Physiatry Practice Management Resources

Gregory H. Nizich

Many physicians face a common problem that can be frustrating and can cause a practice to become stagnant. The situation occurs when, to the outside observer, the practice appears to be in chaos. Boxes, papers, and books are piled all over the business area, as well as every other area of the office. Cash flow is tight, morale is low, and you just don’t know where to start to turn your practice around.

In many ways, this situation is similar to when you try to tackle the job of cleaning your garage or basement. The task seems so immense that it’s easy to walk away from it. Yet, the job clearly has to be done if you want to be organized and reduce the stress in your life.

If you find yourself faced with this problem, start by tackling the simple tasks first—those that give the greatest visible evidence that progress is being made.

. . . start by tackling the simple tasks first—those that give the greatest visible evidence that progress is being made.

Clean up your act.

It’s impossible for your practice to function efficiently and effectively when paperwork is in piles on the counter and desktops, books used for reference are misplaced, or out of date, and patient charts are strewn across the office on table tops and desk tops. Use these four simple steps to organize and streamline your office:

• Buy some multicolored round stickers to identify the procedure to be followed for the tagged item. The tags might have the following meaning: A green tag might indicate that this document is useful for reference, or is required to be maintained by law. This item should be filed in the appropriate place. A yellow tag might indicate that the particular item may be useful and that this item should be kept in storage in the event that it is needed. A red tag might indicate that this item is not needed and should be thrown away.

• Close the office 2 hours early, on a Friday, and ask your staff to place a colored sticker on any items, boxes, books or paraphernalia that are not in the right place.

• On a separate occasion, have your staff go through the office taking the items that were tagged with the red label and packing them in boxes to be thrown away. File the yellow tag items in boxes with a label indicating the date they were placed into the box. Finally, have the staff organize the items tagged with a green label and split up the filing responsibilities so that everything gets put back in its proper place.

• Six months after this procedure, review the yellow-tagged items stored in boxes. Any items that still remain in the box were not accessed by the office in 6 months. It’s probably safe to say that such items are not useful or relevant in day-to-day operations and should be thrown away.

Find More Cash

The next step is to try to increase the practice’s cash flow, always a good way to boost your morale. Given the requirements of today’s managed care climate, and the volume of administrative responsibilities, it’s a full time job just to see patients and get bills out the door, let alone follow-up and manage the accounts receivable. In fact, accounts receivable management is severely neglected in most practices today.

The first thing to understand is that the aged accounts receivable report is a tool to help you determine the type of follow-up activity required for each account, based on the length of time each is outstanding. In many practices, accounts are left in the billing system, and never removed. Some balances are more than 2 years old! To clean up accounts receivable, take the following steps:

• Reclassify any account with a balance over 180 days old as a collection account or some special classification. This removes the account from the active file and or places it in a separate category. With many computer systems, assigning a collections code to an account will remove it from the active accounts receivable system but still allow you access to the information through a separate collections module or through a basic inquiry function.

• Assign the responsibility of researching these accounts to one individual. The individual will investigate each account to determine why it has not been paid for more than 6 months. He or she will be responsible for correcting any problems to help stimulate payment.

Assign the responsibility of researching these accounts (more than 6 months old) to one individual.

• Most billing systems will allow you to print an aged accounts receivable report that gives you the patient name, the amount of the claim, and an indication of how old that claim is. Print the computerized report for your top four insurance payers. Assign responsibility of investigating these accounts to four separate individuals. By splitting up these responsibilities, you should learn about the status of insurance balances four times faster than if you assigned the responsibility to one individual.

• Print out the aged accounts receivable report for the remaining insurance carriers in the system. Call in some temporary employees, whether friends, relatives, sons, daughters, or employees from a temporary agency. Split up the list so that they can make telephone calls to determine the status of these claims.

You will be amazed by the number of claims that “were never received” according to the third party payer. Although this is not likely the case, when insurance companies get overwhelmed with volume, anything can happen. This effort will result in a surge of cash flow 4 to 6 weeks later. If you do experience this surge, maintain this type of pressure to ensure that the practice’s cash flow continues to be favorable in future months.

You will be amazed by the number of claims that “were never received” according to the third party payer.

Vendor Assessment

The next step to refresh your practice is to put vendors to the test. As your practice gets busier and busier, your staff spends less time investigating prices. You also pay less attention to how attentive your advisors are to your particular needs.

