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Young Ophthalmologists
The Five Steps of Supervision, Part 2
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Reprinted from the AAOE News Archive
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A system is an established, step-by-step way of processing work efficiently and effectively. Last month, we looked at how a systematic approach to managing staff can help your practice run more smoothly. However, employees also bear responsibility for their individual positions within the practice. Here, we’ll look at the five steps of employee responsibility that complement the five steps of supervision we introduced last time.

  1. Use the tools: Employees are responsible for appropriately using the tools management provides. For example, if a practice installs a new telephone system that includes a voicemail component, employees would be responsible for using that new tool where appropriate.
  2. Apply training: Employees are responsible for applying the training they receive. For example, if an employee is given training in proper telephone etiquette, they are responsible to use and master those techniques.
  3. Set goals: Employees are responsible for setting goals and working towards achieving progress towards the goals they set. This means that employees are responsible for being actively involved in the progress of the practice.
  4. Request resources when needed: Employees are responsible for asking for help with their goals when they need it. For example, when a person responsible for collections from insurance companies finds that his or her workload is growing beyond his or her ability to keep up, it’s that person’s responsibility to ask for help before becoming overwhelmed.
  5. Be accountable: Employees are responsible for checking in periodically with their manager for progress reports on their goals and feedback on how they are handling the responsibilities they have been given.

How Do They Measure Up?
Now, the question often arises about what to do with an employee who is not measuring up to the expectations the practice has established for their position. The first step to take in the case of a problematic employee should be to review the five steps of supervision and make sure that management is holding up their end of the bargain. Then, if (1) management is providing the tools and training needed by an employee; (2) the employee has set goals for improvement and performance in his or her position; and (3) management is available as a resource to the employee, but the employee is not making any progress towards his or her goals, the employee most likely falls in one of the following three categories:

If the employee is untrained, management should provide additional training.

If the employee is unable to do the job he or she has been assigned, management should move the employee to another job where he or she can be successful (either within or outside of the organization).

If the employee is unwilling, management should counsel the employee regarding his or her attitude. You should consider negative consequences, including termination, only after undertaking a systematic corrective intervention plan. If the plan fails to render the necessary improvement and you deem termination necessary, it is imperative that you document the steps you have taken to work towards a solution.

A Case Study
Let’s take the example of a new refractive surgery coordinator who has seen surgery volumes fall by 25 percent since she took over the job from the previous person and whose goal is to return surgeries to their previous levels. If management has provided the same tools and training that the former coordinator had and uncontrollable environmental conditions are not a factor — e.g., increased competition in the neighborhood — and yet the new person still isn’t making progress towards her goal, then her manager would investigate and determine which of the three categories apply to this person.

The new refractive surgery coordinator may be untrained — she may have received the same training as her predecessor, but she may not have assimilated the training as quickly. Providing additional training in how to present refractive surgery will help if the problem is a lack of training.

The new refractive surgery coordinator may be unable to do the job — she may not have the same enthusiasm for refractive surgery as did the previous coordinator; she may be too reserved to connect with patients quickly; she may not communicate clearly, etc. Typically, when an employee is unable to do his or her job, no amount of training will cure the problem. If that were the case with this coordinator, she should be moved to a position where she can be successful —for both her own good and the practice’s. Sometimes this means allowing the person to find a job outside the practice if no suitable position is available within the practice.

The new refractive surgery coordinator may also simply be unwilling to do what is necessary to reach the goal. Usually, unwillingness comes from a battle that the employee wants to wage with management. In this case, a systematic corrective action plan would be required to remedy the situation.

Train and Explain
Employees don’t usually innately understand what management’s responsibilities are in the employee/employer relationship, nor do they recognize what they, as employees, are responsible for. Once management understands these concepts and has committed to following them, it is critical to teach them to your employees. I recommend that you use staff meetings to train employees in the five steps of supervision and to explain what you will provide to help them do their jobs. Be sure to also explain the five steps of employee responsibility so they know what will be expected of them. When an employee is not making progress towards a goal, you should then describe the three categories of untrained, unable and unwilling and what your prescription will be for each category. This will help your employees understand why they may be having difficulty in a position so that they can take corrective action on their own or ask for help as needed.

As you teach these concepts and refer back to them in subsequent staff meetings and as you continue to follow this system of management, you should expect noticeable improvements.

  • Employees should find increased self-esteem, greater commitment to the practice and further-developed talents as they set and accomplish goals.
  • Management should see more motivated employees, personal fulfillment in assisting in the growth of employees and increased practice success. In addition, you should find yourself spending far less time putting out those annoying personnel brush fires.

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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 the AAOE Consultant Directory. He will also be presenting during the 2013 YO Program — It’s YOur World - Jumpstart YOur Career, in New Orleans.

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