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    Front office investments improve practice overall

    A smooth-running practice can strengthen your bottom line

    Let's face it: In a physician practice, front-office staff members often are treated as the least-necessary employees.

    These employees, however, meet and greet your patients, schedule their visits, collect their co-payments, and field their phone calls. They are indispensable members of your staff. They play an integral role in practice operations. If they are off their game, you are likely to be, too. The entire practice may be affected. From patient flow to patient loyalty, how the front office performs directly affects your bottom line.

    To anyone with a master of business administration degree, this observation would be an obvious one. But to many people with medical degrees, experts groan in exasperation, it isn't obvious at all. And their practices often pay the price.

    "Do physicians understand how the front office fits into the practice both as a clinical and a business entity?" asks Elizabeth W. Woodcock, a practice management consultant in Atlanta, Georgia, turning the question over in her mind. Her answer is quick and unequivocal: "No."


    Elizabeth W. Woodcock
    Some doctors deal with nonclinical staff minimally, and front-office staff members least of all, preferring to focus on medicine to the near exclusion of all else in the practice. So says Simon Sikorski, MD, president of Healthcare Marketing in Sayreville, New Jersey. This behavior, he says, is a mistake.

    "If you are immersed only in patient care, the practice will suffer," Sikorski says. "The doctor must get involved not just in the management of patient care but also in the management of the practice, including the front office."

    Yes, you may have a practice manager whose responsibility includes daily oversight of front office personnel. But you, as the practice leader, have a key role to play, too.

    "In any practice where customer care is important, the front office can make you or break you," Sikorski says. "If the doctor is not involved, I promise you that practice will not be as profitable as it should be."

    What sort of constructive role could you assume as the leader of your practice? Experts offer the following seven suggestions. Each is powerful and empowering and requires a minimal amount of time.

    1. SET AN EXAMPLE BY SHOWING RESPECT

    "Too often, front-office staffers are made to feel like second-class citizens in a practice," says Jim Grigsby, a practice management consultant in Melbourne, Florida. "They're the least-educated and least-paid members of the practice, and they're often disrespected by clinical and back-room staffers as a result."

    That assessment applies to some doctors as well. For respect to be genuine, he says, it's necessary to develop appreciation.

    Although patients come to your practice for medical care, the clinical staff doesn't represent the practice in their eyes. On the contrary, it's the employees in the front office.

    "They are the first people a patient sees when she comes into the practice and the last people she sees when she leaves," Sikorski says. First impressions are important—and, often, permanent.

    Moreover, your front-office staff will have ample time to make a first impression, good or bad, because a patient is likely to spend more time with them while sitting in the reception room than with the entire rest of your staff combined.

    Woodcock cautions against taking a myopic view of the people who work in your front office. They are not just answerers of phones and makers of appointments. They are your practice ambassadors—your marketing department, your public relations agency, and your bureau of patient satisfaction rolled into one. Patient loyalty (or lack of it) is largely in their hands.

    "The number one area by which new patients will judge your office is the front desk," says Marty Linz, who has spent the past 35 years managing primary care, cardiology, neurology, oncology, urology, surgery, psychiatry, and dermatology practices in New York. "The front desk should never be undervalued. It's the pulse and heart of the office."

    Michael J. Bernardo, MD, the lead physician in a family practice with three doctors, three midlevel providers, and a total of 20 employees in Newberry, South Carolina, views his front office staff as being integral to the care offered by his practice rather than being separate and distinct from clinical operations.

    "The healing process begins as soon as the patient walks in the door—or it should," he says.

    To show respect for the folks in front, it's the little things that count. Know and address each staff member by name, Woodcock advises. Recognition, acknowledgement, and appreciation by you are important. Be generous with all three. "Thank you" and "great job the other day" go a long way, particularly when the words come from the lead physician.

    Demonstrate by example that you respect and value the front-office staff, and others will follow your lead.

    2. PLAY AN ACTIVE ROLE IN RECRUITMENT


    Simon Sikorski, MD
    In recruitment of front-office staff, both your practice manager and you have a role to play.