Assign someone the responsibility of going through the invoices and identifying some of the major supply purchases made over the past few months. Have this person look through various catalogs and price shop to determine whether you paid the best price for those items. If you didn’t, establish policies to ensure that your staff doesn’t simply buy where, and when, it’s convenient for them It is imperative that they take into consideration the cost of the item to be ordered. Limit the dollar level of items or of total order that can be purchased without your specific approval.

Advisor Assessment

The same process should be applied your advisors. Your accountant may also have grown a bit lazy about how he or she attends to your practice’s needs. Review your invoices and determine how much you are paying your accountant per year. Try to make a list of the services your accountant provides. Ask yourself whether such services are desired or whether you want more than just income tax form preparation, for example.

Make a list of the additional services that you want your accountant to provide. Schedule a meeting with him or her to discuss the additional services. Let him or her know that if a significant increase in your monthly fee will be required, you need to research whether another accounting firm might be willing to perform the services for less. This should “wake up” your accountant and make him or her a little more attentive to your needs. Perhaps your accountant will now help sift through some of the more delicate financial decisions needed to improve your practice.

Take an inventory of the insurance premiums you are paying and determine whether you’re getting the best possible price. Prepare an inventory of the types of coverage currently in effect for your practice. Ask a few insurance agents to provide prices for equivalent insurance through other insurance companies.

Contact your pension advisor and schedule a meeting to review your current roster of employees, your personal financial condition, and the practice’s expense structure. The goal is to determine whether the plan you selected, perhaps many years ago, is still the best plan for the practice. Many physicians are finding that, due to changes in the health care industry, the expense of offering current retirement benefits has grown significantly. It may be time to alter the type of benefit offered to the staff.

Take an inventory of the insurance premiums you are paying and determine whether you’re getting the best possible price.

Work Distribution

The next area to review is your staff structure. As a medical practice evolves, responsibilities may be assigned to individuals due to the lack of alternative, rather than based on a fundamental strategy for the most effective assignment of that task. This is no one’s fault; it’s simply how small businesses develop. At this point, however, it may be helpful to make changes to the distribution of responsibilities to ensure that it is the most functional and fundamentally sound allocation of responsibilities possible. To accomplish this, follow these steps:

• Ask each employee to make a list of the tasks they perform on a daily basis. Encourage them to go into as much detail as possible. Many times, it’s not the major job requirements that consume an employee’s time, but dozens of menial tasks. Encourage your employees to be thorough in completing their list.

• Look at each employee’s list for inconsistencies in the type of responsibility that has been assigned. For example, having a receptionist post a Medicare explanation of benefits is inconsistent because the qualities and responsibilities of a receptionist are primarily patient-oriented. They generally have good people skills, rather than the skills required to post claims. The posting of an EOB is a more technical function that requires attention to detail. It would be appropriate to shift responsibility for posting EOBs from the receptionist to the bookkeeper or a billing clerk. These employees are number-oriented and are better suited to the task.

Look at each employee’s list for inconsis tencies in the type of responsibility that has been assigned.

• Make a list of what is not getting done. Is your practice confirming appointments, sending out recall notices, verifying insurance of new patients, following up on referral forms, and any number of other tasks that are important but for which employees don’t always have time.

• Take a look at the responsibilities assigned to current employees and determine whether any employees have time to perform these tasks. Don’t make the mistake you made before by assigning a task to someone because that person has time even though he or she is not suited for the assignment. If you don’t have anyone to assign vital responsibilities to, consider hiring someone to ensure that these things get done.

Conclusion

Each of the functions described above does not require a great deal of time; responsibilities can be spread across many employees. They also can be accomplished in a relatively short time frame—this whole project might span over a course of 60 days. When you look back at your practice after accomplishing all these things, you’ll find that it doesn’t look as chaotic as it did before. In fact, you’ll feel more in control and more confident that your practice is on the right path. n

By David H. Ghusman, CPA

One of the most challenging issues facing the back office of any medical practice is the efficient use of personnel in the collection of accounts receivable. On a normal day, an office may see anywhere between 25 and 75 patients per physician. At the same time, there are hundreds, if not thousands, of outstanding accounts receivable that must be continually monitored for optimum collection. Most practices would consider collecting accounts receivable more efficiently to be one of their priorities. So how does a practice go about doing this?

