How to Keep Good Staff from Leaving Your Practice

Employees can financially make or break a medical office. Discover tactics physician leaders can use to retain highly valued workers.

All businesses suffer with staff retention issues. Nowhere does this seem truer than in the health care industry. We tend to blame high turnover on low wages, but often the reasons for leaving are multifactorial. Why is retention so important?

Statistics continually show that staff can financially make or break a practice. According to the Horizon Group's Survey of Family Practice, the top factors influencing patient satisfaction, in order of importance, are:

• Front-office staff.

• Practice facility ambiance.

• Clinical support staff.

• The physicians.1

Employee-retention expert Leigh Branham offers explanations for employee "disengagement" as well as advice on how to retain your best employees in his book, The 7 Hidden Reasons Employees Leave.2 Although much of Brahnam's ideas were written for the corporate world, his seven reasons can also be applied to our medical practices.

Disengagement and Needs

As physicians, we have limited experience being directly supervised by someone who controls how we operate within an organization. Sure, we may have government regulations and insurance companies making policies and dictating reimbursement rates, but this is a far cry from being a sales clerk at Target with a supervisor 30 feet away.

It is this lack of exposure that may desensitize us to our staff situation. In general, a staff member rarely quits for no apparent reason, but there are exceptions to the rule. Many of us have had an immature receptionist or file clerk just stop coming to work without bothering to call. Yet, if you're still hiring this type of employee, you will never improve the overall function of your practice.

There are several telling signs of unhappy employees. Most go through a process of "disengagement" that must be identified before they quit or resign. Unhappy employees will first question their decisions to accept their positions. They may then think of quitting but decide to stay and try to change the circumstances making them discontented.

Next, the workers may talk to the medical director or the office manager to express concerns. Finally, if they are not able to improve the situation, they will either quit, or stay and disengage.

A disengaged staff member is usually disappointed and bitter with the environment, and that negativity can be harmful to the financial success of your practice.

Branham states that an employee may begin to disengage and think about leaving if basic needs are not being met. These include:

• Trust. Expecting the physician or employer to be honest and open in all communication, to treat staff fairly and to compensate staff in a fair and timely manner.

• Hope. Having an opportunity to grow with the hopes of advancement or career progression.

• Sense of worth. Desiring some type of recognition for their dedication and commitment to the success of the practice.

• Competency. Expecting to be matched with a job that is in line with their skills or talents.

Why Do Staff Members Leave?

1. The job or workplace was not as expected. I previously worked in an office that hired a 40-something-year-old receptionist who told a co-worker that she took the position so she could spend more time with her children. She wanted to come into work late and leave early.

She also thought that her position allowed her to bring her children to the clinic for an examination any time they had a cold, regardless of the patient schedule. Needless to say, she was not happy when her expectations proved to be untrue, and she soon quit.

There are several ways to improve a potential employee's expectations for a position. First of all, create a job description including the critical requirements of the position for which the candidate will be responsible.

Secondly, include other staff members who will be working directly with the potential candidate in the interview process. Current staff may be able to better answer some of the candidates' questions regarding the position. This will also help increase acceptance of the new member to the practice and promote a team approach to hiring.

In addition, try to hire from within your practice whenever possible. If your office manager leaves and you have a qualified biller, that person may be an ideal person to step up and fill the role.

Another option is to hire through staff referrals. Employees tend to describe their roles more realistically and are interested in maintaining friendships with the individuals they refer.

When I practiced rural medicine, we hired a medical assistant from a town 60 miles away. Despite the commute, she was always dependable and performed her job with pride. When a front-desk position opened, she referred someone she knew who got the job. They carpooled together and were usually the first ones at the clinic. In the end, they both proved to be some of my best office staff.

2. There is mismatch between job and person. Many practices believe office staff are interchangeable and can be cross-trained to perform multiple duties. This may not be the best approach to filling vacancies when an employee calls in sick.

Our clinic hired a front-desk receptionist who struggled to perform her duties despite being properly trained. She simply could not handle answering the phones and dealing with patient registrations.

Because she had been a loyal employee and was well-liked by co-workers, the office manager opted to train her as a file clerk. She excelled in this position, with misplaced charts eventually becoming a thing of the past. The key was simply matching the employee's talent with the appropriate job.

3. Too little coaching and feedback. Most offices offer minimal training for "low-level" positions such as receptionists, but this is a major mistake. Receptionists are the first to come into contact with patients and help shape the first impression of your practice.

