Making Conversations Count! Developing True Relationships Across Your Practice Part II: Focusing on Administrator and Physician Communication

his article is the second of two parts.

You Don’t Have to be Present for Your Presence to be Felt

In thinking of the most common situations and inquiries, e-mails, tasks, results, and requests, the following basic strategies can assist with conveying a polite and concise message:

• Keep it simple. What do we do with an urgent item when the doctor cannot be interrupted, such as something that needs to be signed right now or an issue that demands immediate attention? Purchase a red folder. Put the urgent message in the red folder, and place it on the provider’s desk. The person will know what is inside is urgent…and we don’t need to wait in the doorway!

• When responding to e-mails, always be sure to include a salutation and use a courteous tone that affirms your correspondent’s value and role within the patient encounter. Even a “thank you for your efforts” goes very far for support staff (e.g., as you respond to the placing of a referral appointment, express appreciation to staff on helping that patient to be seen much sooner).

• Ensure that your message reflects your cooperation and commitment to teamwork.

• Consider timing of tasks and the statement that defines essential details and parameters. “ASAP” may mean “now” to one person but “within 48 hours” to another.

Administrators and Gaining Physician Trust

Building Bridges

Without realizing it, we easily become segmented—if for no other reason than because we all have our own routines. When you add physical barriers in the office such as “pods,” this can naturally lead to independent mannerisms, policies, and procedures. We need to bring everyone together periodically for the “group hugs.” It is our job to remind staff of the practice’s goals and standards with a unified vision that employees share, and that, in turn, is reflected in patient care.

New Staff Members

Are you a new manager, or new to a practice? Take the opportunity to spend time with physicians and staff one on one. This is your time to create a rapport, and to bond and build trust. Employees will appreciate your valuing their role, and providers will understand that you are looking after their best interests.

If, on the other hand, you have a new manager, meet with this most important leader of your practice to establish bonds, accelerate alignment, and improve performance. Review and renew practice goals together—with a timeline to solidify a cohesive approach as you work with employees toward the same initiative.

Are you a new provider? Make time to meet with the managers as well as other key staff. They are your map to the practice and contribute greatly to your success as a provider.

Promoting Initiative

I once worked with a physician who asked why staff would not speak up. As I interviewed employees, one stated that this provider began screaming as soon as he entered the building. When we feel intimidated, we tend to remain quiet. We do our job, and we go home. And we are most likely looking for another position in another practice.

Intimidation on any level—in any way, from any employee—leads to fear.

The impact of our communication style directly affects the response of others. Intimidation on any level—in any way, from any employee—leads to fear. This emotion leads staff to consider the following before speaking: “I will be passed over for a raise,” or “I will be picked on by coworkers,” or “I will be fired.” These feelings affect their responses.

Just as with our patients, we have to be 100% accepting and accessible to our staff and peers. And it is our job to promote that extra initiative through accessibility and support.

Meetings That You and Staff Members Need

As administrators, we need a set time to meet with physicians one on one. The physician should recognize this most valuable time and use it to ensure the practice runs efficiently.

Offering each employee the chance to be heard pays back on a variety of levels. Having regularly scheduled general staff meetings with key physicians present to listen increases employee engagement.

Patients will tell you that that one of the most important things in their care is to be sure that their doctors communicate with each other regarding that care. How we communicate is part of our professionalism, and we want to visually relay that we take pride in our practice!

Explore and Implement Communication Solutions That Fit the Workflow

Is it possible for a physician–nurse council to mentor together? Such a committee can improve communication and allow the group to work on behavior issues such as trust, respect, communication, care coordination, and dysfunctional behaviors. This provides a joint oversight of performance, peer review, daily operations, and budget planning.

Mentorship, one of the most important tools for professional development, is linked to greater productivity, career advancement, and professional satisfaction. The advantage of a mentorship program is that generational differences can disappear, and each party can learn from the other. This is a win–win situation indeed. The following sections present two examples for physicians and administrators (see sidebar)

Physician and Staff Conflict: What Works and What Does Not?

There are times when an administrator can step in and others where conflict must be handled by the managing physicians. The presence of emotional intelligence or active listening skills helps us deal with the emotions and sets the stage for solving problems. This means paraphrasing, asking questions, and seeking to understand both what the person is saying (the substance) and how they are feeling (the emotion). You gain further insight from their perspective, and that insight helps determine the best approach for this issue. This is the time to utilize professional resources for a balanced resolution that protects all parties involved.