One of the first issues that should be addressed is the evaluation of the amount of time spent by the staff on accounts receivable collections. It is important to ensure that the A/R staff is spending their time as effectively and efficiently as possible. In order to do this, it is necessary to empower the staff with the appropriate tools. This starts with an appropriate accounts receivable/billing system. Any good system will have the ability to differentiate between those outstanding accounts that need attention by the staff from those that are simply in the normal timeframe of collection from the appropriate insurance company. If your system has the ability to identify "expected payments" for each service rendered (this is normally based on the insurance coverage by the patient) combined with the information from the contract your group has with the insurance carrier and the payment history for the same procedure codes, then your system can routinely advise management of the total amount of collectible accounts receivable by insurance carrier. Monitoring this amount, and having an aged accounts receivable by carrier, will allow for better use of billing staff time.

The use of electronic records for incoming Explanation of Medical Benefits paid (EOB) documentation will additionally allow the computer system to provide optimum tools for the staff to use. Whether your computer system provides the ideal circumstances or not, the staff needs to spend time first on the older and larger accounts receivable. The ability to sort accounts receivable based on age, as well as on dollar amount, will lead to the best use of the staff time available.

One of the other issues that will frequently raise its head in the billing function is a particular insurance carrier delaying payment or changing their pattern of rejections. For this reason, it is very important to continually monitor the outstanding accounts receivable aging by carrier. Whether it is done electronically or manually, certain parameters should be applied to each insurance company based on a contract and their history of payment. As an example, if XYZ insurance routinely pays clean claims in 40 days, there should be a trigger for any claim that is outstanding to that carrier for 60 days. If the carrier begins to fail to meet their required timeframe, two things should happen:

· The carrier should be notified in writing, as well as with a phone call to the Group’s representative, to determine if there is any problem.

· The insurance company should be notified of the imposition of any interest or other penalty as appropriate in the contract.

The use of this technique will help "nip in the bud" the occasional changes that may occur in an insurance company’s payment policies.

An additional area that requires attention is: Secondary Insurance Companies. When a patient has more than one insurance company, the "primary" insurance company will always be billed first. Once the primary insurance company has made its payment, billing to the secondary or tertiary insurance company should then be completed. In certain circumstances (primarily Medicare patients who have MediGap coverage with a carrier related to a Medicare intermediary) the secondary insurance payment will be made automatically. In many circumstances, however, the billing office must generate a new claim which, in some circumstances, may require the initial EOB to be attached to the secondary insurance claim. The ability to quickly identify those claims requiring secondary insurance billing and to generate the bills on a timely basis will greatly enhance the speed of collection and reduce the overall time needed in the billing department.

An area that is often overlooked is collection at the time services are rendered. It is far more effective and efficient to collect funds at the counter when the patient is there than it is to send a bill and try to follow-up after the service is completed. This is especially true when patients have co-payments and deductibles at the beginning of the calendar year. Simply asking the patient whether they have a co-payment and/or deductible will sometimes provide the correct information, leading to the ability to then request payment. An efficient way to obtain the co-payment and/or deductible information would be to get that information directly from the carrier in advance of the patient visit. One to two days before the patient is scheduled to visit, a call to the carrier for this information will provide a practice with the ability to notify the patient when they are in the office of their responsibility. The ability to then accept credit card payments and/or checks will again speed up cash receipts and reduce the collection efforts significantly.

It may also be important, depending on the practice, to establish a policy with regard to uninsured or uncovered services. Most practices will attempt to maintain their fee schedule at an optimum level for total reimbursement by all carriers. Nonetheless, it is understood that many carriers, through contractual relationships, will pay substantially less that the fee charged. In most instances, it is allowed (and may be appropriate) for a practice to offer a discount to an uninsured patient, or one undergoing a non-covered service for prompt payment. Again, the ability to make the collection effort at a time that services are rendered will reduce or eliminate the need for follow-up effort by the billing and collection staff.

It is a good idea to review your A/R reports with your administrator and billing manager on a monthly basis with a good solid review each quarter to make sure your staff is collecting all the money due you. Often, it is discovered that practices are not optimizing their collections, not because the staff does not want to do a good job but because they are either overwhelmed with the current insurance company climate or the department is understaffed.

