The Three Phases of Staff Development
by William D. Esteb
At what stage of development is each of your staff members? Are you doing and saying the right things to nurture loyalty and commitment? Are you unknowingly sabotaging their desire for a career and setting the stage for high staff turnover?
Calculate the financial and emotional cost of replacing a staff member. Consider the disruption and reduction in your capacity. Try to measure the effect on patients who perceive a lack of managerial prowess. "What happened to Barbara? I was just starting to get to know her..."
Directing the actions of others is just one of the critical managerial responsibilities of running a business. While many doctors yearn for an arrangement where they only have to focus on the healing dimension of chiropractic, staff management will always be part of the daily routine, even with an office manager to assume some of these duties. Success lies in recognizing the changing needs of your staff and systematizing your response so it isn't a continual source of stress.
Much exists to help select and hire new staff members, yet few resources exist for doctors who are thankfully enjoying their third or fifth anniversary with their carefully chosen front desk assistant or X-ray technician. How do you prevent burnout? How do you keep enthusiasm up? How do you avoid losing someone because there is little chance for upward mobility in a small, closely-held business?
First, recognize that given the chance, staff members pass through three stages of development. These stages are not unlike the three stages of care patients experience. Like patients, some are not available for anything more than a job (Initial Intensive Care). Some continue with Rehabilitative Care and discover a career (Maintenance Care).
Encourage continued growth
Why do some patients fully integrate chiropractic into their lifestyle, while others remain hopelessly unavailable? While it doesn't guarantee longevity, patient education plays an important role in this process. Use this same sensitivity to create and nurture a loyal and committed staff by changing your "management" strategy during the three phases of employment: Entry, Excitement, and Empowerment. These three phases acknowledge that people remain in situations where they are growing, and leave situations when they stop growing.
The Entry Phase. The Entry Phase covers the hiring process and about the first month or so in the office. Offices interested in creating lasting staff relationships test applicants not only for necessary skills (typing, math, filing, etc.) but also for a shared value system. Because even if a potential new staff member can file flawlessly and type 100 words a minute without error, if there isn't a shared value system and pre-existing "health awareness," you are looking at a short-term relationship. It will never be more than a job.
How do you test for values compatibility and health awareness? First, ask what's important to them. Have them think of someone they used to work with. What were some of the values or characteristics of that individual they especially appreciated? What are some of the important values they want others they work with to have?
Interviewing for a sense of health awareness is somewhat difficult, since you will probably be dealing with candidates weaned on the medical model. Don't let that distract you! What you're looking for are people in touch with their own bodies who will have a better chance of empathizing with patients. Again, give them a chance to reveal their health attitudes while talking about someone else. Have them think about someone they know who they perceive as being very healthy. Then have them describe some of the characteristics that contribute to that person's health. Then reverse the question. Have them think about someone who isn't healthy and describe those characteristics. You're not looking for clinical insights; you're looking for their use of language, sensitivity, and other subtle clues. Because many people become self- conscious at job interviews, trying to give the "right" answer, help them feel more comfortable by focusing their attention on someone else.
The rest of the Entry Phase is obvious if you recognize the mind-set of your new staff member: they want to win. So, during their initial phase in the office they are likely to be very "I" directed. How can I do the right things? How can I not make a mistake? How can I look good to my new boss? After a rudimentary explanation of chiropractic, its purpose, and its language, the primary focus should be procedural. Help your new employee feel and look competent as quickly as possible. Chiropractic philosophy falls on deaf ears in the same way new patients cannot hear the key words in your report of findings when they are still in pain.
As soon as the basics are mastered, staff members are available for the Excitement Phase.
Excitement Phase. Because the most pressing need when hiring a new staff member is often clerical in nature, it's easy to neglect the development of the naturally occurring Excitement Phase. Or, before investing too much time and energy in staff education about chiropractic, we decide to wait and see if your new protege will "work out." And they do. They master the clerical side of the job quickly and start looking so good, we forget that their chiropractic knowledge is as superficial as that of most patients entering the practice. And because their chiropractic education is not systematized, getting a staff member truly excited about chiropractic is time-consuming and takes a second place to maintaining patient flow. This is why the Excitement Phase is usually remembered by most new staff members as the Endurance Phase! Without a vision of chiropractic larger than that of the apparent solution to an endless string of patients suffering back problems, being a chiropractic assistant becomes a repetitive job with little fulfillment.
With the mastery of office procedures, your new staff member can look beyond the "me" orientation of the Entry Phase and is available for a "you" perspective. Only now is your staff member available to begin the process of nurturing patients. "How are you doing today, Mrs. Jones?" Respond by laying the groundwork for them to have a career in chiropractic. They should be learning everything they can about chiropractic. Spend lunch hours and staff meetings sharing your chiropractic philosophy. Send your staff home with books and audiotapes. Encourage questions. Share the clinical progress of some interesting cases. Get them involved beyond the mere clerical. Remember, you're battling an entire lifetime of health attitudes shaped by the germ theory and the belief that ill-health is only associated with obvious symptoms. Use this time to explain your adjustment technique, X-ray analysis, and the many other things you do. Show your post X-rays. Celebrate your victories. Share your frustrations. The objective is to deepen their involvement beyond keeping a neat appointment book. Remember that patients are seldom more excited about chiropractic than your staff is.
Wait too long before developing this awareness in your staff, and you miss an important window of opportunity that may doom the future of your new employee.
Soon your newly-hired staff member will be ready for the Empowerment Phase.
Empowerment Phase. You'll know when your staff member has entered this stage of development when you discover their new sense of initiative. Now, the sense of "we" emerges. A sense of "psychic ownership" in the practice blossoms.
If lateral moves within the office aren't available, such as becoming a new patient advocate or performing preliminary patient exams, your employee may have exhausted the opportunity for continued professional growth. Seize this opportunity by continuing their growth on a personal level. And while the specifics vary with each individual, help your staff member identify areas of potential self-development. This is when it makes sense to invest in your staff through a Dale Carnegie course, advanced chiropractic seminars, public speaking programs, business communications classes, and a whole range of other activities whose dollars and cents return to the clinic may only be indirect or long term. The strategy here is to maintain some form of growth so your employee remains alert, vibrant, and alive.
Doctors who recognize these changing stages of employment can respond appropriately. Motivating the staff is easier when you can see that the source of job satisfaction changes during the course of employment. It takes extra effort, but it is a small price to pay for reduced turnover, sense of team, and the stability that patients want in an environment designed for healing.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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