    "Initial interviews are conducted by the office manager and are based on a candidate's knowledge, experience, and ability to get along with other people in the practice," Sikorski says. "But it's the doctor who must decide whether this person will fit into the practice. That's an emotional decision. As such, the hiring decision ultimately should be yours."

    Because a good fit is so important, other members of the practice with whom a candidate would be interacting should have an opportunity to meet him or her as well.

    "Staff should be included in the process of hiring co-workers," Sikorski says. "It's a practice, a team. Everyone must be involved in the decision-making process. Not everyone's decision carries the same weight, but their opinions should be valued."

    When Linz finds a promising candidate, she arranges a coffee klatch so that the staff members who would be the candidate's colleagues have a chance to meet her in a relax, informal setting. You can suggest this approach to your practice manager if your practice isn't doing it already.

    "When a new person comes into the practice, the ability to get along is key," Sikorski says. "If problems are going to arise with a new hire, they most likely will arise because of poor fit."

    What other traits are desirable? "After fit, hire for customer service attitude and experience," Woodcock advises. People skills are particularly important. "It's easier to teach how to register a patient than to teach someone to smile," she says.

    "If a person lacks patient interaction skills," Sikorski adds, "those can't be taught."

    Woodcock recommends that practices hire medical assistants (MAs) as schedulers. MAs earn approximately what non-MA schedulers earn, she says, and the former are more likely to learn to schedule patients into the appropriate time slots with the appropriate physicians with minimal training.

    In addition, when an MA is a scheduler, communication with the clinical staff may improve, Woodcock says. Because clinical areas also are staffed by MAs, a sort of cultural divide between the front-office staff and clinical staff often is bridged, knitting them together into more of a team.

    3. MAKE AN APPEARANCE ON NEW HIRE'S FIRST DAY

    Woodcock says the time to start thinking about retention is the moment a new employee first walks in the front door. "Re-recruit," she urges, "starting on the very first day."

    Doing so means going out of your way to make a new staff member feel welcome. "Have a name tag prepared in advance; don't force her to wear a tag that says 'Temp' until you get around to having a personalized tag made," Woodcock says.

    One practice that she knows of presents new employees with a cake. "Welcome to our family," followed by the person's name, is scripted in the icing on top. It's for the new employee to take home to enjoy with her family. "It makes a powerful statement," Woodcock says.

    Other practices send a bouquet of flowers to a newly hired employee with a note saying "Welcome aboard." Little gestures mean a lot.

    Your making an appearance to extend a personal welcome means a great deal as well. When you show up, busy as you are, that means it's important. No action is more welcoming than that one.

    4. PARTICIPATE IN TRAINING FRONT-OFFICE STAFF

    When a new staff member arrives for her first day at work, the first person she should spend time with is not your practice manager, Sikorski says. It should be you.

    "Even before office duties are addressed, the doctor should take a new employee through the entire day, step by step, so she understands how the practice operates and what patient flow is like," he says. This practice allows front-office staff members to understand the big picture, fosters teamwork, and improves performance.

    Woodcock recently wrote a book designed to make the nitty-gritty training easier on your practice manager. Published by the Medical Group Management Association, Front Office Success: How to Satisfy Patients and Boost the Bottom Line is a handbook of sorts to give to front-office staff members to speed learning and answer common questions. To that end, it offers tips, checklists, quizzes, and scripts for providing better customer service, receiving patients, answering telephones, scheduling appointments, collecting payments, managing waiting patients, and checking out patients.

    As practice leader, ensure that all front-office staff—for instance, the receptionist, the person at registration, the scheduler, the cashier, the co-pay collector, and the referral clerk—are cross-trained to do each others' jobs. This way, they can fill in for each other when someone is ill, on vacation, overwhelmed, taking a lunch break, or moving on. Appreciating what goes into doing each job fosters teamwork, empathy, and mutual respect among members of the staff.

    5. MAKE MEETINGS OPEN TO ALL

    Front office staff often are excluded from meetings at which everyone else in the practice is present. This practice doesn't build teamwork or foster mutual respect. It's a good policy to reverse.

    "Have a quick huddle before the day begins," Woodcock says. "At minimum, you, a nurse or MA, and your scheduler should meet, although at some practices, the entire staff is present. Review the schedule for the day. Look for anomalies. For example, patient A needs more time than she's slotted for. Patient B will be a no-show; she was admitted to the hospital last night."

