Misdiagnosing New Hires Is Costly

By Leanne Hoagland-Smith, MS
September 12, 2019

Winning the war for talent will propel profitable healthcare organizations ahead of the competitive flow. Today there are psychometric tools that can support busy leaders who are tired of a range of disappointments, from mis-hires to underperforming employees.

This article discusses several of these assessment tools, addressing when and where they should be used. Additionally, it shows how by adopting the three Ds—Diagnosis, Determine, and Decide—you can stop losing money, stop the employee aggravation, and reduce your stress.

Have you ever thought any of these questions:

  • Why can’t these people do their jobs?
  • Don’t these employees ever think?
  • Who hired all of these underachievers?
  • Why can’t I find—or worse yet—keep great employees?

Of course the answer is the same for all these questions—and that is you, as the leader of the organization.  Your leadership is directly and 100% accountable for:

  • People not doing their jobs;
  • Non-thinking employees;
  • Those underachievers who were hired; and
  • Finding and retaining great employees.

A profitable organization requires exceptional employees. “Great” is no longer good enough, given the continued constraints from federal compliance to patient-centered healthcare and ever-shrinking profit margins. The question for today, as it was yesterday and will be tomorrow, is simple: How do I find those exceptional employees within those endless piles of electronic resumes and referrals that will take my practice to where I want it to go? Now may be the time to consider applying your own process of Diagnosis (assess); Determine (clarify), and Decide (execute). These three Ds may propel your practice ahead of the competition while simultaneously increasing:

  • Profitability;
  • Patient loyalty;
  • Employee loyalty; and
  • Peace of mind (less stress) for you.

Each of the three Ds has a three-round process to ensure high-quality hiring and, therefore, better employee retention, productivity, and loyalty.


First Round

Assessing patients is the first step in arriving at a diagnosis, from taking basic vital signs to ordering laboratory work to recommending more extensive tests. Without the results from these diagnostic assessments, you are literally making determinations (the next step) in the dark. Bad determinations can be very costly to both you and your patients because they lead to bad decisions. The same statement can be made about hiring new employees. Unless you have some idea about their talents, their behaviors, and what motivates them, you are also in the dark. Having this type of data is just as critical for new hires as it is for new patients. Formal assessments for hiring and developing employees have expanded during the last 15 years or so. With the war for talent beginning in early 2000, this awareness has created increased emphasis on talent management strategies. The American Psychological Association has published a paper on the growing trend to assessments within talent management. (1)

Many psychometric assessments are available. Robert Hartman’s Dimensions of Thought (2) is probably the least known and the most accurate specific to statistical metrics of validity and reliability. Two assessments, the Attribute Index and TTI Success Insights, are based on Hartman’s work at Yale University and the Massachusetts Institute of Technology. Building on the science of value that began with the early Greek philosophers, Hartman is considered the founder of modern axiology. Hartman’s work qualified an individual’s ability in over 80 business-related areas. His work revealed that people think using three dimensions of thought: systems judgment (heads); intrinsic (heart); and extrinsic (hands). From his research, he was able to determine that there is a direct correlation between how we think about something and the value we place on it. Because this assessment is deductive and objective in construction, its results are far more accurate and stable than other psychometric assessments. Most psychometric talent assessments average near .85 reliability and validity coefficients, with some as low as .74 (e.g., StrengthsFinder by Gallup). The assessments based on Hartman’s work, depending on the publisher, score as high as a .92 specific to statistical coefficients. (3) These scores place Hartmann’s assessment as probably the most accurate of all psychometric assessments in the modern marketplace. Hartman’s assessment provides a basic understanding of how an individual makes both external and internal decisions. Additionally, 78 core attributes or talents are identified. The ranking of these core attributes is the foundation for the determination of how people make decisions, both externally and internally.

People focus on improving their weaknesses instead of leveraging their strengths.

young woman-868534_960_720One significant aspect within assessments based on Hartman’s work is uncovering the real attributes or talents of individuals. From my own research, more than 98% of those who have taken this assessment were not aware of one of their top five talents. More than 97%, however, know at least one of their five lowest talents. This disconnect is easily explainable, given that people have been conditioned since early grade school as to what they do not do well. As a result, they focus their energies on improving their weaknesses instead of leveraging their strengths. Once the results of this first round have been reviewed, a determination regarding the candidate’s desirability is made, and then a decision follows to have the potential employee complete a second assessment, the DISC Personality Profile, where DISC stands for Decisive/ Interactive/Stability/Compliance.

Second Round

Once you have clarity specific to a potential employee’s decision-making and talents, it is time to look at his or her behaviors. The DISC is a psychometric assessment used to accomplish that goal. This diagnostic tool is based on the works of William Moulton Marston and his theory of human behavior. (4)

Marston determined four quadrants of behavior:

  • Decisive: behavior toward problem solving;
  • Interactive: behavior toward people;
  • Stability: behavior toward pace; and
  • Compliance: behavior toward procedures.

This assessment would be employed during the final hiring selection. Especially in healthcare, compliance with procedures is essential, along with the ability to engage people. Also, since quality is important, rushing through paperwork may not be the most desired behavior. The ability to problem-solve (i.e., think on one’s own) is also essential. Reviewing the results of the DISC profile along with the Attribute Index provides a solid knowledge foundation and reduces the potential of a mis-hire. However, no psychometric assessment or hiring process is 100% foolproof because each human being is a unique individual.

