Discretionary Energy

by William D. Esteb

In Hal Rosenthal's book, The Customer Comes Second, he observes that the recent focus on customer (patient) service has been misdirected. He suggests that employees come first, not customers. Employees treat customers (patients) the way their supervisors (doctors) treat them. If the boss is authoritarian and untrusting, staff members use the same level of hostility towards customers. The reverse is true too. At its most fundamental, it is a question of leadership. Poor leadership creates inattentive, unresponsive and detached employees. Great leadership fosters committed, enthusiastic and conscientious employees. Offices with low staff turnover and delighted patients are offices in which the doctor taps the "discretionary energy" of their staff.

Your car mechanic takes the effort to show you how proper tire inflation will improve your gas mileage. Your wait person gently steers you away from a menu item that she knows is poorly prepared. Your hotel clerk asks you whether you'd prefer a room with a view of the gorgeous sunsets or the beautiful sunrises. These are examples of discretionary energy. They require the front line service provider to go beyond the required and expected. When expected levels of service are rendered, the event is barely noticed by the customer. When extraordinary service (requiring discretionary energy) is delivered, it is memorable and provides customers with the motive to remain loyal and refer others. Getting staff members (and doctors!) to embrace this servant attitude and regularly deploy their discretionary energy seems elusive. It is not something that can be mandated by office policy. It is earned.

In a chiropractic setting, discretionary energy prompts staff members to remember little details or preferences of each patient and make their visit more pleasant. It's when the doctor takes the time to call the patient after the first adjustment. It's when a staff member bends the rules just a little to help solve a patient's problem. It's when staff members step in to help a patient's temporary transportation problem. It's the ability to recognize the thousands of little opportunities that reveal themselves when you're working with other people. It can't be ordered or policied. Each staff member decides if their additional energy reserves will be used in the service of patients or taken home to a hobby, the bowling alley or squandered in front of the TV set.

Many management firms seem to overlook ways of empowering doctors to harness this important type of energy in their staffs. Whether they'd rather more directly serve the needs of the doctor who pays them, incorrectly assume creating long term staff relationships is impossible or that they don't know how to adapt to this management reality, is difficult to know. In the past, quickly training low-wage women to process patients and paperwork was the only goal. Staff members rarely stayed more than a year. Burnout was epidemic. Today, one thing is clear. As insurance continues to be less of a factor and chiropractic enters the free enterprise market economy it will be those offices able to cultivate the discretionary energy of their staff that will enjoy a competitive edge.

Here are some ideas that can help prepare the soil so discretionary energy can grow and prosper in a chiropractic environment:

Spirit: This has to do with shared values. It is essential that doctors and staff share a similar value system if the most frequently mentioned patient complaint about staff members is to be avoided: turnover.

You've seen it before. The potential new staff member has incredible skills. He or she can alphabetize better than a dictionary. Or he or she has a winsome way with delinquent patients. The only problem is they smoke, worship trees or think piercing body parts is, well, attractive. Too bad. The foundation of long term doctor/staff relationships (and long term doctor/patient relationships) is a shared value system.

Belonging to a team: Many suggest that belonging to a group is a fundamental yearning of most of us. If you want to tap into the discretionary energy of your staff, help them to assimilate into your team. That's more difficult than it sounds. Think back to the Apollo mission to the moon. Consider the incredible teamwork required. Give people a big vision and watch their commitment increase. Small dreams (making a salary, getting by, paying the bills, etc.) attract small people. Big dreams attract big contributors and inspire the very best in everyone.

Access to information: I continue to find it amazing how many staff members are kept in the dark regarding some of the most basic office information. You'd be surprised how many staff members are not under care themselves and haven't the foggiest idea what chiropractic is! Worse, the office mission statement and practice values are never articulated and even statistics are considered state secrets. Staff members see the big checks coming in the mail, but rarely see what it costs to run the office. When information isn't shared, staff members are left to their imagination--with counterproductive results. "Why knock myself out," wonders many staff members, "when I'm getting paid peanuts and the doctor is making a million dollars a year?"

Big vision: We all want to be part of something bigger than ourselves. This desire to belong and identify is a powerful force exploited by sports teams, religious cults, swat teams, political parties and many other groups. Yet, instead of taking opinion polls and worrying about what employees (and patients) think, everyone is looking to their doctor for direction and leadership.

Leaders are much more concerned about doing the right things, than doing things right. If you want to tap into the energy reserves of your staff, make sure everyone knows the target you're aiming for. Take a stand. Share a vision.

Safe risk taking: With a clearly articulated vision, staff members can be more confident and resourceful in making the judgment calls required of them. Each staff member should feel safe to make mistakes in non-life or death situations. The staff should be encouraged to try new methods. Break the rules? Of course--when it's appropriate. Staff members need to know that when something goes wrong the "system" (or lack of one) is as much to blame as they are. Creative new solutions and a "can do attitude" thrive in environments which encourage appropriate risk-taking. Staff members give 110% only when it's safe.

Appropriate acknowledgement: Funny, but staff members rarely give that "extra something special" unless someone notices it and acknowledges it. Fortunately for some staff members all it takes is to have a patient say, "I enjoy coming here just to see your bright smile." Yet, for most staff members it requires more than a chance comment from a delighted patient. This is the responsibility of the doctor. Aggressively search out occasions to thank, congratulate and be delighted by things your staff says and does. Virtually every employee motivation study suggests that money is much less of a motivator than praise, encouragement and working with appreciative people.

Doctors who whine that "all they want to do is adjust" discover that their dream can come true if they are willing to put into place office systems and employee training that can leverage their time and talent. It is hard for staff members to offer their discretionary energy if they have to handle everything three times: first when a problem is presented, second when it is described to the doctor and finally a when they act on the doctor's direction. No wonder few staff members use discretionary energy--it gets used up just trying to get through a typical day!

Excerpted from
Beyond Results
Originally published in 1995
240 Pages
US $24.95

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