How many HR classes did you take in med school? What about leadership training?
For most ophthalmologists, the answer is probably ‘not many’. Discussing a diagnosis with a patient is second nature, but when it comes to communicating with staff members about their performance (good or bad), doctors tend to clam up. It’s normal to want to avoid tough talks, but if you want to avoid the costs of staff turnover, you’ll have to tough them out.
The exact numbers depend on your practice, but some estimates peg turnover costs at about 20% of a given position’s annual salary. You’re likely aware of direct costs like severance pay and paying temporary or overtime staff to cover the vacancy. But don’t forget about the indirect costs. Loss of expertise and historical knowledge, workflow disruptions, and stress on remaining staff members all take their toll.
Managing turnover in your eye care practice means retaining valuable staff members while addressing those who aren’t meeting your expectations. Author and motivational speaker Tracy Spears, keynote presenter at AAO2015, notes that holding on to under-performing employees affects your entire team, and could even cause you to lose high-performers. When good employees are forced to pick up the slack or deal with the drama of a troublemaker, they are more likely to experience burnout and start looking for a job elsewhere.
Spears advocates an approach she calls “Coaching Up or Coaching Out.” Whether you are heading up a solo practice or managing a team of junior physicians and staff, these four crucial conversations are an essential part of every leader’s toolkit.
The Rockstar Reminder: This is an incredibly simple discussion, but few practice managers actually do it. Why? It’s easy to leave well enough alone, and staff members who perform well with little oversight tend to fly under the radar. If you have an employee who exhibits great potential, use the Rockstar Reminder to tell him or her about it! It can make a big difference in nurturing and retaining high-level talent.
- Don’t hold out for perfection. This employee might still be learning, or have hit some bumps in the road. And that’s OK; this is a reminder that you see the potential.
- Do let these employees know that you expect great things, and that you plan to be their partner in achieving them.
The Stand-Up Talk: Used when an employee is floundering or causing issues within your team, this problem-centered talk is stressful for both the giver and the receiver. Spears suggests making it a quick exchange delivered while standing—the posture lessens the chance the employee will become defensive. Explain the reason for the meeting, stating the issue and why it concerns you. Then, give a clear recommendation for improvement, asking for confirmation of understanding.
- Don’t ask for an explanation. This invites excuses, turning the focus away from where it should be: on the problem and the solution.
- Do schedule a follow-up at a specific time, and keep the appointment. Use it to assess any improvement and discuss next steps with the individual.
The Now or Never: A last resort, it’s time for this conversation when a Stand-Up Talk has failed to bring about improvement. Spears acknowledges that it’s undeniably uncomfortable, but says that it’s also a chance for a manager to set him or herself apart by acting with honesty and candor. This is when you let the staff member know that you are running out of options and that this is the time when things must change.
- Don’t mince words. Make the employee realize that the ball is in his or her court by saying something like, “You are making a decision about your future with your performance, and you are at risk.”
- Do end on a positive note. Reiterate your confidence in the employee by telling him or her, “I would hire you again, and you still have great potential here. I would hate for this to be the reason that you’re no longer on our team.”
The Stay Interview: Do you have a proven, valued team member you can’t live without? Spears advises conducting a Stay Interview to cement your relationship and prevent this person from seeking greener pastures. This is the exit interview’s proactive cousin. It’s a way of gauging a key employee’s opinions, level of job satisfaction, and even frustrations….while he or she still works for you.
- Don’t schedule too far advance (a day or so is best). You don’t want this person to feel anxious about a meeting with The Boss. During the meeting, use your tone and body language to keep things casual and upbeat.
- Do act on the information you glean. If there is something in your power you can do to address the staff member’s concern, do it! Spears notes that your action can positively influence culture, employee retention, satisfaction levels, and ultimately, your practices performance.
With more and more value-based reimbursement coming into play and MIPS on the horizon, patient satisfaction scores will affect reimbursement calculations from Medicare and some private insurers. If the faces in your office are constantly changing, the personal relationships that your practice has built with patients will suffer, making high satisfaction scores—and optimal reimbursement—harder to achieve.