    When front-office staff members are invited to meetings and encouraged—even expected—to make a contribution, they will start to feel more like equal partners in the practice, and the rest of the staff will start to view them in that way, too.

    Front-office staff members should be included in weekly or monthly office-wide meetings, too. "A staff meeting could be held over lunch, or a follow-up meeting could be held at the end of the week," Sikorski says. "Recap the significant events of the week, and give people a chance to comment and offer suggestions. If there are any problems or concerns, this is an opportunity to bring them up. A prime topic at weekly meetings should be: 'How are we doing as a practice?' "

    Tension between front- and back-office staff is a common problem. One way to deal with this, Grigsby suggests, is by holding orientation sessions to familiarize each staff with what the other does. "They need to walk a mile in the other's shoes," he says.

    Linz is in favor of orientation, too. "This isn't cross-training," she says. "It's cross-appreciating. It's making the front and back office aware of one another's tasks and why these tasks are important."

    6. RECOGNIZE AND REWARD GOOD WORK


    IN MOTIVATING FRONT OFFICE STAFF, IS MONEY THE ANSWER?
    It's important to incentivize front office staff members to do their best. The standard motivator is a gift of cash. Experts are divided on the wisdom of offering monetary incentives. Some insist that money talks. Others have found that cash gifts can backfire.

    Woodcock believes in the almost-magical power of two little words to brighten someone's day: Thank you. Doctors should try using them more often, she says. When a doctor takes the trouble to say thank you personally to a member of the staff, it carries extra weight.


    Marty Linz
    Not an advocate of financial incentives, Woodcock offers other, inexpensive ways to show appreciation: gas cards, spa gift certificates, retail gift cards, or movie tickets.

    Linz has mixed feelings about offering individual incentives. "It can lead to competition among the staff," she says. She favors group outings, such as a bowling night, "in which the person or team with the highest score wins win a prize, usually a gift certificate. That's a fun competition and builds team spirit. We've also gone to a Broadway show, and there's the holiday party."

    7. DO WHAT'S NECESSARY TO RETAIN GOOD PEOPLE


    Jim Grigsby
    Retaining good front-office staff definitely is about money, but it's about so much more as well. If front-office staff members are treated as second-class citizens, if doctors don't acknowledge their existence, if other staff members look down on them or snipe at them, if they are excluded from staff meetings as if they are non-persons, then turnover will be high regardless of pay, the experts say.

    "People leave because they don't feel as if they are part of something," Grigsby says.

    Sikorski says: "Retention can last from a few weeks to several years. Especially in smaller practices, if you choose cheap labor—college students, uneducated people, people holding down more than one job—it doesn't make a practice successful over the long term. You need a stable staff. Skills count. You must be willing to pay for that talent."

    Sikorski believes that finding top people and paying them more than prevailing market rates pays dividends down the line.

    "A medical office receptionist costs $60,000 in New York City, but it's more cost-effective to hire someone really good for $90,000," he says. "The front office makes or breaks your practice."

    Particularly in a small practice, "receptionist" hardly describes the work that actually is performed. "This person is greeting patients, giving them forms to fill out, checking their insurance, managing the flow of traffic, and much more," Sikorski says. "If you are seeing 50 or more patients a day, that front-office person is the most important person in the practice after the clinical staff, especially if you aren't using nurse practitioners or physician assistants."

    Retention rates could be improved via the automation of many front-office tasks, which would make work easier for staff members, Woodcock says. For example, scanners make it easy to input insurance and patient information into the practice management system that otherwise would need to be entered manually. A practice Web site that offers downloadable new-patient forms to complete before an office visit means one less thing for the front office to deal with during a hectic day.

    Feedback is important, too. To retain good employees, be clear about your expectations for their performance, and offer regular feedback on their work. Those who are doing well need to hear it. Those who could use improvement need to hear it even more. In exchange for their loyalty, staff members must feel not just that they're being fairly paid but also that their contributions are valued. Be sincere and generous in your appreciation. Treat your staff members appropriately and they will stay.

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    Neil Chesanow
    The author is a former Senior Editor of Medical Economics.

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