To improve patient services, we should borrow a page from Walt Disney's customer service handbook. Disney spends two weeks training custodial staff members; not because sweeping is difficult, but because they are frequently approached by guests with park questions.3

Consider training new staff members through mentoring or having them shadow other staff for a specified period. Also, clearly delineate what is expected and how staff will be evaluated.

Schedule monthly evaluations to provide employee feedback on job performance and keep an open-door policy for staff questions. In addition, allow staff members to provide evaluations of supervisors. Although this is rarely done, it provides great insight into managerial areas that need to be addressed.

4. Too few growth and advancement opportunities. Advancement opportunities may be difficult in many practice settings simply because people are usually hired to perform a specific task. Unless you work for a large group practice, upward mobility may be impossible.

One solution to this problem is to offer to pay for training that will benefit the overall mission of the practice. For example, billers and coders can be sent to seminars to become certified in their respective fields. In the case of my medical assistant who drove 60 miles to work every day, she has recently decided to enroll in a licensed vocational nurse program. When she completes her training, she is guaranteed a position working at the clinic.

5. Feeling devalued and unappreciated. We had a physician whose personality was similar to that of Dr. Jekyll and Mr. Hyde. One day he would come to work happy and respectful to all the staff. The next day, he would refer to office personnel as ignorant or lazy. Nurses refused to work with him because they were often belittled in front of patients.

To resolve this problem, we began having monthly meetings and encouraged staff input. Believe it or not, the physician didn't even realize that he was offending so many staff members. He started working on his behavior and even asked the staff to let him know when he spoke inappropriately. The staff appreciated having input at the monthly meetings and sharing ideas on how to improve the function of the practice.

Staff appreciation and recognition are often ignored in many practices, usually because providers think it is too expensive. But always remember that happy staff will be more loyal to the goals of the practice. Some inexpensive ideas include small "thank you" gifts such as free movie passes or monthly pizza parties. Another option is to schedule group outings such as picnics or a dinner night with staff and family.

Keep in mind that to make more money, you have to be willing to spend some money. Offer staff financial incentives that can be based on productivity, such as number of patient visits or amount collected per month. I know a family physician in rural Texas who takes all of his staff members and their spouses on an all-expenses paid vacation each year. Needless to say, he is well-liked by his employees.

6. Stress from overwork. Unless you are employed as a test subject at a massage therapy school, no job is stress-free. Much the same can be said about working in a medical practice. Both physician and patient demands can seem overwhelming for staff at times.

In addition, most practices require staff to work long hours, often through lunch. To get staff commitment, you have to give them the resources they need to perform their jobs well. Small things, like music in the office and comfortable seating, can make a world of difference. If long hours are a problem, consider offering shift work or "nontraditional" schedules.

Try to make the workplace fun while retaining a professional appearance for patients. At my previous clinic, we kept a cork board in the lounge with comics for staff to read. In addition, we wore casual clothes on Fridays and dressed up for holidays such as Halloween. To stay positive, we kept a dry-erase board in the main hallway, and each staff member rotated writing a famous inspirational quote weekly.

7. Loss of trust and confidence in senior leaders. The key to keeping your staff's trust is to back up words with actions. How often has a staff member come to you with a problem that needs to be resolved?

Often, we say that we'll look into it, but may completely forget. If after a few weeks nothing is done to investigate to problem, staff may lose faith in the leadership. They may feel that you are not in touch with their daily issues.

At my previous clinic, we had a clinic administrator who lacked both organization and communication skills. She never kept minutes at monthly staff meetings, so the same problems remained unresolved. We reached a point where several of the providers stopped attending the meetings. Fortunately, she was later replaced.

To combat the loss of trust, we as leaders must inspire confidence through our own competence. If we can't do our jobs, how can we expect our staff to perform theirs?

In the end, losing good staff members is never fun. To keep the ones you hire, you must first clearly define what the position will require. Train your staff well and provide feedback often.

Always listen to your staff. They will help you identify and remedy problem areas in your clinic. Don't forget to show your staff how much they mean to you and always lead by example. When staff morale is in doubt, put yourself in their shoes to gain a better perspective.

Peter Valenzuela, MD, MBA, FAAFP, is the CMO for Sutter Medical Group of the Redwoods in Santa Rosa, California.

REFERENCES

1. 1997 Survey of Family Practice. Virginia Beach, Virginia. The Horizon Group, Ltd.

2. Branham L. The 7 Hidden Reasons Employees Leave. New York, NY. AMACOM. 2005.

3. Connelan T. Inside The Magic: 7 Keys to Disney's Success. Austin, Texas. Bard Press. 1996.