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Young Ophthalmologists
The Five Steps of Supervision, Part 1
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Reprinted from the AAOE News Archive
For the business advice you didn't get in medical school, turn to AAOE, the practice management division of the American Academy of Ophthalmology. Learn more:

“Putting out brush fires — that’s all I seem to do!” lamented the office manager. “From the time I get here in the morning until I leave the office late at night, I am constantly dealing with staff problems. I can’t seem to get anything else done!” I listened carefully, then asked her a couple of questions: “How do you manage your employees? What system or process do you use to help them do things the way they need to be done?” She seemed surprised. “Well, I guess I try to be fair with everyone and set a good example of how to work effectively.” Her answers were excellent qualities that managers should have, but they didn’t describe a system for managing employees.

A system is an established, step-by-step way of processing work efficiently and effectively. We have systems for most of our work processes — for example, we wouldn’t think of trying to send out insurance claims without having some kind of a systematic approach. Having a system or a defined process for accomplishing a task allows for review of the necessary steps and corrections when something goes wrong. Unfortunately, too often our method of management is a bit haphazard rather than being systematic.

A system will help you to get the most productivity from your employees by helping them develop their skills and talents. This can be accomplished by implementing the five steps of supervision.

Step 1: Provide the Tools
Employees must have the tools they need to be able to effectively do their jobs; it is management’s responsibility to provide those tools. They may include adequate space, computer equipment, written forms, telephone equipment, furnishings, etc. If employees do not have the proper tools, they cannot be held accountable for accomplishing their work efficiently.

Step 2: Provide the Training
Employees must be properly trained in their responsibilities; it is management’s responsibility to provide training opportunities. Areas in which employees need training include technical and computer skills, company policies and procedures. In addition, although we may wish that all employees would have basic social skills when they come to work for us, there are times when we need to coach our employees in the interpersonal skills they need to be able to relate well to patients and co-workers.

Step 3: Set Goals
Practice owners and managers should set overall goals for how they want to position the practice and what they want to accomplish. Then, each department or work group should set complementary goals which, when accomplished, will help the practice reach its overall goals. Managers should then help their employees focus on the practice and departmental goals and assist them in setting goals for individual performance improvement. Management should review and approve all employee goals. Sometimes, a manager may need to set a specific goal for an employee, but the greatest commitment from employees generally comes when they are working on goals that they have set for themselves. Also, employees often set higher goals for themselves than their managers would have set for them.

Step 4: Become a Resource
Once employees have the tools and training they need and have set goals for improvement, management needs to become a resource to the staff. If an employee is working on a goal and they have done everything they can, but have reached an impasse or an obstacle that they cannot overcome by themselves, management should be ready to assist them in obtaining the training, tools or resources needed to accomplish the goal.

For staff to be willing to look to management as a resource, managers must be available, approachable and ready to listen with an open mind. If a manager resorts to scolding or blaming rather than coaching when problems arise, the employees will not see that manager as a resource to them in accomplishing their goals. However, managers must also be careful to let the employee retain responsibility for their own goals; the manager is only a resource — she or he should not take the responsibility of reaching the goal away from the employee.

Step 5: Hold Accountable
The final step in the supervision process is to hold the employee accountable for progress towards their goals. Since goals are often set without full knowledge of all the factors that will be faced on the road to accomplishing the goal, it is appropriate to measure success by progress made rather than only by whether or not the goal has been accomplished in the projected time frame. For example, if a billing person has a goal to increase collection of past-due accounts by 25 percent in 90 days, and at the end of the time period collections have increased only 22 percent, you should emphasize celebration of the improvement and progress, rather than consternation that the goal wasn’t quite reached in the artificial time frame. Employees can be held accountable through regular reviews and individual interviews. These are also good opportunities to give employees positive feedback, coach them individually in their responsibilities and help with course corrections when needed. Employees who are working hard on their goals will see regular reviews and interviews with their manager as opportunities to report on their successes rather than as a burden to be avoided.

How the System Works
Let’s take a look at how this system would work with a common situation in ophthalmology practices. Let’s say your practice has set a goal of collecting refraction payments from patients at the time of service. Your check-in (or check-out) person has the tools (fee slip, computer, cash box, credit card machine) to be able to receive refraction payments and she has been trained to collect co-pays and does a reasonably good job in that area. She now sets a goal of collecting 90 percent of the refraction payments at the time of service.

After a couple of weeks, she is only getting about 40 percent of the patients to pay for their refractions. She comes to you for help and explains that many patients are confused about why they have to pay: some say they didn’t want a refraction, while others are sure their insurance will pay everything but their co-pay. As her resource, you may take any number of steps to help her reach the goal of 90 percent collections.

For example, you might put a sign next to the check-in counter that details why refractions are patient responsibility or you might have a printed sheet at the front desk with the refraction information or even include that sheet in the packet that is mailed to new patients before their first appointment. You might also provide additional training to her in ways of explaining refractions to patients so that it is clearer to them that it is their responsibility. After a period of time, you meet with her to see how the collection process is going and she gives you an accounting of her efforts and results.

If management consistently follows these five steps in supervising employees, there will be far less effort spent on putting out the personnel brushfires that seem to take up so much management time in many practices. Next time we’ll look at the five steps of employee responsibility.

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About the author: Derek A. Preece, MBA is a senior consultant and partner with BSM Consulting, based in Orem, Utah. He consults with medical practices in the areas of financial benchmarking, strategic planning, mergers, and employee management and is a member of our AAOE Consultant Directory.

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