A Primer for Staff Management
Training, attainable goals, and a shared mission can help you create a successful staff for your practice.
By Mark R. Wright, OD, FCOVD
Dr. Wright is the president of Pathways to Success for Optometrists, a consulting company for eyecare practices. He also serves as the faculty coordinator for the practice management program at The Ohio State University College of Optometry. He was the 2005-2006 Benedict Visiting Professor for the University of Houston College of Optometry.
We are now in an "experience" economy. Patients are looking for a positive, memorable experience in our offices. Our staff are essential in order to deliver a positive, memorable patient experience efficiently and consistently. This primer for staff on patient management provides the structure necessary to offer the desired level of care.
It all begins with the mission statement, which is an often overlooked but essential tool in an eyecare practice. Disney has one of the best models for a mission statement. Disney's mission statement (Disney calls it a Service Theme) is: "We create happiness by providing the finest in entertainment for people of all ages, everywhere." Every staff member should be able to recite the mission statement. Everything — every decision, every answer — should start with the practice mission statement. For example, every decision in the practice should start with the question: Does this help us better achieve our mission statement? Modeling this behavior to staff teaches them how the mission statement guides every decision.
Using Disney as our model, our mission statement could be: "We create ___ by providing ___ for people of ___ age(s), ___." Fill in the blanks based on what is important to you in your practice, and you have a mission statement to guide every action.
In an effort to give staff even more guidance on how to deliver the mission statement, Disney uses Service Standards. These standards provide the operational criteria that ensures consistent delivery of the mission statement.
The Service Standards are prioritized in this order: safety, courtesy, show, and efficiency. Translating this into an eyecare practice, safety trumps everything else. Safety involves issues such as disinfection, cleanliness, privacy, and compliance. Courtesy comes next and involves always showing respect for patients, always being friendly, the ability to easily provide answers to patients, and being pr oactive about patient problems.
In our world, "show" is anytime we are with patients. "Show" helps us identify what should be done on-stage and off-stage. For example, staff eating is an off-stage activity and should never occur in the sight of any patient. The "show" must be an uninterrupted, positive, memorable experience for patients.
Efficiency involves patient flow, speed of service and operational checklists to make sure the office is prepared to see patients. Prioritizing the Service Standards gives staff a hierarchy. As an example, when faced with a solution that improves efficiency but is not courteous, courtesy trumps efficiency.
You can adopt Disney's service standards or create your own. The key is to provide staff guidance to ensure consistent delivery of your mission statement.
How Personality Affects Your Practice
To provide the best care to patients, you must plan your actions. Take a roll of butcher paper to an office meeting. On the butcher paper, in sequential order, have staff identify every step involved in moving a patient through the office. Identify what actions need to occur in front of the patient as well as what actions need to occur behind the scenes. Identify where problems occur. Identify solutions to all problems. Make sure every action has a staff member assigned to manage the action. Review this process at least once a year — more often if you are experiencing service difficulties.
Do we have the right people doing the right jobs? This involves two core concepts: competence and personality. Competence raises the question: should you hire someone with skills or not? Is it easier to train someone who has no optical knowledge or to retrain someone who may have learned bad habits in a different practice? Experience shows that it is often easier to train someone who has no experience than it is to break bad habits.
You can train someone how to do a job, but it is impossible to change a person's personality. There are many methods for evaluating personality. Is the system established by Hippocrates easier to implement than a more complicated system such as Myers-Briggs? Hippocrates identified four personality types: Choleric, Sanguine, Phlegmatic, and Melancholy. Table 1 shows how the Hippocratic approach is the basis for many personality systems in use today.
The LaHay and Littauer version of the Hippocratic model is Popular, Powerful, Perfect, and Peaceful. Table 2 provides characteristics of each personality.
Observing and listening to people offers sufficient insight into personality. Let's examine each personality type. Pay particular attention to what each personality type wants most from other people. This is a major key to effectively managing and keeping these people on staff. This is also a major key to effectively managing and keeping patients in the practice.
Attention and approval are what the Popular personality wants most from other people. A Popular personality actively searches for an audience. Populars are fun to be around. To a Popular, people matter more than tasks; however, the result may be inefficiency and procrastination.
Achievement and appreciation are what the Powerful personality wants most from other people. A Powerful personality actively takes charge and leads. Achievement is more important to the Powerful than details and rules are. Powerfuls make quick decisions and love change, but can run roughshod over people's feelings in the drive to achieve.
Order and sensitivity are what the Perfect person ality wants most from other people. Perfects get things done, are detail oriented, always on time, tidy, and love analysis, lists, and schedules. Perfects often get lost in details, do not like change, are supersensitive, and hold a grudge forever.
Respect and a feeling of worth are what the Peaceful personality wants most from other people. Peacefuls are loyal, calm, easy to be around, sympathetic and kind. Peacefuls are not in a hurry and go out of their way to avoid conflict. Peacefuls achieve, but in their own time frame, which can be very frustrating to Powerfuls and Perfects.
Mastering an understanding of personalities affects every relationship. With better understanding of the strengths and weaknesses of each personality, doctors and staff can work together and with patients more effectively. A Powerful doctor wants to get to the action plan in the case presentation while the Perfect patient is waiting for all the details as well as time to analyze the details before making a decision. The Popular frame stylist wants to get frames on the face as fast as possible because that's the fun of a new look, while the Perfect patient wants details and analysis of why this frame is better than that one. Understanding personalities permits a more effective case presentation in the examination room and frame selection in the dispensary.
