A Good Fit: Making the Right Staffing Decisions for Your Practice
A medical practice’s success depends on far more than excellent physician services — though, of course, those are key. For your practice to maintain profitability and stay current with the latest value-based services and patient care trends, you need the support of a qualified and engaged staff. But rather than reacting to every new initiative by just quickly hiring another staff person, why not be proactive in your approach?
Several principles can help generate more enlightened management of practice human resources. The first of these is to make thoughtful employment decisions. At times, management rushes to fill an open position, hiring the first qualified person who applies. Later, a mismatch becomes apparent, productivity suffers, morale declines and the employee is let go.
A better way is to establish detailed criteria for the position before beginning recruitment. Doing so requires scrutinizing potential candidates so you find somebody who meets your requirements and fits into the practice culture.
Keep qualifications front and center
It’s become a cliché that practice personnel, particularly clinicians, should work “at the top of their licenses.” This means that each licensed person should concentrate on the highest-level tasks that he or she is allowed to perform. If there are activities that both a physician and a nurse practitioner (NP) can provide, they should be handled by the NP. If there are duties within the license scope of a physician assistant (PA) and a registered nurse (RN), the RN should perform them. This often results in clinicians taking on greater patient care responsibilities — within the scope of their licenses.
In a cost-constrained world, it may make sense to employ more, rather than fewer, staff in different roles. The most effective practices often have greater staffing ratios for RNs, licensed practical nurses and advanced practice nurses. The cost of employing larger numbers of nurses recoups itself by allowing practices to see more patients and offer more attentive care.
It’s an established norm in forward-looking practices to use advanced practitioners, such as PAs or NPs. Although the added cost of hiring more clinicians can be outweighed by the resulting improvements to practice efficiency and revenues, NPs also have a different approach with patients. They bring a focus on patient education and counseling, care coordination, and wellness promotion that’s often different from that of physicians.
Focus on patient care
Depending on individual state laws, nurse practitioners are able to provide a range of primary and specialty care services that include ordering and interpreting diagnostic tests, such as X-rays and lab work; diagnosing and treating acute and chronic illnesses; prescribing medications; and educating patients on disease management and prevention. This usually can be done independently or under physician supervision.
Ultimately, NPs and PAs help practices generate revenue by increasing patient volumes and allowing physicians to spend more time delivering higher-level direct, billable patient care. This new class of providers leverage their advanced medical training by focusing on more routine care and managing clinical tasks.
Provide accurate job descriptions and feedback
To develop high-performing staff, you must tell them what you want them to do, and then follow up with feedback on when they’re performing well or poorly. It’s important to prepare accurate, comprehensive job descriptions, give them to all employees, and update them whenever job content changes substantially. The description is the starting point for holding employees accountable for their work performance.
Get in the practice of routinely and informally commenting on employee performance. This is best done immediately after a relevant work event. Provide both positive and negative comments. Follow the rule, “Praise in public, criticize in private.” Critical feedback can easily be misconstrued, so make sure it’s constructive. Look for legitimate reasons to compliment employees, too, preferably in front of co-workers. It will do wonders for everyone’s morale.
Consider tangible and intangible factors
In a medical practice, nothing is static. Making the right call on when to simplify, when to consolidate and when to expand requires ongoing planning and periodic adjustment. But careful consideration of such factors as professional qualifications, practice culture and niche, and patient type in your hiring decisions can ensure your practice will thrive.