Third Round

Healthcare is an emotional experience. Being able to recognize and understand the emotions of the patient while recognizing and understanding one’s own emotions and then managing both of these sets of emotions is the essence of emotional intelligence. According to research, (5) women are said to have a slight advantage when it comes to emotional intelligence. Also, as people age their emotional intelligence increases because their people experiences increase. Building emotional intelligence is not difficult. Just changing certain words can increase responsive empathy. For example, how would you feel if someone told you, “You need to lose weight”? Do you think your patients feel any differently? What would happen if the words were changed to something far less judgmental, perhaps to “Have you considered the benefits of being healthier? You would be able to do more activities with your family, your grandchild, [fill in the blank]. What does healthy mean to you?” Even though you are arriving at the same destination—weight loss—the patient is now probably more willing because your words have struck a positive emotional chord instead of a negative one. When candidates for the job share similar results, this assessment may help you determine which candidate is more emotionally intelligent. Of course the application of any assessment within the hiring and keeping (developing) process must adhere to Equal Employment Opportunity Commission compliance. Complying with federal and state labor laws begins by having a documented process that is applied consistently to all potential and existing hires.


First Round

From the results of the psychometric assessments, your ability to determine the best candidate for the open position is enhanced. Additionally, the investment in these assessments is small compared with the lost profits that result when you make the wrong hire or promote the wrong person.

Second Round

Before you hire that candidate, make sure your practice has:

  • An updated and specific job description;
  • A performance appraisal aligned to the job description; and
  • A culture that will engage and energize your candidate.

Knowing your workplace culture is part of the determination process. Within the Attribute Index, there is an area called “Preferred Working Environment.” If your workplace is not congruent with the candidate’s preferred working environment, this may create additional barriers to a high performing practice.

Third Round

After reviewing the results from the DISC and Attribute Index, along with a personal interview, you as the leader decide which person to hire. Of course, depending on the size of the practice, an office manager may make that decision or recommendation. However, you as the leader are still accountable for the outcome because you hired the office manager. Notifying the candidates at all phases of the selection process reveals the positive core values and business ethics within your practice. It may be that one of those finalists may be a better fit when another position opens. Now is not the time to burn any bridges. Unsuccessful applicants may still be excellent future referral resources.


First Round

Your decision has been made, and now it is time to implement (execute) it. This is when your successful candidate needs your support more than ever before. How you interact with this new employee will either keep him or her in your office or have him or her quickly searching for a new job.

Even the best process will fail if the culture of the practice is toxic.

Beyond the basic “onboarding” or employee orientation, much more is required to keep highly engaged and productive employees. This is the time not only to provide the employee handbook but to share the results of the assessment. Unfortunately, many practice management leaders stop with the basic introduction to the practice.

Even the best process will fail if the culture of the practice is toxic. The word alignment comes into the picture. Alignment means all employees know where you as the leader see the practice in the future. Your vision for the practice must inspire your employees. All your employees know that adhering to the core values of your practice is a must. Violation of those positive core values may be cause for dismissal. The consistent demonstration of core values reflects a high-performance workplace culture. Additionally, your employees are completely clear regarding goals to be achieved during the current year, from quality of care to retention of patients to referrals of new patients. Keeping your employees in the dark because you have not shared your business goals usually results in misdirected actions and, therefore, misdirected results (think lost profits).

Second Round

After the employee has been on the job for about 30 days, you should work together to establish a plan of action to ensure that the desired result—an engaged and loyal employee—is achieved. This plan is reviewed at three months. Depending on the organizational structure, the action plan and actual conversations may be conducted by the office manager.

Third Round

At six months, the performance action plan requires a review with you as well with the office manager. First, you, as the leader, must have a conversation with the new hire to learn what is going well and possibly not so well. Then a second conversation with the office manager should take place. From these two conversations, you will gain a good perspective on the employee as well as any organizational culture barriers keeping your practice from being a high performer. Applying the three Ds of Diagnosis (assess), Determine (clarify), and Decide (execute) to the hiring process within your organization establishes clarity and leads to sustainability.

Remember: hiring the wrong person is costly beyond the actual up-front hiring costs if you truly want to win the war for talent.  



  1. Church AH, Rotolo CT. How are top companies assessing their high-potentials and senior executives? A talent management benchmark study. Consulting Psychology Journal: Practice and Research. 2013;65:199-223. www.apa.org/pubs/journals/features/ cpb-a0034381.pdf.
  2. Robert S. Hartman Institute; www.hartmaninstitute.org/.
  3. Innermetrix. www.innermetrix.com.
  4. Disc Insights. www.discinsights.com.
  5. Goleman D. Working with Emotional Intelligence. Bantam; 2000.


Leanne Hoagland-Smith, MS

CEO Advanced Systems: The People & Process Problem Solver

Article appeared in The Journal of Medical Practice Management, Jul/Aug 2015

Topics: Management

Are You Leading Through the Crisis... or Managing the Response?
Effectively Recruiting and Retaining Physicians: A Strategic Approach for 2020