fix this practice

Help! My Practice Is Held Hostage

If you don't command your staff's respect, they'll command your practice.

RICHARD S. KATTOUF, O.D., D.O.S.

Q I have a very knowledgeable employee making unreasonable demands on me and the practice. she knows more about operations than I do. What do you recommend?

Dr. D.M. Vincent via e-mail

A: The reason for the dilemma is the owner's/doctor's lack of control, pulse on the practice and knowledge of overall practice. Ask yourself: Do you command respect from the staff?

Dr. T.C. Gilbert purchased a 30-year-old practice. The staff retention was 100%. The senior/selling doctor had a great rapport with his patients and employees. There were specific consequences to negative behavior. The senior doctor had established an excellent pulse on all aspects of his practice.

The buyer, who is an excellent clinician, attempted to befriend the staff. He encouraged long after hours phone calls and destroyed the line of demarcation that must be present. The result: Employees became tardy and took time off with no request. Attitudes changed. A once well-oiled machine became a group of cliques that looked out for themselves.

The wrong direction

Staff performance under Dr. Gilbert went south. Recall notification was not done for months, scripts which were very specific, were not to be heard. Gross income fell by $100,000 in one year. Dr. Gilbert felt his professional skills were the answers to operating a practice. He lost control due to over delegation with no pulse on the practice.

Dr. Gilbert's most vulnerable area was the optical department. He knew nothing and allowed Launa, the optician, to have total control. Launa was the strongest link with the former patients. It was common for many patients to ask for her to handle any and all office situations. As Launa flexed her muscles, she demanded exorbitant raises and became condescending to other employees and the doctor. No consequences occurred. Two very good staffers quit.

Now Dr. Gilbert was in fear of losing Launa. He had no knowledge of frames, managed care vision, billing and medical coding. He realized that Launa had achieved a level of control that was pathological.

When I went on-site, I stripped Launa of several of her duties knowing that her territorial nature would create an environment that she would not tolerate. Launa quit and notified several of what she called “her patients” of her dissatisfaction with Dr. Gilbert. She followed up with a second correspondence informing the same group of her new optician position and location. This behavior came from Launa, an employee who had been with the practice for 15 years.

The point to understand is that Launa never displayed these tendencies under the senior doctor's leadership. It was when there was no longer a strong owner that the negativity reared its ugly head.

If the staff knows the defined boundaries and consequences, they will stay in bounds.

When employees sense weakness, indecision, lack of management knowledge, the owner is enabling them to perform poorly.

Make note that when employees use the term “my patients,” they are usually out of bounds. It normally means over delegation, lack of a practice pulse from the owner, which enables power and performance to stray out of bounds. OM