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Dr. Crutchfield featured in "American Medical News" discussing Practice Managment Strategies

Motivating the mediocre: Getting the maximum out of someone who's giving you the minimum

Disruptive or incompetent employees need to be dealt with. But what do you do about a staff member who is settling for average? Experts offer tips on how to spot someone who is in a rut and help kick the employee out of it.

By Larry Stevens, AMNews correspondent. April 14, 2008.

Underperforming staffers can seriously hurt a practice. And one of your longest-lasting, most loyal employees could be a culprit.

Experts say it's easy to spot an employee who can't do the job, but a mediocre employee is less obvious And, perhaps more pernicious.

  • Preventing mediocrity

A mediocre employee does the job, but only the minimum amount. Or tells other employees that certain tasks are "not my job." Or doesn't interact with patients in the friendly way you want. Or is exhibiting several qualities, that, while annoying, don't warrant a firing, not when it's hard enough to find halfway decent people.

Undermotivated employees may take longer than their peers to complete routine functions, take an inordinate number of sick days, forget important tasks, or even be abrupt with your patients.

The problem can occur shortly after the staffer is hired, or after a number of years of satisfactory service. Whatever the symptoms, experts say, unless doctors or administrators take rapid action, the problem can spread like a virus, affecting the morale of other workers who have to take up the slack, reducing office efficiency, patient satisfaction and revenue.

Tides can turn

The toughest part might be that the mediocre employee could be someone you've trusted and relied on, and might even think of as a friend.

"You have a relationship, a history," says Anne Dohrenwend, PhD, director of Behavioral Medicine at the McLaren Regional Medical Center in Flint, Mich. "You know they can do better, and you also know firing them can be much more dislocating to the practice than getting rid of new hires."

She points out that doctors and other staff often have an emotional attachment to the employee who is having a problem. Firing a long-standing worker may reduce morale if other workers believe the termination was unfair or worry that they may be next.

And the group's investment in having trained that employee over the years may justify more of an effort to remediate the situation, Dr. Dohrenwend says.

Helping with success

The first step to improving any employee's job performance, she says, is to specify the problem. "Is it a matter of ability or a matter of willingness? Each of these presents its own challenges."

The only way to determine the answer is to have a conversation in which the worker is allowed to freely express opinions about the work and explain why he or she is having problems.

In response, Dr. Dohrenwend says, doctors or managers shouldn't simply say "your attitude isn't what it used to be" or "you don't seem to be posting files as quickly."

Instead, workers should be told specifically what they are not doing -- how many fewer files they are posting; how many co-payments they are not getting compared with their co-workers. "You shouldn't leave the employee wondering what has to be done in order for her to improve her performance," Dr. Dohrenwend says.

Dan Baltzer, a consultant at Minneapolis-based human resources outsourcing and consultant Empo Corp., agrees that quantifiable goals are important. He says doctors should train managers and administrators to be more focused on productivity than attitude.

"The most valuable measurable item an employee produces is the deliverables such as completed tasks," he says. "This is where a supervisor needs to focus his or her attention."

Sometimes other workers can help identify problems before they get to the attention of the manager.

Charles E. Crutchfield III, MD, an associate professor of dermatology at the University of Minnesota and a dermatologist in Eagan, Minn., says as part of his group's semiannual review of each employee, he solicits input from the employee's colleagues.

This input contributes about 15% to the overall review, which affects the employee's pay raise. In Dr. Crutchfield's experience, the reviews, which are anonymous, "tend to be remarkably quite accurate. Not merely a popularity contest, as I at first feared." He believes people do work harder because they know their colleagues will notice it and give them better write-ups. "And if there is a problem with someone, their colleagues are often the first to know," Dr. Crutchfield says.

Making improvements

Once the problem is identified to the worker, experts say a practice should put together a specific and quantifiable improvement plan.

If a group doesn't want to hold formal evaluation sessions, it's important to at least recognize workers' improvement informally, says Roger Shenkel, MD, a family practice doctor with Primary Care Partners in Grand Junction, Colo. "Too many managers are focused on problems, and once the problem is solved they've moved on. We're careful to focus on improvement and make sure the worker knows that we notice it, and that we appreciate it."

Beyond the improvement benchmarks, some groups attempt to look for and solve any underlying problems. It could be that an employee has been doing the same job the same way for too long, and is stuck in a rut. There could a miscommunication in terms of expectations.

Sometimes the problem has nothing to do with the office. "We try to be aware of crises in our employees' lives. If they've been good workers, we'll bend over backwards to try to accommodate them," Dr. Shenkel says.

For example, some groups might offer a worker a leave of absence to solve a home problem. Others may allow workers to reduce their hours.

Of course, small groups will not be able to accommodate all employees' personal needs. And getting too deeply involved in employees' emotional, health or other nonwork-related challenges can create another set of problems, experts say. The best course may be for doctors or managers to steer an employee to resources, but not try to solve the problems themselves.

Drastic action

When positive reinforcement and support don't work, experts say, perhaps the problem is not a mediocre employee, but an employee who just isn't cut out to work for your practice anymore. The distinction is especially important if one employee is requiring a disproportionate amount of the practice's time and attention.

"Managers I worked with usually err on the side of trying to fix someone to make them fit instead of making a change that is to the benefit of both the office and the problem employee," says Skip Weisman, president of a small business consultancy, Weisman Success Resources, in Poughkeepsie, N.Y.

"Continually trying to make a problem employee fit puts way too much focus and energy on problem employees and takes the focus away from the employees that are doing the right things."

Virtually all staff are "at will" employees, meaning they can quit or be fired without stating a reason. However, a doctor can be sued for wrongful termination if the employee is fired for religious affiliation, refusing sexual advances or having a disability that can be reasonably accommodated. Even employees fired for incompetence may claim they were terminated for an illegal reason. In addition, employees who can show they were fired without cause are eligible for unemployment compensation.

"We document everything," Dr. Shenkel says. "That keeps us out of trouble."

Preventing mediocrity

Many experts say the way to prevent employees from settling for average is to communicate from the start that excellence is expected. Primary Care Partners of Grand Junction, Colo., say this approach works for the 19-physician practice.

At orientation

  • Provide a handbook to help the employee understand the organization, its purpose and the role of the employee in meeting its purpose.
  • Provide a job description.
  • Provide a notebook or manual of specific procedures and policies.
  • Encourage note-taking.
  • Provide "cheat sheets" on each physician's preferences on variances from standard office procedures.
  • Advise new employees they need to stay busy. Train staff to be aware of co-workers and where they might need help to keep the flow going.
  • Pair the new trainee with another staff person who is a good role model.

On the job

  • Have a physician or others fill out a short feedback form, daily, for the employee's first three months.
  • Have a supervisor or someone in authority review the form with the employee.
  • If an employee underperforms, address the specific issue right away, before bad habits form.
  • If problems persist, prepare a disciplinary notice and have the employee prepare a work improvement plan.

By managers

  • Make sure tasks and projects are appropriately delegated, so employees feel empowered.
  • Motivate employees with verbal, face-to-face recognition of a job well done.
  • Offer small financial incentives to recognize employees who have come up with money- or time-saving ideas.


Copyright 2008 American Medical Association. All rights reserved.

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