's behavior, or does the doctor freely communicate office objectives?

2. Appropriate division of labor. Does everyone understand their duties and how they contribute to the intended outcome of the practice? Are job descriptions specific, yet flexible enough to allow growth? Are staff members laterally trained so they can cover other positions in an emergency?

3. Accepted leadership. Even though it's the least glamorous part of running a small business, have you embraced your leadership role, providing management direction? Or do you depend upon a "from the hip" response to the latest emergency? Is your management style participatory or dictatorial? Have you dealt with the differences between being liked and being respected?

4. Agreement on the plan and process. Is there a detailed procedural manual that empowers the staff to make necessary decisions? Or is every new staff member inventing their job? Do staff members constantly have to "check with the doctor" on too many issues?

5. Solid relationships of mutual trust. A good indication of this is whether staff members see other staff members in social, non-working situations. Or does everyone come together during clinic hours just because they have to?

6. Good communications. This may be the most important of all. Are there frequent staff meetings? Proximity does not guarantee communication-or understanding. Is the door always open to talk about any issue? Even the Emperor's Clothes?

Team celebrations

These six issues contribute to the sense of teamwork important to psychic ownership. Another overlooked component in nurturing a sense of psychic ownership is in celebrating together. Often intra-staff communications are limited to problems-with patients, insurance companies, or others. No wonder we avoid staff meetings! Instead of discussing the three negative patients, stress the 10 unusually pleasant or appreciative patients. Have everyone collect and share at least one positive experience they had during the week at each staff meeting. Consider occasional meetings outside the office to give your meetings a fresh outlook and perspective.

The doctor as a coach

Another vital aspect of psychic ownership is the way day-to-day management and supervision take place. When the doctor hovers over the appointment book it undermines confidence and communicates a lack of trust. Reactions to new ideas determine the willingness to volunteer future ideas. How you handle the inevitable mistakes teaches risk taking. How the doctor stands up for staff members in disputes with vendors or others is a barometer of trust and respect. Today's successful manager is a facilitator, cheerleader, and coach.

Providing opportunities for staff members to have psychic ownership takes confidence. Since psychic ownership cannot be purchased with higher paychecks, it is a rare quality. But to bask in its power takes the biggest risk of all. It requires honesty in facing limitations. Exposing hidden agendas to others. Even rejection or allowing others to take advantage of a vulnerability you've extended. But above all, it may require doing the most terrifying thing we ever do: change.

Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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