The ability to determine which carriers are rejecting claims, and necessitating the billing department to start over – both delaying the ultimate receipt of the funds and costing dear time for the limited staff - will also enhance the efficiency of the office. Many practices will perform an analysis of rejections by carrier and by staff member. Each type of rejection can then be tracked to limit or eliminate repeat occurrences of the same issue, often avoiding the issue being confronted later in the case of a second carrier following the same protocol at a later date.

The ability to perform the analysis of what has gone wrong before, and to correct the internal policies and procedures to avoid these same issues being repeated, will usually be well rewarded. By way of example, the knowledge that Carrier A is rejecting otherwise clean claims due to a lack of a referring physician in the case of an office consultation can lead to either an additional claims "scrubbing" routine or a manual review of this area before the claims are submitted to this carrier. Also, the knowledge that biller C is responsible for 35 percent of the rejections due to lack of date of birth on the billing submission, while she is only responsible for 10 percent of the practice’s billing will lead to the knowledge that additional training and/or supervision may be required. This type of enhanced information on the rate and type of rejections can lead to a better incentive system for the billing department, and the front desk staff, based on a reduction of the rate and type of rejections from the base lien level.

Let’s not forget there is another option. Your practice may benefit from outsourcing their billing. This is a common issue that often arises when a medical practice is deciding whether to buy a new updated practice management system because they have recently found out that theirs will not be supported in the future or because they are having trouble finding quality billing staff and their accounts receivable balance is climbing. It may be a good idea for the medical practice to at least explore the billing company option to see what it can offer and how much it will cost compared to what they are paying now.

The ability to maximize the use of staff time and optimize the efficiency and effectiveness of the billing department relies upon a complete and coordinated cycle in the collection process. This cycle begins at the billing desk when the patient is there, collecting those funds that are available, and making sure that all insurance and mailing information is correct and updated, and then, utilizing the time appropriately, making certain that those items that begin to fall behind are caught early. Most practices find that these steps greatly increase the total efficiency of the accounts receivable collection function.

David H. Glusman, CPA, is a principal at Margolis & Company P.C. and is co-chair of the firm’s Healthcare Services Group.

Laura Sachs, B.A

Generous helpings of praise and criticism are key ingredients for good staff management and motivation. Unfortunately, most employees muddle along day after day without any clue as to how they’re doing. Thus, their bad habits and mistakes continue, and their best efforts and achievements go unrewarded.

Many employers feel uncomfortable facing their staff with comments about their performance, either positive or negative. They assume, incorrectly, that employees already knows how they’re doing. They take good work for granted and curse the bad work silently, to themselves.

Clearly, anyone supervising others needs to learn how to give feedback sensitively, at the right time, and in the right way. With practice and guidance, praise and constructive criticism will become second nature and a great tool for boosting morale and performance.

Why Praise is Important

A few well-chosen, well-timed words from you can sometimes do more for an employee’s morale than money, promotions, or other tangible rewards. But in most cases, the little feedback employees receive from their supervisors concentrates on their weaknesses and mistakes.

Although criticism is important, the boss who never seems to remember good work may be his or her own worst enemy. Over time, employees will feel unappreciated, defensive, and angry and will reduce their efforts.

. . . most employees muddle along day after day without any clue as to how they’re doing.

10 Tips For Giving More Positie Feedback

Praise should not be limited to formal performance reviews but doled out generously on a regular basis. Listed below are ten specific ways to give positive feedback:

1. Keep a written record of each employee’s good work, such as meeting deadlines, developing good relationships with patients, or mastering new skills. Keep these lists in your personnel files and refer to them at performance reviews.

2. Praise good work publicly when you can. For example, you might congratulate successful efforts at staff meetings.

3. At the performance review, ask the employee what he or she has done right since the last review. This is your chance to catch up and reward good performance you haven’t noticed.

4. Catch your staff doing something right and commend them for it. Don’t look only for monumental efforts or results. Each of us is proud of our accomplishments, whether large or small, and values recognition.

. . . anyone supervising others needs to learn how to give feedback sensitively. . .

5. Be specific with praise. Use the same approach you’d use if they’d made a mistake, only tell them the good things they’ve done. For example, instead of saying, vaguely, “You’re very good with kids,” you might say, “I’m very impressed with the way you handled Alicia Hills this morning. She was very frightened but you turned her around in no time. Great going!”

6. Praise promptly. If too much time elapses, you may avoid saying anything because you’re embarrassed. Or, you do say something and the employee wonders why you’re just now getting around to it.

