HUMAN RESOURCES MANAGEMENT
The most valuable resource in a medical practice is the physician's time. There are many skills that physicians need, yet are poorly trained for at both undergraduate and postgraduate levels. The issue of hiring and firing staff is one that is infrequently needed by physicians, but one that can be vital in terms of building a complimentary team of co-workers.
Physicians should concentrate their energies on the practice of medicine. Usually, routine tasks can be delegated more cost effectively to trained staff, leaving the physician to perform only tasks that cannot be responsibly delegated.
Consider the amount of time that is spent in the medical office and how important it is that one hire the best staff available in order to get the job done effectively. Due to time constraints and the pressures of running a full time practice physicians are often too busy to devote the necessary time to the hiring process. As a result, staff are frequently hired on subjective grounds and instinct rather than based on skills and objective assessment tools.
The goal should be to remove as much emotion as possible from the hiring process and make the selection as painless as possible. Once a staff person has been hired, it is often a question of luck as to whether that individual thrives in your medical practice. Too often, the physician learns to accept their staff person's limitations and this uneasy relationship continues for years, as the physician is not comfortable terminating the employment relationship. Having an effective mechanism to terminate a staff member is an important part of running a small business and let's face it, we are all small business people, trying to provide a high quality service and at the same time trying to maintain a viable business.
WHERE TO STARTBefore actually hiring someone to perform any tasks you must analyse the tasks to be delegated. Are they necessary? Who is the right person to do them? How much responsibility are you prepared to delegate? When is the best time to have tasks completed - on an immediate basis, once a day, or bi-weekly?
Many of the jobs in a physician's office require a combination of skills. This is because financial limitations and a relatively low workload prevent specialist staff being hired for each area of expertise. Careful consideration must be given to the kinds of skills that will best satisfy your own needs and the needs of the practice. Are you managing administrative functions effectively? Is your accountant concerned about cash-flow problems? As a specialist, are you behind with correspondence and reports? Do you spend too much time on minor tasks better suited to a nurse? Define the areas where you could best utilize support staff.
Questions related to physical working conditions also need to be answered. Do you have enough space for an employee to work properly? Is the furniture suited to the tasks you wish to delegate? Do you have the proper office equipment for the employee to perform the job functions effectively?
STEP-BY-STEP PROCESSHaving decided that you need a nurse, a receptionist, a secretary, a bookkeeper or a person with some combination of these skills, you must prepare yourself to select that person with whom you will be working so closely. Picking the right applicant to hire is a gamble, but your odds for success can be dramatically increased by following a systematic, step-by-step procedure:
A job description is a primary screening device, which informs prospective candidates what the job entails and outlines the qualifications needed to perform it satisfactory. Very few people, if any, will apply for a job for which they know they are not qualified. List all of the functions you can think of and then re-arrange you list in order of importance. This ranking of duties and responsibilities is usually based on the importance of and amount of time needed to perform any one task. Attempt to establish standards for each job function, which later can be used to judge performance. Make sure these standards are practical and attainable. Ideally, the method of applying the standard should be included on the job description.
Formal requirements, such as experience and education or special training, should also be clearly stated on the job description. The qualifications and experience will be determined by the level of responsibility you intend to delegate. These criteria will determine the salary level you must pay to attract, hire and keep any employee. Standard clerical and secretarial tasks such as answering the telephone, typing and filing can be performed by relatively junior staff whereas accounting or nursing skills are performed by trained sub-specialists. Discussions with colleagues, hospital personnel administrators, employment agencies and community colleges can provide you with useful guidelines for pay scales in your area. Be wary. Employment agencies may promote inflated salaries in an attempt to increase their commissions.
Before starting the recruiting/interview process you should establish the conditions under which employees will be hired. Candidates are entitled to know about the position being offered, general working conditions, and your expectations as to performance levels. Make sure you are realistic in establishing guidelines. If the conditions do not match expectations and the job is not what was described, the newly hired employee will begin to search for another job and you will have to repeat the time-consuming recruiting/interviewing/hiring/training process.
