What does your new employee orientation look like? For many practices, not much. You show the new hires around and introduce them to their coworkers (although everyone’s too busy to stop). You give them a handbook (that probably hasn’t been updated since The Office went off the air) and have them sign for it (even though they haven’t read it). You assign them a staff member to shadow (naturally, you pick your very best—and busiest—tech). And that’s it. With a welcome like that, it’s no wonder that turnover is high in medical practices.
What does a new employee orientation have to do with reducing turnover? Consider this: new hires are usually excited to start. They come in with high expectations, but then they feel “thrown to the sharks” because there’s no real orientation, explains Keith Casebolt, who presented along with Patty Casebolt at the 2018 ASCRS·ASOA Annual Meeting. They don’t know how they fit in with the practice and culture, and after a few weeks, they start thinking that maybe they made the wrong decision. Next thing you know, you’re short-staffed and looking for a replacement.
Turnover tends to be mostly in entry-level positions, the front desk, and some techs, according to Patty Casebolt, who is the clinical director at a large practice in Medford, Oregon. But a well-thought out, engaging orientation can stem that turnover—the same turnover that brings lost productivity, low morale, and the high cost of replacement.
“New people were cycling in and they really didn’t know much about our practice, particularly as we got bigger and more sophisticated.” — Keith Casebolt
During their ASCRS session, the Casebolts gave attendees a blueprint for a new employee orientation that worked for their practice—an “employee orientation in a box.” Can it work for yours? It can, if you follow these five steps:
1. RE-recruit to Your Practice
A common misconception about orientations is that you’re just going over a bunch of policies, and why would you need to do that when they’re all in the handbook, explains Keith Casebolt. There’s more to it than that, he points out. When he leads an orientation, Casebolt is “re-recruiting” new hires to the practice. You’re trying to get what he calls their “discretionary emotional investment.” It’s a way of demonstrating your practice’s culture, forming bonds, and getting their full buy-in. Emotional investment in the practice’s success isn’t necessary for an employee to do their job, but if you can get it, “the practice tends to be way better off,” Casebolt says. To get that investment, start with your mission statement. Why does your practice exist? What are you known for? How can new employees become part of that narrative?
Tip: The Casebolts recommend having a variety of speakers. It adds interest, keeps things moving, and lets employees meet other leaders in the practice besides their manager.
2. Develop Relationships
An often overlooked benefit of a good orientation is that it gives new staff members a chance to connect with each other and with the leaders in the practice. That way, they feel less like the ‘new kid,’ Casebolt explains. They’ll have someone to talk to when they go to the break room, and they won’t feel as much like an outsider, he continues.
To get people talking and lighten the mood, conduct ice-breakers early in the session. The Casebolts like to circulate a list of several get-to-know-you questions to new hires. Each attendee picks three questions to answer, and they take turns presenting their answers. Their answers are also circulated around the practice. It creates opportunities for conversation, and gets the new staff interacting with the current staff.
3. Ramp up Knowledge
Like many practices, yours probably has its share of drama. Strained relations between front-of-house and back-of-house staff are not uncommon, but in the Casebolt’s practice, the drama stemmed from a surprising source. Patients often ask front desk staff about a particular service, and those employees didn’t have the knowledge to respond adequately, Patty Casebolt explains. Sometimes, they wouldn’t even know that the practice offered a certain product or procedure. It made them feel defensive and resentful of back-of-house staff members, who they thought were hoarding knowledge.
From then on, the Casebolts made sure that orientations contained information about each of the practice’s service areas—even if the employees weren’t working in that particular area. Providers from each department come in talk about what’s exciting about their particular program, Patty Casebolt says. They make sure that everyone can talk about at least the basics of every area in the practice, even if they have no eye knowledge, or no billing knowledge, for example. They found that if they gave the staff basic training, they just thrive more.
And it doesn’t stop there. Employees—new and current—have the opportunity to shadow in every area to build their knowledge. If they want to see what it’s like to help a patient choose frames, they can shadow in the optical. If they want to see a cataract surgery, they can shadow a surgeon.
4. Set Expectations for Behavior
It’s not the most exciting part, but every orientation must include the practice’s policies and procedures, including HIPAA and risk management—you don’t want to find this out the hard way. Patty Casebolt tells of a practice that was sued a few times by one particular attorney. The attorney was “shopping for plaintiffs,” placing ads to recruit patients who were unhappy with their laser procedure, she explains. The practice realized they “needed to do a better job of systematizing everything [they] do for patient safety,” she adds. Even the smallest discrepancy in documentation or variation in process could open your practice up to liability.
How do you lighten up these often boring—but essential—topics? People learn better when they’re having fun, the Casebolts say. They foster teamwork and inject the atmosphere with some excitement by playing “family feud” or “survivor” style games. You could also add small prizes for the winning teams (think $5 gift cards).
Getting the practice leaders involved in setting behavior expectations is essential. The Casebolts like to have managers share stories about times when things went wrong, and explain how they handled it. In addition to it being a learning experience for new hires, it boosts camaraderie. The new employees benefit from seeing that the managers are human and make mistakes, just like anyone else.
5. Get Them Engaged Through Participation
Active participation is a key part of the Casebolts orientations. It’s not just saying “blah blah blah, here’s a bunch of information,” and watching them nod in agreement, Keith Casebolt says. “It’s their orientation, not our propaganda,” he continues. You want to make it about them just as much if not more than you want to make it about the practice.
Try some team building exercises, the Casebolts recommend—fun games that get the new hires working together to solve a challenge. The ice-breaker “First or Worst” is another way to get people talking. Have each new hire share either their first job or their worst job, and a lesson they learned. There are inevitable funny stories, but everyone gains some insight, too.
Finally, don’t forget the feedback. These programs aren’t static. They should be constantly evolving as you learn what works and what doesn’t. After each orientation, the Casebolts ask attendees to complete an evaluation that asks three things about the orientation:
- What do you want us to stop doing?
- Is there anything we should start doing?
- What do you want us to continue doing?
6. Don’t overlook the details.
These small details may seem basic, but careful planning will help keep attendees attention while boosting their retention:
- Don’t have the speaker at the front and attendees in rows. “I would never set up an orientation seating like a conference,” Casebolt says. Why? You want to diminish any distance—physical and psychological. Try a circle/oval or U-shape instead.
- Try to make the new staff feel a little bit cared for. Have water and good snacks available. You could even consider a boxed lunch.
- Schedule one or more breaks to let attendees move around, use the restroom, etc. They’ll be more easily able to regain their focus if they can clear their heads for a few minutes.
- Eliminate distractions like cell phones. Ask participants to place their cell phones in a basket, and give them time to check during breaks.
- Prior to the orientation, let employees know what to expect. For example, if your environment tends to run cold, let participants know to dress in layers.
7. Get the Timing Right
Try to do an orientation within the first three months of adding staff members. Schedule it on a day that will have the least impact on the clinic. Keep groups to no more than 10-15 people, the Casebolts recommend. For smaller practices, that likely won’t be a problem, but if you have a bigger group, break it up to keep that personal feel.