7. Don’t overdo it. Too much praise seems insincere and is just as ineffective as too little.

8. Praise employees for specific things they’ve done, but from time to time, let them know that you also appreciate them for who they are. Tell each person how important he or she is to you and your practice overall, and why. For example, write a personal note of thanks to each employee at Thanksgiving, enumerating the many reasons you are thankful to have him or her in your practice.

9. When the employee accomplishes something important, put your praise in writing. A letter of commendation or thank you card sent to the employee’s home (with a copy in the personnel file) can be extremely effective (See sample letter, Fig. 1).

10. Praise your staff as a whole, but also look for chances to praise and reward individuals for their outstanding efforts and achievements.

Response to Praise can Help You Increase Productivity

The next time you praise a member of your staff, study the reactions you receive. Praise triggers reactions from the deepest parts of the personality. Knowing what makes people tick, based upon their reactions to praise, can be a great help in unlocking their potential.

The important thing to look for is not so much the response to an isolated incident, but rather, the pattern of reactions to praise. Although there are of course exceptions, the following is often true:

• People who respond to praise with disbelief often try hard to be accepted by those around them. They’re often willing workers who are eager to please.

• People who turn praise into a joke are usually trying to keep a certain distance from you and others around them. They value privacy and make it hard to others to form close relationships with them on the job. Similarly, employees who make light of or belittle their own good work may want to avoid the spotlight.

The next time you praise a member of your staff, study the reactions you receive.

• People who pass on a share of the credit to others generally enjoy teamwork and work well with others.

• People who respond with embarrassment are usually sensitive, hard-working, and trustworthy employees. However, you may find it hard to supervise them without hurting their feelings or embarrassing them from time to time.

• People who react by changing the subject and continuing with the business at hand are often no-nonsense achievers, independent thinkers, and potentially, well-organized managers.

• People who accept praise graciously and easily are generally assertive, independent, and well-satisfied with their own performance. Such people may have the potential to take on more responsibility.

Never criticize a staff member in a chance encounter or in front of other employees or patients.

Giving Criticism That Gets Results

Few people like to be criticized. However, you’ll find that your staff will accept criticism more willingly if you offer it in a constructive, rather than a destructive manner.

The following guidelines will help you obtain the results you want without making employees feel “put down,” angry, or alienated:

1. Choose a good time to discuss employee problems. Never criticize a staff member in a chance encounter or in front of other employees or patients. Avoid coming down on employees when you or they are in the middle of major work or a personal crisis. And, don’t have a talk at the end of the work week, when the employee is likely to go home and stew over your criticisms all weekend.

2. Pinpoint the specific behavior(s) you want to criticize. Be precise and use a concrete example. For instance, don’t give general criticism like, “You always misplace things.” Rather, say, “You misplaced Mrs. Brown’s file. That’s the fourth file you’ve misplaced this week.”

3. Criticize the act, not the person. For instance, say, “The file drawer is very disorganized,” not, “You’re a slob.” Or say, “You’ve refused to work overtime three times this month,” not, “You’re lazy.”

4. Be certain the change you seek is possible. Don’t ask for results the employee is unable or unwilling to make. For example, don’t say, “Would you please stop blowing your nose? That allergy of yours is driving us nuts.” Rather, you might suggest, “Might you be able to blow your nose away from patients? They may not know you have allergies and assume you’re sick—and contagious.”

5. Offer the person motivation to improve. Will your criticism help that individual grow personally, achieve greater success, make the job run more smoothly, improve his or her relationship with you or others, or offer some other benefit? If so, focus on this positive aspect. For example, you might say, “Re-filing patient’s files promptly and correctly will make it much easier for all of us to find the files when we need them.”

6. State clearly what you want the person to do, and when possible, establish deadlines for results. Again, be as specific as you can. Spell out the precise changes you’d like to see. For example, don’t say, “Please be more considerate.” Instead, say, “Please wait to take your lunch break until you know the phone and reception desk are covered.”

7. Make sure you are understood. If in doubt, ask the person to repeat your criticism in his or her own words.

8. When appropriate, state your criticism as opinion, not proven fact. That will make it easier to take. For example, don’t state as fact, “You don’t try hard enough.” Instead, offer the opinion, “It seems to me that you could try harder when . . .”

