Becoming an effective manager of employees is a challenging task for every doctor, no matter the size or age of the practice. And this is not unique to heath care providers; it’s a nearly universal challenge in all businesses. Let’s explore a few simple structural pieces to be sure are in place in your practice and are actually used effectively and consistently.
When I start with a new client, the most common response when asked to produce this is either that we don’t have one, or it’s around somewhere, but nobody pays attention to it anyway. This document is essentially the rules of being your employee. It should cover basic areas, such as professionalism, confidentiality, dress code, hours and punctuality, etc. It also outlines what the employee should expect from you in terms of payroll, pay structures, vacation time, paid holidays, sick time, reviews and other forms of feedback.
If this is not in existence or is not being followed, the employees will eventually feel that there are different rules for different people, the employer is playing favorites, or that there is some form of unfairness going on. It also does not give you a reasonable basis to compare your performance expectations to reality.
Smaller offices can go with a shortened, outline form policy document. This would apply if there is only one main provider, and no services are provided (by auxiliary providers) when the main provider is not there. In this scenario, you are going to know right away if there are any sorts of violations by your employees. But, as soon as you have staggered hours with another provider, job sharing with a defined job description, or any other form of augmented services, a policy handbook is a must.
Procedural manuals are usually present in new client offices, but in rudimentary form at best. Many times the admin staff has something resembling a checklist, and that’s about it. On occasion there is a formal procedural manual for each position, but this is the exception rather than the rule. The three main areas that require procedural manuals are:
- Front desk for all patient facing activities
- Back desk for all financial, insurance and information flow activities
- Patient flow for all technical procedures
These manuals are provided by me to all full time clients, but these can be hired out commercially or can be constructed by the provider and staff. If you opt for the latter, be advised that this is much more time consuming and challenging than it appears to be!
The front desk manual is critical in order to insure that the quality of patient contact is maintained over the course of time and also between job-sharing employees. Use of scripts will insure quality and consistency of delivery. Otherwise, the employee will simply use their own ways of communicating, with mixed results.
The back desk manual has many common features from office to office, but with the advent of computerized back office management through server or web-based systems, this really has to be customized to an individual office. General procedures and policies regarding insurance collections, patient responsibilities and other financial items can be summarized simply. It’s worth making knowledge documents pertaining to individual payer types and even particular insurance carrier if they have idiosyncratic features. Use of web links, screen shots and checklists can make life easier for lower frequency transactions.
The provider’s patient flow manual should be drawn around the typical procedures and flow for the patient. For the chiropractic office, it would flow from consultation, examination, imaging or specialty testing, report of findings, initiation of care plan, re-examination, then either further care, referral or discharge. Discharge would take one of three forms: complete release from care, prn care, or supportive care.
I have had several offices work on a much more detailed provider manual for specifics about treating particular conditions and illnesses. If you choose to take this pathway and you are starting from scratch, this is a good use of time for a new professional hire. An easy way to begin this process is to take the “dirty dozen”, or the 12 most common conditions presenting in the practice, and write out expected treatment and response algorithms.
This is an infrastructure exercise in your office. Not particularly sexy or exciting, but does lend significant strength and stability to the business as a whole.