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Physicians may reason that their energy, education, and training should be focused on patient care and research, whereas staff education should be the responsibility of practice managers. But physicians have an important role in staff development.
Many corporate business owners and managers give little thought to staff education. They do not think it is part of their role, or if they do, they never have time to get around to it. For physicians in practice, another factor may contribute to a lack of involvement in staff development. Physicians may reason that their energy, not to mention their years of education and training, should be focused on patient care, research, and staying abreast of clinical advancements, whereas staff education should fall under the category of personnel and be the responsibility of practice managers.
If you have not given staff development much thought or think it does not affect your practice or patients, this article is for you. You have an important role in staff development: establishing its priority, encouraging it by example, and supporting it in your attitude and budget. The truth is that if staff education and development are not a priority for the physicians who own the practice, they will not be a priority for anyone under them.
Staff education should include a formal orientation program, cross-functional training, maintenance of professional skills, coaching, career development, and personal development. The pay-off for your practice is as follows:
Practice management consultant Kenneth T. Hertz, CMPE, points out that supporting staff education also affects the profitability of the practice. “It all goes to the bottom line,” he says. “By promoting staff development, physicians create an environment where they say ‘you're important to us. We respect you and value you more than just the person that answers the phone.’ When they create that kind of environment, they set things in motion that produce improved employee attitude, patient satisfaction, and physician satisfaction.”
Your attitude—the emphasis you place on staff development—is the critical element. Not every practice can include tuition reimbursement as part of its benefit package, and covering expenses for travel to out-of-town conferences may not always be feasible. But many essential aspects of training have no direct expenses. Let your staff know that you consider their development important.
Many managers have never had any formal management training. They became managers because they excelled in their work, but the skills that made them the best nurses, the most efficient coders, or top-notch office organizers do not necessarily make them first-rate managers. In addition, supervisory responsibilities such as coaching and team development may get short shrift because clinical or administrative productivity remains an important part of their job.
But good management skills are critical, because employees often decide to stay in jobs or leave them depending on how their bosses treat them, not because of the organization for which they work. Set an expectation that all managers in your practice receive management training. Many educational opportunities in basic management can be found through their own professional organizations, local universities, and professional training organizations.
Traditional orientation—providing basic information about the practice, a tour, and face-to-face meetings with other staff—should be expanded to incorporate a longer process with a broader goal. The term onboarding (also known as assimilation) is now being used for an orientation process that has the goal of decreasing the time for a new employee to become productive.
An effective onboarding program starts before the employee's first day and continues for several months. The new employee's workspace, phone, e-mail account, and name badge should all be in place before he or she starts the job. Most important, there should be work for the new hire to perform during part of the first day. Your practice should have an established training program for relevant office procedures, and the employee's supervisor or an experienced staff member should have explicit training and coaching responsibilities.
Improve the onboarding process by making sure information flows two ways. When employees start work, ask them about their own concerns, whom they wish to meet, what they wish to learn, and what motivates them. After a few weeks, ask for feedback about the onboarding process and what other information or approaches might be incorporated to improve the ability of new employees to do their jobs well.
Employees, particularly front-office staff, typically receive on-the-job training for their positions. This training is highly variable because it depends on the knowledge and proficiency of the trainers. To reduce the variability, training should follow a structured list of tasks and subjects to be covered, the estimated time needed for training in each area, and performance standards to be achieved.
Continue training for employees throughout their tenure. A misguided belief shared by many managers is that if you hire competent people and pay them competitive wages, they will perform well indefinitely. Managers often do not understand the connection between performance and personal development. Do not limit training to new employees. Provide ongoing training programs in areas such as customer service, conflict resolution, and effective communication. Make cross-function training a standard part of your practice. In addition to the obvious advantages of providing leave-time coverage and continuity in case of abrupt departures, cross-training offers employees a chance to see what others do and gain a greater understanding of the overall practice.
Just as the billing staff must receive regular updates in coding changes, and changes in the Clinical Laboratory Improvement Amendments are critical to the laboratory, it is essential that managers keep abreast of the constantly changing field of employment regulations. Too often, physicians and managers rely on common sense or what they learned about the Consolidated Omnibus Budget Reconciliation Act, the Occupational Safety and Health Administration, and equal employment law in seminars they took 10 years ago to guide them in human resources practice.
Employment law is constantly changing, and small missteps can have grave ramifications in the areas of hiring, firing, performance evaluations, and documentation. Be sure that the senior management in your practice participates regularly in education in workforce regulations and that both physicians and employees are kept informed about current requirements and best practices.
Many educational opportunities that can benefit your staff are free. The following are a few examples:
Paying the annual dues for membership in professional associations is an excellent way to support staff development. The benefits of membership in a professional society—such as free publications and education, access to industry surveys, and, perhaps most important, networking opportunities—will accrue to their performance and the success of your practice. Membership in the Medical Group Management Association (MGMA) has specific benefits for oncology practice mangers. At no additional charge, MGMA members can belong to the subgroup Administrators in Oncology/Hematology Assembly, an active group that holds its own annual educational conference and has an online forum.
Paying for dues in professional organizations such as the MGMA or Oncology Nursing Society is one of numerous benefits provided by the Kansas City Cancer Center (Overland Park, KS), an organization with approximately 350 staff members and five comprehensive cancer centers. “The physician leadership definitely consider staff education and professional development an investment in the practice,” says Mindy Swayne, CMPE, practice manager of one of the group's centers. The group also promotes certification and pays for education needed to attain and maintain it. For example, all nurses are required to be certified in oncology, the billing department has certified coders, and the practice manager at each location is certified by the American College of Medical Practice Executives. Swayne notes that support of education is not reserved just for professional staff. “If I have a receptionist who is interested in taking a workshop on customer service or how to deal with angry patients, she can receive paid time to attend, and the registration fee will be covered.”
Training and coaching are distinct, although, certainly, there is some overlap. Training involves imparting knowledge and skills about processes, equipment, or services the employee will use on the job. Coaching is providing advice, recommendations, and guidance for the employees to perform well.
No formula can be applied to when, how, and by whom coaching should be done. Managers, team leaders, and coworkers may each fill the role of coach at various times. For new employees, a coach should be specifically assigned.
Mentoring is also an important part of employee development. Although coaching is largely task related and focused on performance, a mentor guides the employee as an individual. A mentor is typically selected by the employee rather than being assigned and is usually a role model. The mentor advises, shares experiences, and guides the employee in self-discovery and career development.
Leadership training for both staff and physicians will pay off in many ways. Effective communication, development of a team culture, and conflict resolution are just a few of the many aspects of leadership training that can make a big difference in the practice. Do not limit leadership development to supervisors and executives. For example, any employee at the Kansas City Cancer Center can apply for the leadership development program offered by the practice. The structured 8-week leadership development program includes 2-hour classes in the evening and is offered three times a year. As practice manager Swayne comments, “Leadership is essential at all levels.”
The authors indicated no potential conflicts of interest.
Conception and design: Dean H. Gesme, Elaine L. Towle, Marian Wiseman
Administrative support: Marian Wiseman
Data analysis and interpretation: Dean H. Gesme, Marian Wiseman
Manuscript writing: Marian Wiseman
Final approval of manuscript: Dean H. Gesme, Elaine L. Towle, Marian Wiseman