9. Indicate your willingness to work with the individual to improve. When appropriate, admit some responsibility for management failure, and try to find joint solutions.

10. Curb your anger. Body language and voice tone convey your attitude as much as what you say. Even the most constructive criticism loses its effectiveness when delivered through clenched teeth.

11. Don’t criticize with humor or sarcasm. It only weakens the impact of your criticism and can backfire by making the employee think the criticism isn’t serious.

12. Avoid comparing the employee to other staff members, or to his or her “infallible” predecessor. Each person is unique. Comparisons almost always cause hurt, and make co-workers competitive and resentful of one another.

Criticize the act, not the person.

13. Don’t exaggerate. Telling an assistant she “never” fills out forms correctly, when of course she does sometimes, may result in your total message being ignored.

14. Don’t assume you know all the facts. Before you criticize an employee, make sure you know why he or she behaves the way he or she did. You may find that your employee’s behavior was caused by factors outside his or her control, such as office policy, other employees—even you.

15. Don’t save criticism. Storing up complaints and dumping them all at once can be devastating. n

Laura Sachs, B.A

Generous helpings of praise and criticism are key ingredients for good staff management and motivation. Unfortunately, most employees muddle along day after day without any clue as to how they’re doing. Thus, their bad habits and mistakes continue, and their best efforts and achievements go unrewarded.

Many employers feel uncomfortable facing their staff with comments about their performance, either positive or negative. They assume, incorrectly, that employees already knows how they’re doing. They take good work for granted and curse the bad work silently, to themselves.

Clearly, anyone supervising others needs to learn how to give feedback sensitively, at the right time, and in the right way. With practice and guidance, praise and constructive criticism will become second nature and a great tool for boosting morale and performance.

Why Praise is Important

A few well-chosen, well-timed words from you can sometimes do more for an employee’s morale than money, promotions, or other tangible rewards. But in most cases, the little feedback employees receive from their supervisors concentrates on their weaknesses and mistakes.

Although criticism is important, the boss who never seems to remember good work may be his or her own worst enemy. Over time, employees will feel unappreciated, defensive, and angry and will reduce their efforts.

. . . most employees muddle along day after day without any clue as to how they’re doing.

10 Tips For Giving More Positie Feedback

Praise should not be limited to formal performance reviews but doled out generously on a regular basis. Listed below are ten specific ways to give positive feedback:

1. Keep a written record of each employee’s good work, such as meeting deadlines, developing good relationships with patients, or mastering new skills. Keep these lists in your personnel files and refer to them at performance reviews.

2. Praise good work publicly when you can. For example, you might congratulate successful efforts at staff meetings.

3. At the performance review, ask the employee what he or she has done right since the last review. This is your chance to catch up and reward good performance you haven’t noticed.

4. Catch your staff doing something right and commend them for it. Don’t look only for monumental efforts or results. Each of us is proud of our accomplishments, whether large or small, and values recognition.

. . . anyone supervising others needs to learn how to give feedback sensitively. . .

5. Be specific with praise. Use the same approach you’d use if they’d made a mistake, only tell them the good things they’ve done. For example, instead of saying, vaguely, “You’re very good with kids,” you might say, “I’m very impressed with the way you handled Alicia Hills this morning. She was very frightened but you turned her around in no time. Great going!”

6. Praise promptly. If too much time elapses, you may avoid saying anything because you’re embarrassed. Or, you do say something and the employee wonders why you’re just now getting around to it.

7. Don’t overdo it. Too much praise seems insincere and is just as ineffective as too little.

8. Praise employees for specific things they’ve done, but from time to time, let them know that you also appreciate them for who they are. Tell each person how important he or she is to you and your practice overall, and why. For example, write a personal note of thanks to each employee at Thanksgiving, enumerating the many reasons you are thankful to have him or her in your practice.

9. When the employee accomplishes something important, put your praise in writing. A letter of commendation or thank you card sent to the employee’s home (with a copy in the personnel file) can be extremely effective (See sample letter, Fig. 1).

10. Praise your staff as a whole, but also look for chances to praise and reward individuals for their outstanding efforts and achievements.

Response to Praise can Help You Increase Productivity

The next time you praise a member of your staff, study the reactions you receive. Praise triggers reactions from the deepest parts of the personality. Knowing what makes people tick, based upon their reactions to praise, can be a great help in unlocking their potential.

