Assembling a Spine Office Medical Team

Assembling Your Staff
The practice of medicine is by far one of the most
important fields in which people can work. Taking care of
peoples health is such an important profession that it
should have only employees who take pride in their job and
want to come to work each week

•The Business of Spine
•Common Mistakes
•Remember your roots and what you need to grow
•Assembling your staff
•The cost of hiring poorly
•Running your practice
•The future of the Spine Practice
•What SpineSearch can do for you

•Joining a practice
•Starting a practice
•Building a road to success

•Best Practice
•Consistent Process
•Equal access
•Good faith efforts
•You need to know how it works!!

•“I don’t have to worry about…..
• Staffing, they supply me with a secretary..
•Accounting, the practice has someone they have used
for years
•Malpractice, the group has a policy
•Billing, the practice takes care of it
•Marketing/PR, the practice/hospital will promote me
•Staff education, they have been there for years

Not…
Listening
Seeing
Speaking

Or where you are going..
• Strategize your 1st years goal, and 5 yr goals (short & long
term)—Write them down and have a formalized process to
record your progress
•Revisit your goals/progress on a quarterly basis to keep yourself
on track
•Putting goals in writing makes them more likely to be realized
•Don’t be afraid to share goal with staff
•Assign goals to every team member regardless of position—give
everyone something to strive for

•No one will care more about your business than you do
•Listen to those that work with you
•Invite patient feedback, they are your customers
•Spending a little extra time getting things correct in the short term
will reap large rewards over the long term

Why do we have staff?
• So MD’s don’t have to perform nonclinical tasks which
lowers physician productivity.
This is key to remember because there is a tendency to view
employees as a cost. When budgets get tight we fire
employees, MD’s do nonclinical tasks and income drops
more creating a negative feedback loop.
However employing to many employees can just as big a risk as
employing to few

1) Asses the task of each provider (for multi-physician
practices) and staff.
2) Is a physician being interrupted for patient phone calls?
3) Does each physician need a full-time RN, NP, or PA?
4) Are employees in their knowledge areas?
5) Are you appointment schedulers working in shifts so the
phones are continually being answered?
6) Are accounts receivables staff seated where they can
concentrate or at the busy front desk?
7) Are accounts receivables going past their average collection
times or for new practices past the industry averages?

Study after study has salary low on the list of motivating factors.
Higher on the list are the ability to balance personal and
professional life, a sense of purpose and meaning of work, trust
among employees and a good relationship with the supervisor
or manager.
Know your staff—What makes them tick???
Ask them “What is important to you?”

Now key attributes for different age groups and any other
charactersitics that might differentiate the staff of your office
Some examples:
Baby boomers often strive for public and peer recognition,
promotion and control in addition to higher salaries.
Workers born after 1969 tend to place the following above
salary; positive mentoring experience, continual challenges,
continuing education.
Given choice of extra time off or a monetary bonus younger
workers often prefer time off

1. Define job roles
2. Form Mentor/protégé relationships
3. Develop a strategic plan for employees

1. Define job roles:
Most jobs in a medical office are self explanatory right? A
biller bills, a receptionist answers the phone, a nurse sees
patients and assists the MD. On the surface perhaps, but
consider this example: One of your top secretaries schedules
10 new patients to be seen on Monday. No one tell the rest
of the staff and when Monday comes all hell is breaking
loose in the office by 0900. The secretary assumes that the
office manager will tell the MD, the RN, and other
administrative staff to have all documentation and to leave a
little extra time between other patients to handle the large
amount of new patients for that day. The Office manager
assumes the secretary will tell everyone, the MD assumes
some one will tell him, and the assuming goes on and on….
Without clearly defined jobs you have a problem on your
hands!

Thankfully, there is a simple way to solve this problem. Each
person on your team needs a job description.
Job descriptions help to –
Clarify roles and responsibilities – everyone knows exactly
what they are supposed to do.
Increase morale because it’s clear what it means to do a “good
job” and what it means to go “above and beyond.”