Staff and Physician Behaviors

Not infrequently, employee interactions can be viewed by patients and coworkers as inappropriate or disrespectful. We have to be aware of behavioral limits. A classic example is when an employee appears to be challenging a physician’s decision-making (about, for example, phone calls, dosages, and treatment plans). Interrupting a patient visit by entering the exam room to say, “Doctor, this patient is calling for the fifth time. Can you please take the call now?” Or questioning a prescription by asking, “Are you sure? That medicine did not work the last time” are examples of such perceived disrespect. When this kind of conversation is needed, it should be done somewhere private.

Another scenario that indicates a culture of disrespect is when an employee is chastised in the presence of others. In an instance where a member of the team is rude or behaves badly to another team member, the recipient has a choice about how to react. Possible scenarios include reacting with anger, or making a calm statement, such as, “I would prefer that you speak politely to me.” Hopefully we choose the latter.

Conflict of Values

Conflicts of values go straight to the core principles and ethics taught to us by our parents. Value-affected beliefs about things such as religion, politics, social issues, and other strongly held opinions can be the most challenging. There is no “right” or “wrong,” so people rarely have their minds changed in a conflict of values.

Those in such a conflict believe that there is no “problem” to solve or need to satisfy. Some think that they can use persuasion skills or their ability to shout louder than the other person to turn someone to their point of view. I think we know this rarely works.

As you may need to deal with challenges like these, have an established plan tailored for your specific practice with collaboration from professionals (e.g., liability carriers, attorneys) to assist in resolving such issues with minimal disruptions in patient care and staff members’ eyes.

Priorities

It is always important follow the rule, “If it’s important to them then it’s important to you.”

I know it is hard to find time, but please always offer the “welcome mat.” This is a must for managers and physicians. If you are not available at that exact moment, you still seem supportive in their minds if you can set a time to meet. This is big and goes long way to increase engagement, loyalty, and communication. Determining the priority of the issue from that point is then up to you.

When you meet, consider comparing the kind of attention you might offer a patient with that you are offering your employee. Shouldn’t you offer the same consideration when an employee needs you to hear something? We all need to know exactly where we stand.

The best place to have a conversation is where the other party is the most comfortable and confident. Go to and spend time in their space. Listen, and look for nonverbal cues. Let them show you what they do. Pride goes a long way! And as they ask you questions, be clear also in confirming expectations and protocols.

Promote Continual Progress

Hire the best and keep them! Your physicians and peers will look for progress. If they don’t find it with you, they will not stay.

We Want Momentum!

• Do not let your best leaders go because, for instance, the practice would not pay for them to attend an educational conference. In addition to being an opportunity for the staff, including physicians, this also is a golden marketing opportunity for the practice as he or she boasts to peers about their employer. This develops pride in ownership as they become more invested in the practice.

• A learning culture creates initiative, ideas, and communication. Along with continued support for already established professional credentials, be sure to include enough continuing medical education (CME) opportunities that staff can taste a part of the practice’s vision and acquire the tools to make it happen.

• Provide access and settings for employees to voice opinions and discuss changes. As stated earlier, regularly scheduled meetings and other opportunities that allow access for each staff member to have a voice are essential for growth.

• One way to catch behavior changes swiftly is to have continual surveys. You will see patterns in conjunction with real-time versus waiting six months or annually for a scheduled review.

It Pays to Hold On to the Good Ones

Think about your practice and some of your valued employees. If they were to turn in their notice today, what kind of person would you like to replace them? According to a study by the Society for Human Resource Management, employers will need to spend the equivalent of 6 to 9 months of an employee’s salary in order to find and train that employee’s replacement.(1)

The interview expense and cost of onboard training alone are daunting. Your staff, of course, has to cover until you find someone. Now it becomes a morale issue as well.

Disrespectful Behavior

The impact of disrespectful behavior is costly.(2) In 2013, The Institute for Safe Medical Practices conducted a survey on forms of disrespectful behavior by physicians and staff. They looked at “Disruptive, intimidating, disrespectful, dismissive and demeaning behavior.” A good rule of thumb is that any behavior that negatively influences and affects patient care and staff interactions demands that these behaviors be addressed both individually and practice-wide. Such behaviors have been linked to adverse events, medical errors, compromises in patient safety, and even patient mortality.(3)

Clear and respectful communication expresses a professional trust that enhances the employee’s loyalty factor toward you as a leader and the practice as a whole.

Provider Contracts and Ethical Behavior

Establishing parameters for communication and ethical guidelines for providers that set the standard for the practice is essential. The provider contract offers ethical parameters that are appropriate for your practice and culture. Beginning with the mission statement and continuing on through professional attire and behavior, this is your opportunity to define how the staff interrelates in providing patient care.

