fix this practice

Breaking up Isn't so Very Hard to do

But finding great staff often is. Use these ideas to upgrade performance.

Richard S. Kattouf, O.D., D.O.S.

Q Recently, two of my key employees left the practice. After their departure, the remaining staff educated me on their poor behavior and performance. I must confess I had no idea. And my experience with new hires has been horrible. With the unemployment rate so high, why is the pool of candidates so bad?

Dr. C.T. Heddad via e-mail

A: What you describe is very common, as I explain in the following case.

Exit strategy

Dr. J.P. Braxton commenced a long-term, 12-year exit strategy. An associate doctor who will buy into the practice was employed for three months. During a telephone interview with Dr. Braxton, I had numerous concerns that needed to be addressed.

Dr. Braxton's goal was to get the practice in the best sellable shape within two years. This meant increasing efficiency, productivity and profitability. He said he perceived that none of these areas were staff related. In his opinion, the employees didn't display any significant negative behavioral characteristics. The practice gross and net income were flat for the past five years. This is a major problem, as the cost of operations usually increases on an annual basis.

Staff-related issues

Observing the operation and meeting with the staff alone, it was evident that almost all Dr. Braxton's problems were, in fact, staff-related. A long-time staff manager, Jennie, had convinced him to hire her niece five years prior. Through the years, he had delegated coding and billing, staff scheduling, human resources, staff and patient problem-solving to Jennie.

As I see in many practices, the manager wasn't being managed — no check and balance systems. What resulted was five years of favoritism to Carol, the niece. Even though Carol had a weekly schedule — just like the other four employees — she was "allowed" to miss work with no notice. In addition, she would leave work early numerous times per week. To top it off, Carol exhibited disrespect to all staffers and patients with no consequences. In fact, several employees quit due to Carol's actions and Jennie's enabling her to act out. In reviewing Jennie's performance, it was evident her knowledge of medical coding was minimal. Her work ethic was poor. Jennie's total compensation package was $42,000 annually. For years my client assumed Jennie was performing at a high level. Upon bringing the undisputed evidence to my client, it was evident both Jennie and Carol needed to be terminated. I retained a very established coding and billing company to take over this facet of the practice at a fraction of the cost. I also proved to Dr. Braxton that he didn't have to replace either employee. I assigned the management duties to the associate doctor who will be mentored to become an owner/manager. This course of action will prevent this "out of bounds" behavior from reoccurring.

When staff actions are below par, you, the business owner, are at fault. It's your obligation to have a pulse on your practice.

For years, Dr. Braxton was unaware of his daily operations. The results were lost revenue, staff anxiety, lost patients and general chaos. With the new management model in place, his practice is now accomplishing great things . OM