In order to avoid problems between you and staff or between staff members in the same office, it is recommended that you develop and maintain a policies and procedures manual. As you take positions on issues and develop procedures to handle a variety of situations, document them in a policies and procedures manual.
Policies should be set before you hire staff. Policies on the length of any probationary period, hours of work, absenteeism, coffee breaks, vacation allowances, provision of a uniform allowance and smoking in the office are just a few that relate to personnel directly. It is important that you maintain consistency when making policy decisions. These policies become the rules by which the office operates even when you are absent.
Documenting procedures for the completion of specific tasks, which can be completed either you or your staff, is also important. When and how are claims to be sent to OHIP? What information should be recorded on patient files? Written procedures are an invaluable training tool when new people join your team. How would you office function if you secretary were to be absent for a prolonged period of time? The policies and procedures manual will guide your temporary staff through difficult situations. Included in the manual should be the standards of conduct, dress, housekeeping and rules about such things as personal phone calls together with appropriate penalties for non-compliance.
Recruit as many candidates as you can. The more applicants, the better your chances for picking the right person(s). Ask for written resumes so that you can use the correspondence as a further screening device.
Advertising directly in the Help Wanted columns of your community newspaper usually produces a sufficient response. You may advertise by means of a box number at the newspaper or include your phone number and address. The method you choose will be influenced by the time you have available before you need to hire, and the time you have available to handle the response directly.
Word of mouth advertising through local medical societies or community hospitals can be a valuable recruitment tool or you can contact the placement office at a community college. Employment agencies may also be useful in your recruitment effort. Their fees are usually a percentage of the newly hired employee's salary and can amount to several thousand dollars. If you hire through an agency, be sure to obtain a time-related guarantee of satisfaction. You can also contact the Ontario Medical Secretaries Association's job postings.
Do not, under any circumstances, consider an applicant who does not meet the basic requirements. You may not find anyone who matches the requirements in every respect but only candidates with solid work experience, training and positive personal characteristics should be placed on your list for a preliminary interview.
There is an art to reading resumes. Ambiguous statements, frequent job changes and the lack of employment dates are danger signals, as are beautifully worded resumes prepared by professional writers. Be skeptical about references until you have seen or talked to the named individual.
Having selected the most promising resumes, interviews should be arranged. This first interview will permit you to ask questions about the candidate's job experiences, gain and some understanding of their personality traits, and form a first impression about their suitability. The meeting will give you an opportunity to explain duties and responsibilities in detail and to provide information on fringe benefits, hours of work, etc.
You would be wise to take notes about the candidate's strength and weaknesses so that you can refer back when considering you final selection.
The types of questions you ask during the interview are important. Each candidate should be asked the same series of questions so that you develop a common basis for comparison. Government regulations and human rights legislation forbid you to ask questions related to age, sex, marital status, religion, race and a host of other topics. Your questions should be confined to job related subject but be sure that you obtain enough information to analyse each person's character, drive and competence. A printed booklet published by the Ontario Human Rights Commission will provide you with guidelines on suitable questioning techniques.
Get the candidate's permission to record their names on the question sheet. This should get you more considered answers that will reflect the candidate's true feelings. Do not editorialize at this stage in the interview; your undivided attention should be directed to the candidate's responses. Later, if you ask business colleagues to provide you with a second opinion on a candidate's suitability, or wish to compare the answers of one candidate against another, you can read what the candidate said directly rather than relying on a personal, subjective analysis. Before the candidate leaves your office, obtain permission to speak to the named references.
Having conducted a preliminary interview and determined that the candidate is the type of person you would like to work with, you still need to ascertain technical competence. If you are seeking a secretary, you might consider having each candidate perform a few standardized typing tests. Several typing tests have been designed with deliberate spelling and punctuation errors which the candidate must recognize and correct. In addition, you may wish to request that a sample dictation tape be transcribed as part of the interview process. Critical analysis of these sample letters and paragraphs makes the process of selection more objective. Tests should be kept with the candidate's application and interview summaries - they will help you make your final selection.