Whether placed in your policies and procedures or personnel manual, be clear about expectations for new employees—spell it out! The following are examples of guidelines that should be presented to all new employees and followed by everyone in the office:

• The practice’s mission statement;

• Professional attire and behavior;

• Provider ethical standards, updated each time a new provider is added;

• A clearly defined hierarchy to follow when reporting any issues and concerns;

• Built-in responsibility;

• A learning culture with regularly scheduled meetings that support communication with continuous access to peers and providers;

• Maximized potential for engagement;

• Respect for coworkers, patients, and other providers; and

• Definitions in the contract for such things as criteria needed for all federal compliance efforts; guidelines and initiatives; monies received from federal agencies or compliance standards belonging to the practice; timing of submission of completed patient charts and charges to be billed; and

Exit Interviews

Conduct an exit interview whenever you can. It is an opportunity for employees to say what they may have been hesitant to say in the past. Employees often feel freer to speak as they are walking out the door, and the information they offer can be enlightening.

Real-Life Examples of Bad Communication—And One Good One

It is easy to make a casual remark that either gives the wrong impression or inadvertently wounds your employee. Some examples of things not to say and do follow:

• Never say, “You’re lucky to be working here!” We want to affirm staff’s value; the last thing we want to do is to diminish their role. (And by the way, you are lucky to have me!)

• Imagine the shock of being told, “We don’t pay our front desk to think.” This was actually said to me during a meeting with my lead physician. I was glad this was said in private and asked him never to say that again . . . especially in front of staff. I then explained the 20 crucial things the front desk does that are very important to the success of the practice—including getting claims paid, maintaining excellent customer service, and maintaining patient flow.

• Picture the scenario of planning an anniversary party for the practice. Think about whether or not communication reflects respect for your employees. At one practice where I worked, during the planning for a practice’s 25-year anniversary party, the spouse of one of the physicians casually suggested that the front desk staff should serve the food. The practice manager quickly pointed out that this is the staff’s practice, too.

• Imagine going to a “team building” retreat and then discovering that one of the physicians decided to record all of the conversations. Talk about halting communication in its tracks! Rule number one of a retreat is, “What is said here stays here,” right? As soon as the recorder was turned on, people stopped talking.

On the other hand, a good, respectful relationship is a wonderful thing to have. In one job, I, the practice manager, was entering a doctor’s office to ask a question, and a medical student condescendingly waved me away. I went immediately to the medical director, described the situation, and requested that the student be written up for disrespecting staff. The physician displayed his trust and respect toward me and indeed wrote up the student for that belittling response.

For many reasons, it is vital to communicate clearly, directly, and with specific and documented intentions. Due to daily schedules and devices, we sometimes tend to handle things a little too quickly, and possibly with reduced involvement.

As leaders of the practice, your goals and expectations should be clearly understood and shared with physicians. If we take the time and establish regular meetings to actually listen and respond, we can build practice-wide bonding and trust that fully support a team approach to patient care. This active engagement leads to improved performance and patient outcomes, a win–win situation for all!

References

1. Kantor JS. High turnover costs way more than you think. Huffington Post. Updated February 11, 2017. www.huffingtonpost.com/julie-kantor/high-turnover-costs-way-more-than-you-think_b_9197238.html# .

2. Disrespectful behaviors: their impact, why they arise and persist, and how to address them (Part II). Institute for Safe Medication Practices. April 24, 2014. www.ismp.org/resources/disrespectful-behaviors-their-impact-why-they-arise-and-persist-and-how-address-them-part?id=78 .

3. Rosenstein AH, O’Daniel M. A survey of the impact of disruptive behaviors and communication defects on patient safety. Jt Comm J Qual Patient Saf. 2008;34:464-471.

Recommended Readings

• Carnegie D. How to Win Friends and Influence People. New York: Pocket Books. 1936

• Bradberry T, Greaves J. Emotional Intelligence 2.0. TalentSmart, 2009.

Mentorship Programs in Medical Fields

For Physicians

• The American Academy of Pediatrics (AAP) mentorship program seeks to establish mentoring relationships between trainees and physicians early in their careers and practicing AAP member physicians. Both the AAP Section on Pediatric Trainees (SOPT) and the Section on Senior Members (SOSM) have mentorship programs that you may find useful:

  • SOPT: www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/pediatric-trainees/Pages/Mentorship.aspx.

  • SOSM: https://www.aap.org/en-us/about-the-aap/Sections/Section-on-Early-Career-Physicians/Pages/AAP-Mentorship-Program.aspx

For Administrators

The American Alliance of Orthopedics Executives (AAOE) also has a program for administrators, known as AAOE Administrator. Each new employee can be assigned a mentor, who is someone they can go to for advice or guidance. Information about the AAOE mentoring program can be found at:

• The AAOE website: www.aaoe.net/page/mentoringprogram ; and

• The newly released Mentoring Program handbook, found at www.aaoe.net/page/mentoringprogram