The 3-Minute Staff Management Course

One of the most important things a practicing physician does is manage the people who work for him or her; however, it's an essential skill in which doctors get no training.

One of the most important things a practicing physician does is manage the people who work for him or her. This is yet another essential skill in which we get no formal training. Hiring, managing, and, sometimes, firing people affects patient care and the bottom line, to say nothing of your equanimity. So let’s look at this critical aspect of what we do.

I have written before of the vital nature of hiring “smart.” It is maybe the single most important management task that we face. Some experts in the field, like career coach Marty Nemko, suggest that we start by assembling a pool of applicants. Find them by advertising or by word of mouth. If necessary, get creative. My group once dealt with a shortage of medical assistants by making a deal with one of the local schools. We would take on trainees/interns and, in return, we got the pick of the litter. Win-win.

Nemko suggests that the best interview is a job simulation. All practices, even large groups, are “local” and made up of small groups, so get some key employees involved, both for evaluation and for “buy-in.” Nemko recommends hiring somebody bright over experience and degrees, but I have learned the hard way that character and personality are even more important. You can teach someone how to do an EKG, answer the phone, or file, but you cannot teach grace, maturity, and good judgment.

Nemko, and I, emphasize that you should never settle for an average person, especially under pressure (“But we’re short-handed, doc!”). Only professional, financial, and personal regret will follow. Trust me on this one.

A Gallup survey of 60,000 managers pointed out that if you make a mistake and hire a “bad fit,” then fire that person as quickly as possible. Weak or troubled employees rarely improve and usually function as bad apples.

After hiring, the best key to managing smart is not to micromanage. Let your folks show their stuff and do a good, professional job. You will learn from them, and you will have more time, an irreplaceable commodity, for your patient care.

It is important to have regular meetings with the whole staff to share your vision and values, to get everyone excited, and to get their buy-in. Show a willingness to listen to their ideas. You won’t believe how they can improve things if you are open.

Nemko feels that you can evaluate employees best by walking around, offering occasional praise in public, and the odd suggestion for correction in private. Also, at the outset of the hire, state your standards and expectations. Review the new hire’s progress with them after their probationary period (say, 3 months) and, then, annually. Ask the employee to think ahead and draw up their own evaluation, and you can compare notes on what they have done, where they can improve, and what their objectives are for the coming year. If your organization is big enough, have a supervisor trained to perform this important task.

On the uncomfortable subject of firing, be prepared ahead of time by getting information on the legal requirements in your locale. Get a checklist from a lawyer, consultant, or the internet and obsessively follow it. Everything you do in managing employees should be documented, just as for patients.

Knowing there is a rational, fair process keeping the difficult, but necessary, act of firing someone on a professional basis will help everyone involved and can preserve everyone’s self-esteem. And you have to be mindful of the ongoing positive effect such an approach will have on the balance of the staff. Think of your situation as a small eco-system that functions optimally with a bit of tending.

The last, and perhaps most important, point in managing other people is to be aware of managing yourself. Your attitudes, your behavior, your self-control are critical for patient benefit, for financial benefit, and for keeping your office not only a professional, but also a happy “home away from home.”

We all have the tendency to listen with our eyes rather than our ears, so being the good example is the key to success. Let’s not be that doctor we all have seen: the one who has little self-control in the office, in the OR, and elsewhere, and who acts out in a toxic way.

Bad physician behavior, rationalized or not, can make the effort of successfully managing staff unpleasant, expensive, and, ultimately, self-defeating.

Now, that was a useful 3 minutes.