The important thing to look for is not so much the response to an isolated incident, but rather, the pattern of reactions to praise. Although there are of course exceptions, the following is often true:

• People who respond to praise with disbelief often try hard to be accepted by those around them. They’re often willing workers who are eager to please.

• People who turn praise into a joke are usually trying to keep a certain distance from you and others around them. They value privacy and make it hard to others to form close relationships with them on the job. Similarly, employees who make light of or belittle their own good work may want to avoid the spotlight.

The next time you praise a member of your staff, study the reactions you receive.

• People who pass on a share of the credit to others generally enjoy teamwork and work well with others.

• People who respond with embarrassment are usually sensitive, hard-working, and trustworthy employees. However, you may find it hard to supervise them without hurting their feelings or embarrassing them from time to time.

• People who react by changing the subject and continuing with the business at hand are often no-nonsense achievers, independent thinkers, and potentially, well-organized managers.

• People who accept praise graciously and easily are generally assertive, independent, and well-satisfied with their own performance. Such people may have the potential to take on more responsibility.

Never criticize a staff member in a chance encounter or in front of other employees or patients.

Giving Criticism That Gets Results

Few people like to be criticized. However, you’ll find that your staff will accept criticism more willingly if you offer it in a constructive, rather than a destructive manner.

The following guidelines will help you obtain the results you want without making employees feel “put down,” angry, or alienated:

1. Choose a good time to discuss employee problems. Never criticize a staff member in a chance encounter or in front of other employees or patients. Avoid coming down on employees when you or they are in the middle of major work or a personal crisis. And, don’t have a talk at the end of the work week, when the employee is likely to go home and stew over your criticisms all weekend.

2. Pinpoint the specific behavior(s) you want to criticize. Be precise and use a concrete example. For instance, don’t give general criticism like, “You always misplace things.” Rather, say, “You misplaced Mrs. Brown’s file. That’s the fourth file you’ve misplaced this week.”

3. Criticize the act, not the person. For instance, say, “The file drawer is very disorganized,” not, “You’re a slob.” Or say, “You’ve refused to work overtime three times this month,” not, “You’re lazy.”

4. Be certain the change you seek is possible. Don’t ask for results the employee is unable or unwilling to make. For example, don’t say, “Would you please stop blowing your nose? That allergy of yours is driving us nuts.” Rather, you might suggest, “Might you be able to blow your nose away from patients? They may not know you have allergies and assume you’re sick—and contagious.”

5. Offer the person motivation to improve. Will your criticism help that individual grow personally, achieve greater success, make the job run more smoothly, improve his or her relationship with you or others, or offer some other benefit? If so, focus on this positive aspect. For example, you might say, “Re-filing patient’s files promptly and correctly will make it much easier for all of us to find the files when we need them.”

6. State clearly what you want the person to do, and when possible, establish deadlines for results. Again, be as specific as you can. Spell out the precise changes you’d like to see. For example, don’t say, “Please be more considerate.” Instead, say, “Please wait to take your lunch break until you know the phone and reception desk are covered.”

7. Make sure you are understood. If in doubt, ask the person to repeat your criticism in his or her own words.

8. When appropriate, state your criticism as opinion, not proven fact. That will make it easier to take. For example, don’t state as fact, “You don’t try hard enough.” Instead, offer the opinion, “It seems to me that you could try harder when . . .”

9. Indicate your willingness to work with the individual to improve. When appropriate, admit some responsibility for management failure, and try to find joint solutions.

10. Curb your anger. Body language and voice tone convey your attitude as much as what you say. Even the most constructive criticism loses its effectiveness when delivered through clenched teeth.

11. Don’t criticize with humor or sarcasm. It only weakens the impact of your criticism and can backfire by making the employee think the criticism isn’t serious.

12. Avoid comparing the employee to other staff members, or to his or her “infallible” predecessor. Each person is unique. Comparisons almost always cause hurt, and make co-workers competitive and resentful of one another.

Criticize the act, not the person.

13. Don’t exaggerate. Telling an assistant she “never” fills out forms correctly, when of course she does sometimes, may result in your total message being ignored.

14. Don’t assume you know all the facts. Before you criticize an employee, make sure you know why he or she behaves the way he or she did. You may find that your employee’s behavior was caused by factors outside his or her control, such as office policy, other employees—even you.

15. Don’t save criticism. Storing up complaints and dumping them all at once can be devastating. n