• The Five Steps of Supervision, Part One: Establish Responsibilities

    By Derek A. Preece, MBA

    This article is from September 2006 and may contain outdated material.

    As a manager, there are times when you have to fly by the seat of your pants—yet if you make a habit of that, you run the risk of making a costly mistake. After a few of those errors, your practice’s financial health, not to mention your mental health, may start to come apart at the seams. But what’s the alternative to a seat-of-the-pants approach?

    Systems—What, Who and Why?

    What is a system? The dictionary defines “system” as a “way of accomplishing something using step-by-step procedures.”

    Who uses systems? From signing in a presenting patient, to billing for a service and beyond, every practice expects its staff to follow step-by-step procedures.

    Why use systems? Practices with good, simple, well-established systems provide care more efficiently than those that waste time reinventing the wheel. In other words, the better your practice systems, the more money you make on the same level of patient flow. And how would you fare without those systems? Imagine, for instance, a new billing employee isn’t trained properly—your practice may soon face a cash flow crisis.

    Can a System Help You Manage?

    One day, about 25 years ago, I realized that although all of my employees used systems for their work, I had no system for managing. Would a management system improve the results that I was getting from my staff? And what would such a system look like?

    For inspiration, I considered my career so far. I thought back to a general manager who used a fairly predictable, four-step system of supervision: 1) He would spot a problem, 2) he would yell at whoever seemed to be at fault, 3) he would listen to that person explain why he or she had nothing to do with the problem, and 4) he would apologize and calm down. Clearly, I would need further inspiration.

    Five Steps of Supervision

    It seemed to me that a more helpful system of management would focus on making the employment relationship work well. It would take into account what employees need in order to do their job well. It would also consider what responsibilities the managers have toward their employees, what the limits of those responsibilities are and what responsibilities employees have toward their managers. The system of management that I developed is based on five steps of supervision.

    1. Provide employees with the tools they need to do their jobs. From computers and fax machines to pencils, ring binders and patient education brochures —the tools can be anything tangible that is needed for the job.
    2. Provide employees with the training they need to do their jobs. The key thing to remember is that the learning process is often more difficult than we realize. While some people are quick studies, others need a lot more time to absorb training. For tasks that are complex—handling an irate patient, for instance—try repeating the training every few days or weeks. One common error is to take an approach to training that is too informal. Suppose, for instance, that you hire a new receptionist and she sits with the departing receptionist during his last week on the job. She is learning from someone who may have no natural aptitude for training, who may already have his mind on his next job and who has no incentive to train her well. And if she struggles for the next few months, is that because she’s not up to the job or because the former receptionist forgot to go over some key tasks?
    3. Help employees set goals to improve their performance. What should employees’ priorities be, and what level of performance should you expect from them? It is management’s responsibility to provide each member of your staff with some direction on these issues. I have found that the best way to do this is by helping them set goals for improvement. Although I prefer them to set their own goals, I will ask a staff member to change a goal if it doesn’t seem appropriate. Similarly, I will sometimes direct a staff member to add an extra goal. Suppose, for instance, there is a problem with an employee’s performance that none of his goals address—perhaps he frequently arrives at work late. In that instance, I would help him set an appropriate goal.
    4. Become a resource. Providing people with tools, training and goals is a good start, but what happens when they reach an impasse? Will they ask you for your help? You can encourage staff to look to you for help if you show that you are available, approachable and willing to listen with an open mind. However, you also must be careful to let employees retain responsibility for accomplishing their goals. You should be a resource, but you must not take on staff members’ responsibilities.
    5. Hold staff accountable. Make sure people have opportunities to account for the progress that they have made on their goals. How often should you ask staff to report on this? That depends on the nature of the goal. If an employee’s goal is to get to work on time, I would tell him to report weekly. He would use a written form, and each day he would write both the time that he was supposed to arrive and the time that he actually arrived, then at the end of the week he would hand it to me. In an extreme case, I would ask him to report in writing every day. In another example, suppose a refractive surgery coordinator aims to increase surgeries by 10 percent. To help her meet that goal, she may have set a number of subgoals, such as organizing one seminar each month. I might ask her to report on that main goal quarterly, but the seminar subgoal monthly. I like employees to provide these progress reports in writing. This becomes an excellent record of achievement when it comes time for salary review. And if you need to terminate an employee, you will have good documentation to support your decision.

    The Employment Relationship

    Reciprocal responsibilities. When you employ people, there is an implied agreement between you and your staff. At the bare minimum, the agreement would be: They get their jobs done; you pay them. But that won’t challenge them to improve their job performance. My management system expands that agreement by introducing five reciprocal responsibilities. This is done in a transparent way, so everybody has the same information; employees and management know their own and each other’s responsibilities.

    Employees have five corresponding responsibilities. While the five steps of supervision encompass the manager’s responsibilities to employees, the flip side of this is that employees have five corresponding responsibilities. Employees are expected to: 1) use the tools that are provided, 2) make the most of the training, 3) set goals and then pursue them, 4) ask for help or guidance if they reach an impasse and 5) account for their progress.

    These five steps of supervision provide a management system that helps you to nurture high flyers. This system also helps you to diagnose poor performers and challenge them to do better.


    Mr. Preece is president of Enhancement Dynamics Inc., a practice management consultancy based in Orem, Utah. For his contact information, visit the AAOE Consultant Directory at www.aao.org/aaoe.