Faber Healthcare Solutions

If you want to get the best out of your staff, you have to motivate them all, every single day. Only a well motivated staff will achieve at its peak performance.

Daniel Yankelovich and John Immerwahr wrote a wonderful article for the Public Agenda Foundation in 1983 titled Putting the Work Ethic to Work. In this study, the authors found that among the top ten items employees find most rewarding about their work are working for people who treat them respectfully, recognition for a job well done, and being well-versed about office happenings. What’s wonderful about these three points – and most of the items in Yankelovich and Immerwahr’s report – is that they are absolutely free!

Employees do not become invested in your practice simply because you issue their paychecks. First, you have to show them respect, as people and as professionals. If all you offer is the paycheck, all they will offer is their attendance. To get their best work out of them, you have to respect the work they do, let them know they are appreciated, and give them praise.

The flip side, of course, is reprimanding your employees who step out of line. But this too can be done with respect and dignity. Do not dress down employees in front of their peers, and when you apply the rules they should be applied fairly and equitably across the board.

Motivation goes beyond nice words. You will have to knuckle under and spend a little money, but it is well worth it. Employees need incentives. That doesn’t mean you need to engage in profit-sharing with your office manager. But, for example, if business is slow you can set patient volume goals for your schedulers, or you can incentivize your billers’ accuracy with a bonus for limited billing errors. Provide your dedicated employees with training so that they can better their positions. Throw a holiday party plus a semi-annual dinner as morale boosters. Buy flowers for the medical assistants on Nurses’ Day. Think outside the box too; something as simple as shamrock brooches on Saint Patrick’s Day can generate smiles all around.

Show your staff that you value them, and they answer in kind. If you show your staff that you will go the extra mile for them, they will respond in kind and go the extra mile for you.

Unfettered internet access in the workplace is nearly uniformly available in electronic practices today – that is, practices with computer systems and some form of electronic billing. Employees usually feel that unlimited, unmonitored access to the web is their entitlement. After all, it is an indispensable tool in everyday life today, from banking to messaging to shopping. And (pardon the ungrammatical use of the ‘and’ to start the sentence – I am using literary license here) it certainly can serve as a very useful office tool. But in the workplace, these are all distractions, wasting the practice’s money and drastically affecting employee productivity.

So what can you, the owner, do to strike a reasonable balance between granting employees limitless internet access and banishing them to the electronic dark ages?

The first step is determining what access employees need for legitimate work-related purposes, what access would make employees happy without seriously interfering with the office’s work flow or security, and what access requires outright proscription. Once you have determined that, it is time to have your IT staff (or consultants) properly program your firewall.

[A firewall is a piece of hardware, a gatekeeper of sorts, which sits between the nasty virus- and hacker-filled world of the internet, and your naïve and homely office server and computers. It is an absolutely essential piece of hardware; if you have IT staff in place that has not already cajoled you into purchasing a firewall, you have a problem.]

The firewall can, in most cases, be programmed with what types of internet services to allow (such as web surfing and email), what services to forbid (such as instant messaging and VOIP calls), and what services to limit (such as certain websites or classes of websites, such as pornography or shopping). What capabilities your firewall will have will depend on the model and how much you are willing to spend on it. It is worth noting, when you compile this list, that some pornography firewall settings may actually prevent you the clinician from accessing legitimate medical websites – if your firewall can be programmed to exempt you from its settings, that is a good workaround for this limitation.

Just before having your IT staff program your firewall, have a frank heart-to-heart with your staff to discuss the changes you are planning to make. Explain yourself well. Bear in mind that your younger employees may react as if you are planning to amputate a limb, and will require smooth handling.

It may serve you well, for your relationship with the staff, to share your new internet access policies with them without putting all of them into play in the firewall programming (possibly with some exceptions, such as pornography or myspace and facebook), asking them to police themselves. Some firewalls allow you to monitor the employees’ access, either as individuals or in the aggregate, and you can determine if self-policing is working. If you do plan to monitor your employees, let them know (including in writing, in your employee handbook), and share your findings with them should you decide to curtail their access in the future.