Tailoring your presentation to staff or patients based on their personality is essential if you want to communicate most effectively. Perfect personalities want all the details you can give them. Giving too many details to Powerful or Popular personalities will alienate them. A Popular personality wants to play. Too much playfulness runs the risk of alienating a Perfect or Peaceful personality. A Powerful personality handles conflict easily. A Peaceful personality finds conflict distasteful. It is the responsibility of the doctor and staff to adapt to patients' personalities.
Everyone has both a primary and secondary personality. Consider both to add depth to your understanding of staff personality.
Put the Right Personality in the Right Job
Think of the different jobs around the office and which personality fits each job the best. You want a Perfect personality — certainly not a Popular — for the bookkeeper. You want a Popular rather than a Peaceful for your receptionist. If you have a Popular frame stylist, you may need to have a Perfect do the ordering (or at least check orders) to make sure jobs are correctly and timely ordered. Identify which personalities are best suited for each job in the office. Make sure you have the right personality doing the right job or provide appropriate back-up to make sure every patient has a positive, memorable experience in the office.
One approach to resolve this dilemma in an office that is already staffed is to have staff trade jobs for a period of time. This helps with cross training, but more importantly, it helps identify the people best suited for each job in the office. It is not unusual to have staff suggest job changes after this experience.
Written Position Agreements
There are two opposite viewpoints about job descriptions. The one extreme is best represented by Nordstrom. The Nordstrom Employee Manual states: "Rule #1: Use your good judgment in all situations. There will be no additional rules." At the other end of the spectrum is the written job description in which every aspect including scripts for the position are written down. A reasonable alternative is the position agreement.
The written position agreement has the following seven components:
- Position title
- What will be measured to determine job management
- Results statement (I am responsible for…)
- Position goals (I will make sure that systems exist to ensure…)
- Personal goals (While controlling this position I will…)
- Position management (The following things need to be done daily, weekly, etc.)
- Technical management (To manage this position I need to have the following knowledge and skills)
The written position agreement should exist for every job in the practice that a staff member is managing. This helps ensure consistency in our overall mission statement delivery by identifying what is important for every job without getting bogged down in the minutia of process. Simultaneously, this approach helps identify the information that is in every staff members' head that only they know. If we do not discover and document these important details, then, when that staff member leaves the practice, that information is lost until it is discovered again by trial and error.
People do what you inspect, not always what you expect. Proficiency testing is an important part of training. Before staff are able to interact with patients, proficiency testing must occur to demonstrate competency. Then, random proficiency testing needs to occur to make sure skills are maintained at acceptable levels. If someone fails a proficiency test, then re-train them and test again. This ensures patient care is always at its highest level.
When every staff member has a written position agreement with measurable standards for determining job performance, then goal setting becomes relatively straightforward. As an example, if the staff member is in charge of recalling patients, then goal setting is putting a number to how many established patients should return for care. This goal can be for any time period. A good method is to base the number on past performance with an increase for future performance. It works best when the staff member sets the goal with management help. Rather than impose an arbitrary number that the staff member feels is unreasonable, a dialogue between the staff member and management helps in choosing a number that is acceptable to management and that the staff member feels confident is attainable.
People who state that incentives do not work have not found the right incentive. Everyone is motivated by some incentive. Not everyone is motivated by the same incentive. To find the proper incentive for each staff member requires management and staff to communicate. For some staff members it may be weekends off. For others it may be supporting their child's baseball team. For others it may be additional money. A one-size solution for everyone is not effective. The most effective incentive systems are custom tailored for each staff member. This requires some creativity from management, but it is well worth the effort.
Following is a list of seven possible staff incentives to help you begin thinking of the possibilities beyond just money.
- Allow staff to purchase old computer equipment at a greatly discounted price or even consider giving it away.
- Pay for complimentary hotel accommodations for a getaway weekend.
- Give special days off aside from regular holidays and vacation time.
- Close the office for an afternoon, on a slow day, for the staff to take in a movie or go bowling.
- Give tickets to special events, the theater, or professional sporting events.
- Give a half-day off a month for staff to work with their favorite charities.
- Give gift certificates to a favorite bookstore.
Most laboratories give spiffs or incentives for purchasing at specified levels. These spiffs belong to the practice. You should never permit a vendor to bypass you and directly incentivize staff.
A practical and valuable use of spiffs is to incentivize all staff members rather than just the people working in the dispensary. This approach encourages teamwork.
Most employee reviews are worthless. Staff view them as time to ask for a raise, and management views them as extra work. On the other hand, if every staff member has at least one measurable product and goals have been set on that product, now employee reviews can be valuable. As an example, to evaluate the staff member managing established patients returning for care, all we need to do is look at the numbers. How well did the staff member meet or exceed the goal? We could use the chart in Table 3 to rate the staff member's performance.
When everything in the office is centered on delivering the mission statement and every staff member has measurable work being performed to help deliver the mission statement in a positive, memorable way, then, in the system described in this article, every office meeting can be centered on the three most important issues:
- Are we delivering our mission statement to every patient consistently?
- Does anyone need help achieving their goals?
- How can we use the entire practice to help everyone achieve their goals?
To provide a positive, memorable experience for every patient visit through our offices requires the use of staff. Effective implementation and utilization of the ideas presented in this article will take that from a dream to reality in your eyecare practice. CLS