A job description will rarely be a laundry list of every single task
associated with a job.
As a business owner you are responsible for defining the roles of those
who work for you but you don’t have to go it alone. Invite those
currently executing the job to provide feedback on what they think
their job is and what it should be. This can be a very revealing
exercise!
SpineSearch has a vast amount of experience in creating useful and
efficient job descriptions both from an institutional setting as well as
an office setting. If you would like us to assist in helping customize
job descriptions to help maximize efficiency in your office do not
hesitate to ask!

In most cases, job descriptions do not need to be overly complex
especially if you are a small company.
A good job description will –
Explain the major functions, duties and responsibilities of the
job.
Highlight the specific skills that are most relevant to the job.
Explain what it’s like to work in your environment.
What position
have your
employees been
assigned? Do
they know?

Facilitate the recruitment process because the job you are
looking to fill is clearly defined so it is easy to explain to
prospective candidates.
Define career paths within your company. Those more junior
can see what it takes to execute a job more senior to their own.
Impact the bottom line. When everyone performs the
necessary tasks you can be certain patients are being properly
serviced so they’ll come back to you again and again!!!!

Use your strong staff members to assimilate, train
and mentor new staff until they are up to speed with
proper procedures. Although many medical practice
administrators have graduated from rigorous
academic programs, few in any, have left those
programs with the wealth of skills that are needed for
successful health care management. This matter is
further compocated by the fact that in most cases, the
health care industry does no provide formalized
corporate training for its managers or any other staff.
Utilizing a well trained office manager or other higher
level staff member to bring new staff members along
the e proper path is critical to getting what you want
out of a new higher

•Where there is a problem, the decision-
makers in the medical group must take
ownership and commit to improve the issue.
•Have a strategic plan of action to presenent
to the MD, partners, or board of directors
depending on the structure of your
organization.
.

Avoid the temptation to fix the “squeaky wheel” employees with small
increases or changes without have an overall plan.
Strategic Planning require evaluation of many areas to review
thoroughly before developing a plan of action. Practice evaluation
should include areas such as number of staff, work turnaround time,
and volume of work in objective measures as well as employee surveys
to assess their ideas for improvements. This type of approach prevents
what is frequently called the “Band-Aid” fix, which brings only
temporary solutions and may actually make the problem more costly
in the future.

Many times employers will rush into an overall salary increase as
a plan of action to decrease turnover.
As I have discussed previously salary increase is frequently not
the best action plan to prevent t employee turnover
Ask questions, speak with multiple staff members, develop a
well thought out plan before you act!!
In addition to a strategic plan for situations that arise in your
practice I would highly recommend developing a set of standard
operating procedures for your office.

We can spend thousands or even millions of dollars building an office,
buying medical equipment, purchasing sophisticated software, hiring
powerful marketing firms that will perform every day exactly as we
want. We can adjust and modify all equipment, customize the
software, consult with all the PR firms in the world and we can have an
information system that gathers important data about every patient &
insurance provider that is seen. But if we can’t employ a workforce that
operates the office consistently and efficiently then the whole
operation will fail.
Full adoption of the standard operating procedure (SOP) process can
go a long way toward ensuring that the necessary workforce is in place.
The full SOP process includes planning, developing, implementing,
and monitoring. This simple guide will help demonstrate the need for
SOPs and how they can be a big part of managing human resources

Standard operating procedures are a means to remove variation
in work performance caused by people completing the same
work processes in different ways.
A process is a set of actions that a person or group of people
must perform in order to complete a job. A standard operating
procedure describes the steps that people should use to
complete the process. Thus, in a medical office, phone triage is a
process, seeing a new patient is a process, collecting insurance
information is a process, billing is yet another process. I am
sure you get the picture and the list goes on

Variation in processes can lead to reduced patient satisfaction, poor
payor mix and less referrals among other negative out comes. But
since some variation is normal, how can it have such an impact on
performance? The answer is that there are two types of variation. The
famous management educator W. Edwards Deming defined common
cause variation as the result of the myriad imperceptible changes
that occur in the everyday operation of a
process. Fluctuation in time it takes to see a
new patient from start to finish by only a few
minutes is likely due to common cause
variation and is ok. A 45 minute delay is most
likely due to lack of procedures being
followed and needs to be analyzed and
corrected

The SOP Process and Human Resource Management
Most people think of a standard operating procedure as a piece
of paper that contains step-by-step directions about how to
complete a job. That image is correct…in part. However, in order
to get the full benefit of managing with SOPs, one needs to
think in terms of an SOP process.
The SOP process includes planning for results, development,
implementation, monitoring, and performance feedback; all of
which are proven elements of effective human resource
Management.