Our Federal government has expended an enormous (if unnecessarily complicated and hopelessly difficult) effort attempting to ensure the privacy of our medical records.

And yet …

On the front of every Medicare card (and a few holdout health plans), prominently displayed, is the patient’s Social Security Number. How reassuring.

Since the government is not taking steps to protect these patients, providers can. Patients can be taught a simple step to protect their identity; not carrying their actual Medicare card, but rather a photocopy with some of the digits blacked-out (although, naturally, they will need to provide those numbers at the first service). This can help protect them from pickpockets looking to steal their identities.

It would be a lovely trust-building step for your office to undertake in providing this service to patients. The copy will cost you pennies, but the trust built with patients is priceless.

On April 8th of this year, I wrote “Prepare to apologize. Lawyers cringe at this advice, but doctors who admit their errors, particularly the little ones, and treat the patient with respect and apologize, tend to get sued less frequently. Some organizations, such as the VA, have adopted this guideline as policy, and the number of suits has fallen since its implementation.”

It looks like the New York Times agrees. I recommend this article as a good read.

It can be a frightening time to be a physician; liability insurance costs are climbing, regulation is increasing, patients’ expectations are often unrealistic, and the doctor is still a human being, prone to human error. True, there are technological advances that help guide physicians along a safe path in clinical care, such as electronic medical records, and drug interaction databases, but at the end of day doctors still worry about being sued.

So how can you help protect yourself?

• - Keep good, easily legible, and easily comprehensible records. The best practice here is to get an EMR. Short of that you should write clearly and present your thoughts in an organized fashion. If your writing is so bad that even you cannot read it yourself, and you do not want to spring for a computerized system, dictate. Worse than being sued, is being asked on the witness stand to read your own note and flinching – by then, you’re sunk.
• - Prepare to apologize. Lawyers cringe at this advice, but doctors who admit their errors, particularly the little ones, and treat the patient with respect and apologize, tend to get sued less frequently. Some organizations, such as the VA, have adopted this guideline as policy, and the number of suits has fallen since its implementation.
• - Explain clearly. Tell the patient what you want to do, why you want to do it, and, if appropriate, why you will not do what they want you to do. Explain what the next steps will be, if your initial treatment is successful, and if it is not. If a patient is concerned about the treatment, explain why those concerns are unfounded, or why they are reasonable but are less concerning than not treating. You will still have unhappy patients, but they will have more reasonable expectations about the outcome, and therefore less likely to run to an attorney.
• - Communicate. When a patient is concerned about his care, he will contact your practice. Call him back promptly, at a reasonable time, and with enough time to converse properly.

With these tools, you can minimize your risk of malpractice lawsuits … and also increase your patients’ satisfaction.

One of the gaping holes in American residency training is the utter lack of business training. Today’s physicians graduate from medical school having learned the cutting edge of medical care. Of late, residency programs have learned the value of patient relations, and have successfully integrated humanism courses into the educational framework of residency. Unfortunately, many new physicians are launched into the workplace ill-prepared for the business of healthcare.

Graduating residents have told me that they have great anxiety over their graduation, not because their medical safety net will be removed, but because they feel unprepared for their upcoming roles as business owners and bosses. Recent graduates have told me that they felt their residency programs let them down by not providing proper education about the business of healthcare. Established physicians have told me that it took them many years to learn, through trial and error, how to run their businesses. They also admitted that there were many more errors than they would have hoped, and that they remain unsure if their acquired knowledge is even correct.

It is heartening, however, that today residency programs are aware of this shortcoming, and are taking strides to remedy it. In fact, I have been invited to speak to medical residents at a number of major NYC academic medical centers in the coming weeks to supplement the young business awareness programs these schools have begun to implement.

The previous generation of physicians had a rude awakening, following the Reagan years, of the realities of medicine as a business. All signs indicate that the next generation of physicians will be better prepared, and I sincerely hope that is the case.