Physiatry Practice Management Resources

Tell staffers early and often how they're performing, and listen to their job-related concerns.

In the 1980s, New York City mayor Ed Koch was famous for asking, "How am I doing?" The strategy attracted national attention because it tapped into the human need for feedback—to know that one's work is appreciated, and to find out what needs to be fixed.

Good managers understand this. "Don't assume that employees who are doing their jobs incorrectly realize it," says Richard D. Hansen, vice president of the Medical Group Management Association Health Care Consulting Group. "They need to be told—well before their annual performance evaluation. The evaluation should serve as a review of issues that have been addressed during the year, not a setting in which an employee first learns about your dissatisfaction."

Conversely, don't stint on positive feedback. "The words 'good job' and 'thank you,' are powerful motivators," Hansen notes.

And feedback needn't be a one-way street. Your employees no doubt have much to say about your office and how it's run, and they may even have helpful suggestions on how to improve office operations. But they need to be prompted to air their concerns and ideas. Here's how to keep the lines of communication open.

If consultants have a feedback mantra, it's "praise publicly, reprimand privately." "You can destroy a manager-employee relationship by, say, chewing someone out during a staff meeting," says Nancy Ahlrichs Raichart, a human resources consultant with EOC Strategies in Carmel, IN.

It's also critical to think your comments through before you air them, says Judy Capko, a consultant in Thousand Oaks, CA. "When managers give off-the-cuff feedback, too often it's not thought out and may be inappropriate. You'll be more effective if you set time aside every week or every other week to meet one-on-one with staffers. This shows respect for the individual and the issues at hand, and it allows you to build a relationship with the employee."

Additional feedback rules:

Be specific. Instead of "You did a good job with Mrs. Jones," say "I was impressed that you listened to Mrs. Jones and resolved her problem." Similarly, "It's our policy to return patients' phone calls within 30 minutes" works better than "Our practice is patient-centered."

Avoid giving feedback based on hearsay. If you haven't witnessed an incident, take some time to find out what happened before acting. "A conversation that begins with 'Your co-workers are concerned . . .' isn't likely to be productive," says Marilyn Moats Kennedy, a management consultant in Wilmette, IL.

Comment on the behavior, not the person. "If, for example, a staffer is abrupt with a patient, remarks such as 'You're a lousy communicator,' aren't helpful," says Keith Borglum, a consultant in Santa Rosa, CA. "Instead, say something like, 'I know this is a busy office and there are many distractions, but we need to pay attention when patients are speaking.' "

Judy Capko offers another example: "If someone is having a bad day, you can call them aside and say, 'It seems you're struggling with work today. Is there something I can do to help?' This focuses on the problem and shows empathy."

Put it in writing. "We document every performance-related conversation with employees, let them read the statement, and ask them to sign an acknowledgment that they've read it," says Judy Rapoza, a practice manager with Pediatric Associates of Fall River in Massachusetts. "When you've written something down, the employee is more likely to realize that you mean business. At the same time, we have a paper trail if we ultimately need to terminate the employee."

Watch your body language. "Look the person in the eye and nod when you agree," Capko advises. "Don't cross your arms or lean back in a chair, and don't engage in other activities, like shuffling papers on the desk. If an employee rolls her eyes or looks away from you, gracefully but firmly call her on it. Say, 'It seems I don't have your attention' or 'Is there something I'm saying that bothers you?' This should elicit the two-way conversation and feedback you're seeking."

Don't bother with trivialities. If the employee's behavior isn't affecting patient care or office operations, let it slide.

Accent the positive. "Affirmative feedback reinforces behavior you'd like to see repeated," notes Ahlrichs Raichart, author of Manager of Choice (2003), about attracting top talent. Flowers, luncheons, and notes—both handwritten and e-mailed—are always appreciated. Also, never underestimate the value of cash gifts for employees whose ideas improve office functioning or who otherwise contribute to your practice beyond their job descriptions.

To minimize defensiveness, choose your words carefully. Capko suggests erasing "should" and "ought to" from your feedback vocabulary. "Focus on we or it messages rather than you or I—'Maybe we could have done this differently,' or 'Help me understand how it happened,' rather than 'Why did you do that?' "

If a staffer has been consistently arriving 15 minutes late—because, say, she has to drop her daughter off at school—you might offer to adjust her workday so that it begins and ends a little later. "If the lateness persists even after the adjustment," Borglum says, "you'll know the person has an attitude problem and you may need to begin progressive discipline, a series of increasingly severe measures that might ultimately lead to dismissal."

"If you withhold tough talk when it's needed, you'll demoralize the good employees," says Ahlrichs Raichart. "So if someone is disruptive, chronically late, performing poorly, or is otherwise forcing co-workers to pick up the slack, and you avoid giving negative feedback because you hate confrontation, you may find yourself working only with that substandard employee because all the first-rate workers have left."

"Receiving feedback gracefully—and using it constructively—may be more of an art than giving it," says Marilyn Moats Kennedy.

Staff meetings provide one venue for employee feedback, and allow staffers to bounce ideas off you and each other. Another option is to talk with staffers individually.

During your one-on-one meetings with staffers, Nancy Ahlrichs Raichart recommends asking three questions: How are you doing? How do you think the team is doing? What can I do to help you do your job more easily or better? "As manager, part of your job is to listen," Ahlrichs Raichart says. "When an employee makes a request that you can't honor, explain why, then ask more questions to determine if you can offer an alternative. After you've conducted feedback sessions for a while, employees will think about what they want to tell you and offer more nuanced and doable suggestions."

You might be able to coax a response out of tongue-tied employees by asking, toward the end of the interview, "Is there anything else on your mind?"

Multipart complaints require some finesse. "Ask the person to prioritize—to tell you which issue she is most concerned about," says Richard Hansen. "You can indicate that you'll look into that first." In another delicate situation—an employee coming to you with a grievance about a co-worker—Judy Capko recommends telling the former that she should talk to the latter directly, or that you'll discuss the problem with both of them simultaneously.

No matter what the grievance, don't act hastily. When an employee complains to office manager Judy Rapoza, she says she'll consider the matter and get back to them. "I never give them a decision on the spot. I've learned that if I react too quickly, I don't make the same decision I would have made if I had thought about it."

You can supplement your face-to-face feedback sessions with written questionnaires. Marilyn Moats Kennedy believes questionnaires get in the way of open and honest communication. "If someone has something to say, they should say it directly to you or your office manager," she maintains. But Will Latham, a consultant in Charlotte, NC, believes that many employees won't provide candid feedback when asked orally. He recommends giving staffers feedback forms.

"No matter how you elicit feedback, if you're going to ask your employees what needs to be improved in your practice, be prepared to act in some way," says Latham. "Otherwise, employees feel that their thoughts go into a black hole. I'm not saying do exactly what they want, but indicate that you've heard the feedback and are acting on at least some of it."

By: Gail Garfinkel Weiss
Medical Economics