Having an effective staff can help you give the best care to patients

Does the level of staff turnover at your office remind you of a revolving door? Are your employees not meeting your expectations, or worse, causing a great deal of stress to you, your patients, and other staff? Are you afraid to look at your office statistics because of poor collections, patient dropout, or lack of new-patient referrals? You probably don’t think about it much, but the effectiveness of your office staff has a huge impact on the health and success of your practice. You can be a great DC, but without a capable support team, you are asking for trouble.

Wouldn’t it be great if every employee we hired exceeded our expectations? It isn’t easy, but I’d like to share some ideas and experiences I’ve had in practice that may help you reach that goal.

Recruiting: Find the Right Pool of Potential Employees
Start your quest by writing a job description. If you don’t know what you want the employee to do, how will the employee know? Also, how will you know who is best suited for the job? Think about all the duties that this person will be expected to fulfill in a given day. Once you make this list, you can change it in the future, but at least it’s a start. This is also very useful when you must hire a replacement in the future, which will likely happen at some point due to the nature of business.

Next, you have several options available for finding applicants for the position. Depending on the area in which you practice, different advertising methods may work best. Our offices are located in rather small, rural towns, so we have found that word of mouth tends to bring in several applicants. We routinely receive resumes that we keep on file after sending a letter to that person indicating our intentions. Don’t forget your current patient base, either. These people already know a great deal about you, your office, and chiropractic. There are many, I’m sure, who have experience as receptionists or whose current job is in an accounts receivable department.

The tried-and-true method of placing an ad in the employment section of your local newspaper is a very good choice as well. Temp services and the Internet are some other sources, but no matter what methods you choose, your goal is to have a good selection of qualified candidates. When you start looking for applicants, have a brief, one- or two-sentence description of the position and skills required, and include the salary and benefits. This will allow prospective applicants to weed themselves out if they aren’t interested in the job, saving you valuable time.

There are a few pitfalls that you need to avoid when recruiting applicants. You usually do not want to hire friends of yours or even friends of friends. The problem with doing so is that the person might feel that they can take advantage of you more easily and that you’ll forgive them because of your “friends first” relationship. You need someone who understands the employer-employee relationship. It gets expensive to pay someone to be your friend while your collections suffer. Also, watch out for applicants who have worked in other chiropractic or health care offices previously. They might be knowledgeable about the positions, but they often carry the “we never did it that way” attitude with them. Sometimes it’s better to hire an enthusiastic person who is willing to learn your way of doing things, rather than try to retrain someone who is used to a different system.

Once you have a list of interested individuals, ask them to stop in and fill out a job application. Give them a reasonable deadline; this will further weed out those who aren’t that interested in the job or are undependable. Use a standard application form to help you avoid asking questions that are prohibited by federal employment law (such as questions about race, religion, or disabilities). It’s worth your time to check references prior to bringing the applicant in for an interview. Get the applicant’s consent to check their references. You must get written consent if you plan to obtain a copy of the applicant’s credit report. Because the laws governing credit checks are complex, and criminal background check laws vary from state to state, you should check with your lawyer or state chiropractic association for advice on how to properly go about completing one.

Hiring: Increase the Odds of Finding the Right Employee
Now that you have your list of prospective employees down to a handful of people you’d like to meet, it’s time to take that step. You might choose to have your office manager meet with each applicant first, but in any case, it’s always smart to ward off any potential conflicts with current employees before you hire someone.

We have two DCs in our clinics, so both of us interview each applicant. The interview process in our office consists of the following three parts: a personality profile, an office-skills competency test, and the interview.

Personality Profile
We were recently in the process of hiring a new front-desk chiropractic assistant for one of the offices, so I decided to try a personality profile from the book, Personality Plus.¹ We had each current employee complete the profile, and I was amazed at the results. I could see how the personality traits that I observed and the profile scoring went hand in hand.

The personality profile is a self-assessment in which the applicants rank a series of words describing strengths and weaknesses on how closely they think the words describe them.

