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November/December 2008

Practice Perfect: Human Resources
Boost Practice Efficiency, Part Nine: The Rules of Engagement
By Russell J. Igoe, ABOM, NCLC

Each day, your employees make a decision that determines your practice’s productivity: They choose how much thought and effort they’ll put into their job. And while you can’t force people to be motivated, you can create a work environment that influences the choices they make. Indeed, the Gallup company tried to find out what aspects of the work environment might encourage employees to be more engaged in their jobs. From 1995 to 2001, the company talked to 200,000 managers and interviewed 3 million employees. Gallup concluded that there are 12 key drivers of employee engagement.

People Enjoy Their Work

People should know what is expected of them at work. Used correctly, the job description can ensure members of staff recognize what is required of them. Give this document to new employees on their first day at work, and make it clear they’re expected to perform the skills listed accurately at production speed, without the need for re-dos. Job descriptions should be visible for all staff to see, and they should be updated at least annually.

Ensure job descriptions are “living” documents by using them throughout the year when creating plans for staff development and training, and when you sit down with staff for performance reviews and skills appraisals.

People should have the materials and equipment they need to do their work right. In staff meetings, do you ever ask whether everybody has the resources they need? Some employees may soldier on with substandard equipment because they feel they have no choice. Proactively asking about current and future needs will prove valuable when you’re budgeting for capital planning and equipment replacement.

At work, people should have the opportunity to do what they do best every day. In other words, people are most likely to be enthusiastic about their work when their personality and skills are a good fit for their job responsibilities. If, however, this fit is poor, it is important that you deal with the problem swiftly and directly. Watch out for warning signals, such as absenteeism or “acting out,” that may indicate somebody is unhappy with work. And if a colleague’s personality traits become more pronounced—an extrovert, for example, starts acting more extroverted—this also may be a sign that he or she is disgruntled.

When people are a poor fit for their current job, consider their strengths and weaknesses. You can sometimes give frustrated employees a chance to shine by moving them into a different position, one that better fits their strengths.

The organization’s mission/purpose should make people feel that their jobs are important. At one level—healing the sick—medical practices clearly have a purpose that staff can feel good about, but what about your more specific goals? Suppose, for instance, your practice plans to open two satellite offices and increase its number of patients by 20 percent within the next two years. Are members of staff aware of that goal, and do they know how their job contributes toward it?

When people are aware of the practice’s goals and its mission statement, this knowledge can put a line on the map for them. It helps staff focus on where the practice is headed. In order to emphasize each individual’s role in their practice’s success, staff evaluations can include specific performance measures that clearly relate to the goals of the practice. Similarly, staff incentives can be tied to those goals.


People Enjoy Their Workplace

People should feel there is somebody at work who cares. Suppose a member of staff asks for a little leeway in his work responsibilities while he deals with a family crisis; he’ll remember for a long time whether that request was granted. There are many less dramatic examples where a little empathy can have major repercussions for staff productivity and turnover.

People should have a “best friend” at work. It is important that members of staff each have somebody to confide in. Whether they want to bounce an idea off somebody or simply vent, their “best friend” will listen to them as a person, not as their coworker or boss. People value this deeper sense of relationship, and it can be a determining factor when they’re considering whether to stay with your practice or move on to another job. How do you create an environment in which people feel that they’re viewed as more than the sum of their job responsibilities? One way for you and your staff to get a larger picture of one another is to hold fun meetings, such as white elephant exchanges or scavenger hunts that aren’t primarily focused on operational issues. If you do this fairly regularly, it will pay dividends for the practice in the long run.

People should receive recognition or praise for doing good work. The praise must be genuine, and it is important to remember that praise is in the eye of the receiver—some people appreciate a round of applause at the team meeting, while others might prefer to be thanked in private. With this in mind, you could ask as part of each performance review, “How do you like to be recognized?”

People should feel that their fellow employees are committed to doing quality work. When employees are working hard to put in a high-quality performance, they expect the same from their coworkers. If, on the other hand, some team members don’t seem to be pulling their weight, other members of staff are likely to feel their motivation ebbing away. Furthermore, when it comes to effort and performance quality, it is the attitudes at the top of the practice that set the bar. If a physician or office manager frequently arrives at work late and leaves early, then members of staff will take their cue from that.

People should feel that their opinions seem to count. Provide staff with opportunities to share their suggestions and concerns. If, for instance, you’re going to be adding a new service, bring this up at a staff meeting and ask if anybody foresees any problems. Do this early in the planning process so later you won’t face a Gee, I didn’t think of that moment.

And you need to let people know that their opinions were heard and taken seriously. If, for instance, somebody’s proposal isn’t feasible—perhaps there are regulatory problems—you should still acknowledge the idea and explain why you’re not implementing it. But if you do implement a suggestion, make sure the right person gets credit for it.

You also can solicit anonymous feedback using online survey tools such as, which is free. Limiting the survey to four or five questions will increase your response rate. Since people like to know that their opinions matter, you should send staff a swift summary of the survey results—this tends to prime the pump and will improve the response rate next time around.


People Aren’t Standing Still

In the last year, people should have had opportunities to learn and grow. You can help individuals focus on their development by your use of performance reviews. The review could, for instance, ask, “What are the three things you’re working to develop this year, how can the practice help you to do that, and what measures can be used to establish whether you’re successful?”

In the last six months, someone should have talked to each person about his or her progress. These sessions shouldn’t be time-draining, all-day affairs, nor should they be spaced too far apart. Some practices perform them quarterly, but other practices may want to perform them more frequently.

People should each have someone at work who encourages their development. It can benefit the practice as much as employees when members of the front office staff become technicians or technicians take on more supervisory responsibilities. After all, when people rise up through the ranks, they bring with them a thorough understanding of the practice.


Keep Staff Motivated

Gallup has created a survey tool, called Q12, which includes a question about each of those 12 drivers—for instance, “Do you know what is expected of you at work?”—and staff rate their response on a scale of one to five. Gallup has consistently found that successful organizations score highly for employee engagement. While you don’t necessarily need to conduct a formal survey, keeping those 12 key concepts in mind will help to reduce staff turnover and boost productivity.

Mr. Igoe is director of eye care services at Group Health in Seattle. He works with 14 physicians, 42 optometrists and about 160 support staff at 14 different locations.