A good SOP process is about engaging the creative talents of
managers, workers, and advisors in a cooperative way. When this is
done well, the result is an outstanding procedure that everyone feels
committed to. Attempting to create SOPs at the management or
advisor level and then simply imposing them on workers is an exercise
in futility. Imposing SOPs on others without their input leads to
resentment, rejection of the SOP, and countless small acts of sabotage
that defeat the purpose altogether
The right way to design SOPs is in a participative manner. Participative
management means encouraging everyone that will be affected by the
SOP (the stakeholders) to contribute to its development. Leading this
process takes practice, but it is worth the effort because teams of
people will always outperform individuals.

Be aware of 5 obstacles to overcome when trying to work with your team to produce an
SOP. Remember—employees aren’t used to having any input in what goes on at their
job!
1. Resistance to change. Working together to create great procedures is a radical change
for some medical organizations. Leaders need to make sure that everyone knows what is
happening and why.
2. Mistrust by workers of management’s motives. Workers are used to just working, not
contributing to improvement. It is critical for the leader to create an atmosphere that
fosters development
3. Lack of clear expectations. Workers may not be sure how much to contribute or what
is appropriate. Reassure them that they won’t get into trouble for bringing up their
ideas.
4. Lack of participative skills. Managers, employees, and advisors all struggle with this at
times. Make the opportunity for input as non-threatening as possible. Once again,
sometimes an outside facilitator (SpineSearch) may be necessary.
5. Lack of commitment from top management. Without commitment from the top to
support participation, there is no chance for an SOP process to succeed

Plan For Results
Just like other management activities, advance planning greatly increases the chance of
success with standard operating procedures. The person or small team that will lead the
SOP development process needs to make plans and decisions before the development
process can begin with the other stakeholders. Decisions that should be made in the
planning stage include the following:
1. What business goals will the SOP help to achieve? Clearly define the process and
products that will improve when the SOP is in place. Illustrate for everyone why the
process is important and how it contributes to individual and business success. For
example, the goal of a spine practice SOP is to efficiently and quickly see patients in
a professional manner and eliminate mistakes and unnecessary delays. Standard
operating procedures work best when they are designed to achieve specific results.
2. How will we monitor performance so that we know workers are following the SOP
and so that we have information to feed back to the workers? SOPs are about
reducing variation introduced by people. We must be sure that everyone
understands the procedure and follows it.

3. How will we monitor results to know if the SOP itself is properly designed to
be effective? The old saying, “If you can’t measure it, you can’t manage it,”
definitely applies here. Think about what you will measure. These indicators
would show how efficiently patients are seen and how effective the procedures
are at preventing delays and mistakes.
4. What type of procedure format should I use? There are a lot of ways to
present an SOP. We can’t go into detail about the many different formats in
this presentation but SpineSearch is available to discuss formats, creating,
monitoring and any other part of the SOP process you desire
5. How can I get everyone (management, workers, and advisors) to buy into this
SOP? If you can’t get everyone on board, it won’t work.

Development
Once the leadership has answered the five questions in the planning
stage, it is time to move onto development. It is in the development stage
that the procedure is opened up for input and review from the
stakeholders: workers, other managers, and other advisors.
Implementation
After a satisfactory standard operating procedure is developed and tested,
it is time for implementation. The SOP leader needs to make sure that
everyone receives a copy of the SOP to study and review. In addition, the
SOP should be posted, if possible, in the workplace where it will be
completed
Monitoring and Feedback
Monitoring stems from the performance goals that leadership established
in the planning stage.
An effective monitoring system really must measure two different things:
1. Are all the workers consistently following the SOP, and
2. Is the SOP designed correctly to achieve the desired results?