It has been my experience that some applicants don’t follow the directions of the profile well, even though the directions are clearly printed at the top of the form. If an applicant doesn’t follow the directions on this or any other test I administer, you can be sure he or she won’t be on the short list of potential hires.

I have found that this test is much more accurate than my gut feeling based on 20 minutes spent with the person during the interview. You might even find that this information is helpful in dealing with your current staff members (and helpful for them in dealing with you).

Office-Skills Competency
The next step for the applicant is to complete an office-skills competency test.

We allow 20 minutes (timed) for the individual to complete as much as he or she can for each of three skills tests. The first is a typewritten paragraph that contains several spelling and grammatical errors. The task is to highlight these errors and correct them. Next is a numerical and clerical test. It simulates the preparation of a deposit slip, has a question on alphabetizing names, and tests sequencing and numerical-comparison skills. For the final test, the applicant must type a short letter using the computer. The results from these tests give us the ability to compare the pool of applicants and also gives us a pretty good idea where each stands on these basic skills.

The Interview
For the actual interview of the potential employee, I have a preprinted list of questions with space to take a few notes of the response. I also record the scheduled time of the interview and when the applicant arrived.

Further, I have a section to record the appearance and general demeanor of the applicant. These notes are useful later on, as I can review them once all the interviews are complete.

The questions that I ask are mostly open-ended. They allow me to see how the applicants think on their feet and if they can articulate their thoughts well. I do have a few very specific questions, and I like to see concise answers to those. Some of the most interesting responses I’ve received are from questions such as “Describe your ideal job” and “How would your best friend describe you in one sentence?” You can learn a lot about people’s goals and the way they think when you get the answers.

After I am through with my questions, I always discuss salary and benefit information. We require employees to attend seminars and state chiropractic conventions, so I let them know about this right up front. Getting a commitment (especially when it comes to working on weekends) from the applicant regarding these expectations is important, and can make a huge difference in deciding who to hire.

The last thing that I do is to rate each applicant on a 1–10 scale in areas such as math skills, computer skills, spelling/grammar/alphabetizing, following directions, critical thinking, and typing. This allows me to compare applicants numerically, which can make the ultimate decision easier. While all of this may sound complex, the system can be used every time I need to hire someone. All I have to do is to print out my interview page, and I’m ready to evaluate.

Termination: Why and When to End the Relationship
In a perfect world, this last topic would be unnecessary. Hopefully, you have hired the right people and trained them well, and everything works out for the long-term. However, this is the real world and things don’t always go as planned. No one enjoys firing an employee. Also, you have invested a great deal of time and money to find, interview, train, and pay this person, so letting him or her go is a loss. Sometimes, though, it is better to cut your losses and start over.

Because of the problems that firing presents, it is best to be proactive and avoid the situation. If you have the right type of people and they have a clear understanding of their duties, that’s a great start. Regularly scheduled staff meetings and training sessions help remind them of what they should be doing. Regular performance reviews are a great time to be constructive about problems you’ve noticed with your employee. If you make an early, positive change for a small problem, it probably won’t grow into an issue that requires termination.

We have a section in our employee manual detailing our disciplinary procedures. It is prefaced by the statement, “The officers of the corporation reserve the right to determine if policy was violated, the significance of the violation, and what action is appropriate.” We have five levels of disciplinary action:
• verbal warning;
• written warning;
• 1-day suspension without pay;
• 1-week suspension without pay; and
• termination.

If any level of discipline is required, this fact is documented in the employee’s personnel file. We have a disciplinary form with space allowed to detail the incident. The employee signs the form to acknowledge his understanding of the level of discipline received and that corrective behavior in the future is required. Having this documentation is crucial if the employee files an unemployment claim or wrongful-termination lawsuit.

Recruiting and hiring right take time and effort on your part. If you put together a good system, it will definitely pay dividends. Having an effective staff gives you the time to focus on what you do best—care for your patients. CP

Dan Spencer, DC, practices in Hudson and Reading, Mich. Contact him at drdan@healthchiro.com.

Reference
1. Littauer F. Personality Plus. Grand Rapids, Mich: Revell; 1997.