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In any practice, the physician owner and/or administrators are in charge of overseeing the responsibilities associated with human resources management. This includes employment and labor laws, government compliance issues, employee-related costs and the ever-present threat of employee litigation.
The central components of human resources management include staffing the practice; staying current with the legal environment; developing a compensation structure; creating an employee handbook; and executing procedures for recruiting, hiring, training, discipline and termination.
Staff the Practice
Structuring the staff to best fit the needs, size and culture of the practice is an important task. This will dictate how well the practice runs on a daily basis and patient satisfaction during encounters. It is important to understand the quality of care provided will be largely dependent on the skills and proficiency of the staff.
According to the Medical Group Management Association (MGMA), practices do not operate efficiently and at optimum financial performance when they are under- or overstaffed. Low staff levels constrict productivity and require employees and the physician owner to perform tasks that are outside of their areas of expertise and are an ineffective use of time. This may lead to problems in patient access and poor staff morale.1 Likewise, being overstaffed increases overhead and may lead to confusion as to which employee performs what task.
Ideally, practices should aim to follow rightsizing, defined as the systematic review of staffing levels, tasks and work processes to determine the appropriate number and mix of staff needed to meet business goals.¹ Rightsizing answers the questions: Do you have the right staff in place, and are they tasked with appropriate responsibilities? Rightsizing seeks maximum efficiency by matching the employee’s skill set to the work to be performed. The number of employees needed and the positions they will fill depends upon the type of professional and ancillary services provided and/or the physician’s preference.
Perform a Job Analysis
The staffing structure of every practice should always begin with a job analysis. This process identifies the individual tasks an employee performs, the situation in which they are performed and the qualities necessary for execution. This information should then be used to recruit for the position, identify appropriate candidates and set an appropriate and fair level of compensation. A job analysis consists of:
- Work Activities: Indicate activities performed;
- Equipment, Machines and Tools Used: What is used by the employee to perform their work;
- Work Performance: Anticipated time to perform activities, standards for work and expectation levels;
- Job Context: Physical work conditions, work schedule, organizational context (e.g., culture, climate, etc.), incentives and rewards; and
- Personnel Requirements: KSAs (knowledge, skills and abilities) or KSOs (knowledge, skills and other) the employee needs to do the job:
- Knowledge—facts and principles;
- Skills—well-learned proficiencies acquired through practice;
- Abilities—more stable traits or capabilities of a person; and
- Other—things not covered by the KSAs that are required (e.g., licensure, permit, education).
There are various methods used to collect information for a job analysis. Interviews, direct observation, diaries, and structured questionnaires are all helpful, but the best resources for the purposes of staffing a small medical practice are the ONET Resource Center and the U.S. Department of Labor’s (DOL) Occupational Outlook Handbook.
ONET is a collection of job analyses compiled by the DOL and can be accessed at online.onetcenter.org. The job analyses located on the site are a great place to start, and can be used as a template that can be further developed and customized to fit what is needed at the practice. The Occupational Outlook Handbook can be accessed through the U.S. DOL’s Bureau of Labor statistics. The handbook gives the training and education requirements, required earnings, description of typical job duties and working environments for many different types of jobs. The end process of a job analysis is a written job description, which should be a one- or two-page outline that can be use in a compensation system, performance appraisal and selection system.
Develop Personnel Policies, Procedures & an Employee Handbook
Creating written company policies and an employee handbook may seem daunting, but this is necessary to protect the practice. There are many resources available online, including downloadable templates that can be modified to fit the needs of the practice.
The employee handbook is a collection of the practice’s policies, office procedures, mission, goal and other employment information that is used to guide the employee and clearly define their role. The handbook should illuminate the policies and expectations, and ensure uniformity in the way things are handled in conducting the business of the practice. The handbook is meant to simply be a guide—not a contract—and therefore should be unilateral and appropriate for the entire organization, not specific to any one position or department.
The employee handbook has many purposes. It should provide consistent answers to employment questions and evidence of formal policies that may be needed. It is also a vehicle to communicate the history, ethics and goals of the organization. Most importantly, the handbook is necessary to ensure compliance with various government regulations relating to patient safety and employment.
Keep in mind, as the physician practice owner, you are solely responsible for all policies and statements contained in the employee handbook, regardless of where it came from or who authored the book. It is recommended that an attorney review the content in the employee handbook for appropriate wording and potential legal implications before distribution.
Also, there are some employment policies mandated by law that must be physically posted where employees can easily access and view them. The DOL provides a guide on its website that has a series of questions to help determine which laws apply to the business. After you complete the questionnaire, a customized list of required posters will be provided, and the posters will be sent by the DOL to employers at no cost.
Determining what other policies should be developed and listed in the handbook can be challenging, but there is no single policy list or guide. Additional policies in development depend on both the size and nature of the practice, including written policies related to conduct and ethics. These policies should be universal and followed without exception. If there is a need to make exceptions, then the policy should be amended and dated for compliance.
Managing the human resources area of a practice plays a vital role in ensuring employees feel motivated and satisfied in the practice. This will result in creating a patient-centered and risk-free environment. For general human resources questions for your practice, contact the ACR practice management department at [email protected].
Reference
- Walker DL, Gans DN (2003). Rightsizing: Appropriate Staffing for Your Medical Practice. Dubuque, Iowa: Kendall/Hunt Pub.