Conclusions
No quick fix is possible to remove variation introduced when
different people complete a process. A thorough standard
operating procedure program can remove much of the variation
by bringing workers, advisors, and management together to
design the best possible procedure. Perhaps the best benefit of
the participative SOP process is that many challenges can be
solved at once. A participative style makes managers better, it
leads to happier and more motivated workers, and it creates
procedures that are far more effective than when management
designs them alone.

Because it costs more to
replace staff members than to
retain them, you should
continually monitor your
practice’s turnover rates by job
classification and set realistic
goals for monitoring
performance yearly.

The total cost of replacing an employee runs 50% to
150%. The higher percentages usually apply to
managerial staff. Thus, it can cost your practice
$75,000 to replace a $50,000-a-year employee. Those
percentages include related costs, such as recruitment,
hiring, training, use of temps, and lost productivity for
six months.

MGMA’s 2006 Survey on indicated turnover rates:
•25% for receptionists and medical records staff
•16.59% for nursing and clinical support staff
•10% for billing/collections and data entry staff
•1.56% for nonphysician provider staff
If your turnover rates exceed these median rates, you should
determine the reasons, measure general employee satisfaction
and outline steps for reducing staff turnover.

Do you survey departing employees why they leave the practice?
Exit-interview surveys reveal issues and trends that lead to
turnover and help you develop plans to reduce it.
Sample Questions:
What influenced your decision to leave?
How could the group have made your job more rewarding?
How has management responded to your concerns?
What did you like/dislike about the practice, it works processes
and your interpersonal relationships?
Were the salary and benefits adequate for your responsibilities?

Emp0lyee-satisfaction surveys distributed to all staff members
also reveal areas that need to be addressed. If you’re
determined to improve employee retention, you should also
look at what you offer. Employees are more apt to remain in a
pratcice that:
•Offers attractive salary/benefits
•Allows flexible scheduling
•Supports continuing education and advancement
•Has effective relationships among supervisors and physicians
•Listens to employees’ suggestions and ideas
•Offers a sense of community in the workplace

•In today’s business, practices not only compete for
patients….they compete for
•Make your practice attractive, potential candidates do have
choices in the health care field make them want to be with
your organization
•Past performance is a good indicator of future success
•Little can be learned on an interview
•Have candidates “spend a day in the life”
oBoth you and employee will have better idea
oOne bad day is better than one bad year

The staff in your practice have the intellectual capital to do their
job descriptions. They can take that information to a practice
across town any time they want.
Finding the talents that people in your practice have, inviting
them to use them and rewarding success whey they do is
paramount in successful management.

You want to make sure to set realistic goals so
the employees can actually accomplish some of
them without having to operate on a fully
optimal basis, if all goals are unobtainable
then you will decrease moral not improve it.
Some suggested goals:
•Average time to see a patient
•Average time to collect from insurance
•Number of patients seen per day, per moth, per quarter…
•Time to follow up on a patient message
•Time to follow up on a patient complaint

When individual and are office goals are met employees
need to be rewarded. Recognition does not always have
to be financial—the focus should be on the achievement
not the reward.
General ideas but be creative to the specific employee
and or goal
•Cash reward
•Half day or day off (Friday?)
•Dinner with spouse or significant other on the office
•Office party
•Extended Lunch
Also reward Length of Service (LOS). If you want to
promote loyalty for staying with your practice. Promote
a culture that not just rewards achievement but also
length of service with your office 1yr, 5yr—I think you get
the idea

•What does this mean for you??
•Influx of employees into healthcare
•More resumes, not necessarily more qualified
•Need for proper screening
•Opportunity for smart business practice to obtain highly
qualified professionals

Office Efficiency
 LAS VEGAS -- One of the best ways to improve your
office efficiency is to train and retain good staff, Dr.
David M. Pariser advised at the Fall Clinical
Dermatology Conference.
 "You spend more time with your staff than you spend
with your family," noted Dr. Pariser, professor of
dermatology at Eastern Virginia Medical School in
Norfolk. "You want your employees to know what your
expectations are, and you would love for them to be
able to exceed those expectations."

