Building Accountability in Your Practice

Consultants frequently hear managers say, “Why doesn't my staff do what they are supposed to do?” and “Why do I still have to ask staff members to do the same tasks even though they have been employed at my practice for years?” The answer to both questions is simple and the same: employees are not being held accountable.

Why Accountability Is Missing

Managers do not hold staff accountable for three primary reasons:

• Conflict avoidance. Most managers see accountability as a tie-in to conflict. They worry that if they hold a staff member accountable to a task or behavior and the employee does not perform, they will have to reprimand the employee in some way. Most admit, “I don't like to be a ‘big meanie.'”
• It's exhausting. Holding employees accountable takes a great deal of time and energy. Managers worry that if they hold an employee accountable, it will take more time and energy from their already busy schedules to construct a development plan to try to get the employee on track.
• Employee expectations have never been outlined. Although most practices do have general job descriptions, most have not outlined exactly what the essential daily tasks are for each employee; or, if they have, the duties have changed.

Tips for Creating Accountable Employees

So, how does a practice address lack of staff accountability without making it too painful for managers and staff? Here are seven ways managers can quickly build staff accountability:

Face the problem head on. Managers must first be willing to admit that lack of accountability might be an issue in their practice. There is a good chance that readers who strongly relate to the comments in the opening paragraph are probably not holding their staff accountable. It is important that all members of the management team—including physicians—understand that accountability begins on an administrative level; they are the ones responsible for setting the tone.

Review job descriptions. Having accurate job descriptions that outline employee duties and responsibilities is essential. Staff members need to know what is expected of them. If job descriptions do not currently reflect what is expected, they must be changed. The clearer the description, the more chance there is of staff accountability.

Develop checklists. An effective method of boosting staff accountability is through the creation and implementation of checklists. Checklists are effective because they communicate practice expectations, develop staff ownership, and encourage management follow-up. Most checklists spell out job details and require employees to sign off on tasks (Figure 1). In some cases, they list projected goals and capture data that measures staff performance. It is recommended that administrators sit down with staff members when developing checklists. Involving staff provides valuable employee input, empowers employees by making them part of the process, and increases buy-in. For checklists to be effective, management must commit to regular follow-up. Managers should require that employees turn in completed checklists daily before clocking out. They should also perform occasional spot checks to confirm that tasks are being completed with competence.

Track and measure activities and performance. It is important to remember that people focus on what gets measured. If a staff member's current duties cannot be measured or tracked, she or he may not be contributing to the success of the organization. Managers should make sure tracking is based on both activities and performance. For example, a manager might choose to measure the number of appointments that a front-desk person books in comparison to the total number of telephone inquiries she or he receives in a given month. Setting a percentage goal (30 percent, 50 percent, etc.) is recommended. After goals are established and performance tracked, it's not uncommon for managers to suddenly overhear front staff members actually credentialing the provider, capturing contact information, and asking for the appointment.

Show staff how they will benefit. It's likely that staff engagement will increase once they learn certain behaviors are being measured. However, in addition to engagement, managers want employees to be excited about their jobs and their daily duties. That being said, staff members need to know how achieving individual and group performance goals will benefit both the organization and themselves. Once employees have a clear understanding of these two things, buy-in occurs. Here's an example: The manager of an aesthetics practice has set a goal of having 50 percent of patients enrolled in their loyalty program in the next three months. If the goal is met, the entire staff will be rewarded with a complimentary procedure of their choice during an evening of beauty with the physician (the date for this reward is provided when the goal is communicated to the staff). Meeting the retention goal and receiving the complimentary procedure will consequently motivate staff to educate patients.

Reward what you want repeated. Behavior that is rewarded gets repeated. Managers should ask themselves the following questions: “What type of behavior do I reward at my practice?” “What actions should get rewarded?” “Have I ever polled my staff members to find out what their ‘carrot' would be?” Monetary rewards, time off, complimentary treatments, the option to do more of the work they enjoy, prizes for achieving specific goals, the opportunity for more training— these are all possibilities. Whatever the answer, managers should be listening so they are able to match the reward to the desired behavior.

Schedule follow-up sessions. All employees should always have a series of follow-up sessions scheduled with their manager. The timeframe may vary by employee; however, it is important to note that staff members who meet regularly with managers to discuss performance and execution of goals are likely to become more in tune with delivering on practice expectations. During follow-up, managers should discuss the areas in which the staff member has been meeting/exceeding expectations and identify areas that require some attention. Putting together an action plan (with a timeline) for areas of opportunity is wise. Some managers call this an Individual Development Plan.

Moving Forward

To be a successful practice, staff accountability is a must. Holding staff accountable isn't fun or easy, but it is necessary to get the behavior needed to move the practice forward. Failure to hold employees accountable will put employees in the position of figuring out what to do on their own. Instead, tell them what is expected, show them what is expected, tell them how they will benefit, and then reward them for doing a good job. Like it or not, it is the manager's responsibility to set the staff up for success.

Kim Blackwell is a management consultant with the Allergan Practice Consulting Group, a specialty pharmaceutical company based in Irvine, CA.