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Who’s managing your practice?

Employees can’t run on autopilot. They need proper training, oversight and feedback. You’re not doing your job if policies aren’t enforced and necessary discipline isn’t meted out.

Who’s managing your practice?
Clinic owners who cannot or will not manage employees need to hire a practice manager.

I was consulting at a veterinary practice when two team members began arguing and yelling at each other in the pharmacy/laboratory area. Clients sitting in exam rooms could hear them, nearby colleagues were aware of what was going on, and the practice manager could not have been more than 10 feet away in her office. The clinic owner was in her office and could hear everything, but she and the practice manager did not do a thing. Later, I asked why they allowed the altercation to continue. They responded that they don’t like conflict and prefer to not get involved in such situations.

At another practice, employees consistently came to work late. Others weren’t getting their jobs done and often left early. I asked the practice manager about this and was told that she didn’t like to get involved in employee situations “unless she has to.”

These situations amaze me. Who’s managing these practices? I believe the answer would be “no one.” The problem seems to be more common today. Managers and owners simply do not want to manage their practice, or maybe they don’t know how to manage or are afraid to do so.

To me, management entails hiring, training, oversight, providing feedback and, most importantly, ensuring that team members do the job for which they were hired. If you are a manager and are not doing those things, then you are not managing your practice and thus not doing your job. If you are a practice owner and not doing those things, you are failing to manage your practice and, just like a boat without a captain, your clinic is destined for failure.

Management is much more than supervising personnel. A manager needs to provide direction to the practice, market services, control costs, ensure profitability and do much more. Even so, at least 60% of a manager’s job is dealing with personnel, a critical responsibility.

Responsibilities and Policies

To this end, employees need to know what is expected of them. The process begins with job descriptions. It has long been said that you cannot manage employees who lack job descriptions because these are the foundation upon which you compose an advertisement and hire someone. Once the employee is hired, the job description provides the training framework. Once the trained is completed, the job description is the basis of the evaluation. Without job descriptions, you cannot effectively manage your health care team.

The other foundational document is the employee manual. The manual states all the hospital policies and procedures that employees need to know and follow. It contains many legal policies, such as those governing discrimination and bullying. The manual informs employees about their fringe benefits, such as paid time off, paid holidays, health insurance and retirement plans.

A very important part of the manual is the discipline policy, which deals with employee behavior in the practice and lays out what is and is not acceptable. Most discipline policies revolve around what is referred to as three strikes, meaning a first warning, second warning and termination. The discipline policy will outline any behaviors or actions that warrant immediate termination.

Be an Enforcer

With these foundational documents in place, the practice owner or manager is responsible for enforcing the policies.

Some readers will object to my next statement, but managing employees is very much like bringing up children. Children need to know the rules, be taught acceptable and unacceptable behavior, and be held accountable. If you keep telling a child he will get in trouble if he continues to misbehave, but you never put him in the corner or ground him, you are going to have one spoiled child. The same holds true for your employees. Your manual might contain all the rules and regulations, but if you don’t enforce them, you are going to have chaos.

Children wish to have rules. Likewise, employees want rules and regulations and will resent a practice owner or manager’s lack of enforcement. The owner and manager are looked upon as ineffective.

I am not sure why all this is so hard for so many people to understand. I have managed many employees over the years and have been told by many of them that I was a very good and effective manager. I try to hire the best people for the job, make sure they are trained to be successful, coach them, and provide feedback and positive reinforcement when appropriate. But I also make sure they are doing their jobs and following policies and procedures. If they aren’t, I will sit them down, explain what they need to do, make sure they know how to do it and ask for compliance. Many times, that is all it takes. I am straightforward and honest with my employees, as I would hope they would be with me.

Be a Disciplinarian

If an employee chooses not to follow the rules, I will meet with him or her, and a third person will be present as a witness. We will discuss the problem and what the employee needs to do about the situation. The employee is informed of exactly what has to be done to correct the problem and is given appropriate time to do so. This first warning is written, and the employee is asked to sign the document. If the employee refuses to sign it, I and my witness will sign the document and place it in the employee’s file.

If I continue to have a problem with the employee — it does not need to be the same problem — I will call the employee into my office, explain why and inform him or her that a second warning is being given. During this meeting, the employee is told that if another performance or behavior problem occurs within the next three months, termination will result, as stated in the employee procedures manual.

During this second disciplinary action, I explain what the employee did wrong, how to fix the problem and in what time frame I expect everything to be done. I again have a witness and ask the employee to sign the second warning.

The third warning is a formality if it occurs within three months of the second warning. The time has come for termination. The employee and a witness should be brought into your office. The employee should be informed of the infraction, the third warning and the conclusion of employment. In most cases, no further discussion is necessary. The employee, through his or her behavior, has decided to no longer be employed. Hand over the final paycheck, have the person gather any belongings and provide an escort out of the building. Anyone who has been terminated for cause should never be rehired.

Keep Good Records

Document, document, document! Make sure everything is written up. Can the employee file for unemployment? Yes. In some cases, the person might be awarded unemployment benefits even when fired for cause and when you did everything right. This is just the way it is, but I would never keep an employee so as to avoid paying unemployment. It’s a cost of doing business.

I mentioned that disciplinary action occurs within a three-month period. Most practices provide a three-month reset period in the employee manual. What it means is that if no problems occur for three months, the disciplinary process reverts to zero. It’s not fair to hold against an employee something that happened six months or a year ago. The policy, however, needs to be stated in the employee manual.

Clinic owners who cannot or will not manage employees need to hire a practice manager. Managers who do not manage their employees can no longer be managers.

Remember that employees need to be managed within the workplace and that they wish to be managed. Resentment occurs when employees arrive late, don’t get their work done, leave early or treat colleagues disrespectfully, all without consequence. Such a situation is not fair to “good” employees and allows “bad” employees to control the work environment. That is unacceptable.

Practice Smarter columnist Mark Opperman is president and founder of Veterinary Management Consultation Inc.