One way of rating candidates on an equitable basis is to use an interview report form. Proper use of such a form enables you to quantify the skills and personality traits you consider most useful for the job. The various categories must be evaluated with the job description in mind and only then can meaningful weighting values be assigned. This form should be filled out immediately after the candidate leaves your office. The objectivity of the rating system is jeopardized if you attempt to complete the form at a later time. If you are not comfortable judging the necessary skills required of a bookkeeper (or indeed of any potential employee), rate the candidates as to their personality traits and have your accountant interview them and give you an opinion regarding technical competence.
When checking references, always try to contact the candidate's previous immediate supervisor. Ask questions such as:
You may not get answers to all the questions but you should be able to compare responses to your impression from the preliminary interview. It is important to speak with the candidate's immediate supervisor, personnel managers are reluctant to provide information about former employees over the phone (often because they don't know them personally), and usually will respond only to direct questions and then only with "yes" or "no" answers.
Having decided on a candidate, a letter detailing the offer of employment should be prepared. The letter should outline the salary for the usual pay period (weekly, bi-weekly or monthly), the starting date, and summary of fringe benefits including the basis for vacation entitlement. Having offered the job to the best candidate, it is up to the candidate to accept or reject your offer. (NOTE: an offer of employment is a legally binding contract. Only if the offer is rejected can the position be offered to another candidate. If the candidate accepts your offer, a personnel file is made up with the signed letter of offer, their resume and your interview notes. As and when vacations are taken, or overtime is accumulated, records of these events are added to this personnel file. Part of the orientation process of a new employee should include a detail review of the policies and procedures manual. For areas not covered by the manual, a process of telling, showing and doing will gradually acquaint the staff member with your operating methods. Follow-up from time to time is an important management tool.
PERFORMANCE APPRAISALPerformance appraisals must be based on objective criteria. The employee's performance should be compared directly to the job description that was discussed during the interview and reviewed on the first day of employment. The new employee should be provided with a copy of the job description. This job description may change over time to meet the needs of the office, and this should be done with the agreement of the employee. Performance reviews are to be based on a direct comparison of the current job description to the employee's actual job performance over time.
Performance standards should not be unrealistically high. They should be something that can be exceeded by consistent striving for superior performance. Perfection is not a standard. The following rating guidelines should generally apply:
Any person who hires an employee who proves to be unsatisfactory finds it difficult to fire that person and start the hiring process over. There is no point, however, in delaying the process once the decision is made. There is not easy method to tell someone his or her job is being taken away. Ideally the process should be completed quickly, according to a plan, and with a minimum of discussion.
To protect yourself against any possible legal challenge you must be able to justify firing an employee by recording documented proof of non-performance over time. Ideally, an employer should be able to demonstrate that "progressive discipline" procedures have been followed. Under such procedures, an employee should be given adequate warnings, first stating with an oral warning which must be recorded in the individual's personnel file. Second is a written notice setting out the problem, an example of the problem if possible, and the proposed solution. It is important that any disciplinary documentation placed on an individual's file be signed by the employee. Any employee comments in response to a disciplinary document should also be placed in the file. Finally, if performance remains unsatisfactory, this is followed by either a second written notice or termination.
If termination becomes necessary, plan to conduct the exit interview at the end of the day in order to keep it as confidential as possible. Have the necessary documentation prepared ahead of time. In addition to the cheque, you must give an employee who has worked for you for more than three months written notice of termination of employment. The letter should include details such as: effective date of termination, reason for termination and settlement details such as back pay, vacation pay and the amount of pay in lieu of notice (if any).
According to the regulations set out in the Employment Standards Act, you must either provide proper and adequate notice of termination or pay with benefits in lieu of notice. You are not required to give notice if the employee is being fired "for just cause" (i.e. drinking on the job, stealing or wilful misconduct). .