Once a major program has been put into place, regular monitoring
must be done in many areas. Besides employee surveys and
turnover reports, evalutations of the employee salaries in the
market are also important. Annual review of the market for salaries
of key positions is essential to prevent turnover increase because of
low salaries. Also try to speak with other peers in your industry to
stay on top of industry trends

When hiring employees, it’s tough to find
the eagles in a flock of turkeys because the
latter have learned to disguise themselves as
the former. With the right selection tools
and a few tips, though, you can increase your
odds of hiring someone who soars rather
than squawks.

Just as you make a list of features you desire when
shopping for a new car, develop a shipping list for new
hires. You should hire for attitude and train for skills.
Skills don’t mitigate a bad attitude or disruptive
personality

Another useful idea is a performance profile. This is a
prioritized list of the top six or eight things a person in the job
must do to succeed or excel in the position. It describes the
positions primary performance objectives, key sub-tasks and
challenges. You should look for people who have accomplished
similar tasks at other jobs. By developing performance profiles,
you also ensure that if you have more than one individual
involved in hiring that the process looks for the same attributes
in applicants.
A thorough hiring system and valuable tools allow you to hire
the right person the first time!

Don’t under estimate employment applications—
prospective employees fill them out on site and record how
long it takes them. Look for other indicators, too. For
example, did they leave blanks when they where told not
to?
Applications can be more valuable than resumes because
they tell you what you want to know; a resume tells you
what the applicant wants you to know

Don’t use employment applications – or resumes- as the basis
for interview questions. Instead, develop a standard guide for
the position. Ask open-ended or situational questions and take
notes.

5 Important questions to ask:
1) Tell me about the first job you ever had. Because
the first job they ever had could have been years ago
and unrelated to the one for which they’re applying the
applicants don’t expect this question. The answer may
review their values and ethics.
2) Tell me about the achievements in your life that
you are most proud of and the obstacles or
problems you have overcome. The answer will give
you indication of what motivates the applicants

5 Important questions to ask:
3) Tell me about your last performance appraisal. An applicant
revewls his/her level of self-esteem and feelings about another’s
appraisal.
4) Ona scale of 1 to 10, how would you rank yourself as a (insert
job position)? Then ask what it will take to get them to the next
number
5) What one question would you like to ask me? After
asnwering, ask, “Why, of all the question you could have asked,
did you choose that one?” Role ereversal is always informative,
plus the question reveals an applicant’s #1 priority.

Positioning applicants to tell the truth is also a critical part of
the interview. Let them know what the interview process will
consist of and what you expect from them. Tell them that you
will be truthful with them and ask them to be honest with you

Dorothy Sweeney, a popular employment theorist, feels many
employees leave because of burnout, and she expresses the
symptoms of burnout as frequent absenteeism, low morale, and
high turnover.
Sweeney also supports the argument that burned-out employees
are costing employers major dollars to the bottom line each
year. Expenses related to burnout, such as high absenteeism
and low productivity, are fairly easy for employers to spot.

Other non-employed staff members that you will need to
orientate with how you want to work. Keep in mind some of
these non-employed staff can and will be just as important as
your employees to the success of your practice.
1) Medical Technology Reps
2) Imaging Locations
3) Physical Therapists
4) Outside billing
5) Marketing Companies/PR personal
6) ???

The staffing of your office is a critical link in the longevity of
your success as a physician and a key cog in your ability to
expand, service, and bring in new business. Ultimately if your
staffing function breaks down so will your ability to see and
treat patients.
Your staff is the first impression of your office and we all know
first impressions last for ever (put in Max’s picture with the
underwear on his head)

• 10 years running spine practice
•Importance of phone triage
•Patient satisfaction
•Review of accounts
•Analysis of referrals
•Understand the responsibilities and importance of each
position
•Many connections with experienced MD’s who have
learned from the school of hard knocks—Let SpineSearch
help you learn from their mistakes

Assembling a Spine Office Medical Team

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