Home Forums Discussions General Discussion Discipline

Once again, I look to the wise about this topic. It has always been the biggest thorn in my side.

I know there are hundreds of way, and in the end, nothing works well other than decrease employee morale.

I know that a lot will suggest "writing up employees." I find that very confrontational.

Once the employee has a job description, can I not just keep track whether officially or unofficially as to what I would consider not performing up to standards and then either give raises or not, give bonsues or not. If I give a lower bonus or less of a raise, do I have to actually justify it to them.

Sure, just as with kids, when you address it at the time, I suppose they can change. But, they already know. And, they DON'T change. I don't mean bad employees or fireable offenses. But, I think pointing out things over and over simply serves no purpose.

I guess in the end, is it ok for me just to keep a point system or something in their file or not in their file and give bonuses (or not) or give raises (or not).

Recurring problems sometimes points to a need for a change in the system.

Here's a small example: I have a set of patient education handouts I give to parents at the time of well visits. My receptionist was responsible for giving them to the parents when the child was waiting to see me. She would occasionally forget and several times I reminded her--to no avail. So I changed the system and had her attach the handout to the encounter form so I would see it and give it to the parent. Somehow, knowing that the forms were going to me, my receptionist is much better about getting this simple task done. Problem solved.

A disciplinary problem is transformed into a systems problem with better results and no hard feelings.

Thanks John,

I appreciate your answer, and I don't want to act like I am debating after asking for advice. I am a big fan of systems approach so things aren't missed. Your description above almost falls in between as far as forgetting and just not performing well. My receptionist would likely say, she keeps forgetting or even I don't like doing it. (I know sounds easy -- fire her. As weird as it sounds she is so good at doing other things).

What I don't get sometimes is why someone who is always forgetting something can't take it upon themselves to develop a system. And, the old adage, "Well, that's why we are where we are, and they are doing what they are doing, isn't always enough."

Again, though, thanks.

Yes, Bert, I'm sure we all have a few issues like that with staff.

Sometimes I've found it helpful to transfer a problem from one employee to another--someone who has different gifts/abilities. But more often that not I just to do it myself and try not to grumble too much. :-)

Maybe others have some good ideas.

I just do it myself and grumble. Must be a New England thing.

When I have issues with employees forgetting to do things like restock the gloves or tongue depressors I simply open the exam room door and throw the empty box of gloves at them and smile as I do so. Then I laugh to the patient and say something like "this is an office game we play". The patients almost always find this very humorous and the staff get the message and seem to do a better job at least for a while. I seem to get a better response when I can call attention to a problem in a more light-hearted way. Scolding and stomping and throwing a hissy fit never works. I have even made paper air planes out of uncompleted forms and flown them out to the nurses desk.

What a classic Leslie post. Please come back, Leslie. We miss you!

Oh if you only knew how badly I wished I could!! I miss you all too.

I have had similar issues and am wondering how my colleagues will address them:
There are two (particularly one) employee who constantly talk. They leaves their work areas to discuss simple things that turn into a social talk, giggling and laughing goes on for several minutes. They keep forgetting to schedule follow ups at check out, there are duplicate appointments every week, do not address DNKAs, forget to give vaccine information sheets, .... and it is not funny any more. Any suggestions to improve my office system to minimize these issues?

This is just the type of thing I am talking about. Although, this is much more blatant irresponsibility and misbehavior. The problem in giving advice is the fact that I do have too much objectivity here. It is so simple to look at your problem and just say they need to be admonished.

How do they respond when you simply say you need to go back to your work station? That is one thing about my employees. They will go on their cell phone when they shouldn't. Or forget to do something. But, if I ask one to stop talking and to do something, they do it right away.

I think a big issue is it is difficult to run a practice without an office manager. Every place I worked where there was an office manager, they actually ended up having more power than I. But, then it is easy to let them be the heavy.

It is also more difficult the smaller your office is. When you have only 3.5 employees, you simply have a difficult time disciplining them. Sure, don't be their friend, but if your personality is like mine, that is easier said than done.

I guess coming from me, this may not be as good advice. But, I guess I would use the approach of asking questions. For instance, have them come into your office and have them sit down. First, ask them if they know why you are talking with them. Then name the behavior and ask them if they think it is productive? They will almost always say no. Then ask them what you should do? Let them decide. Of course, you can always say, "I thought of that, but I am actually going to do this." You could ask them, there have been a lot of mistakes in the schedule. Anyone can make mistakes, but do you think doing this type of stuff could contribute to it. Either way, I need you to stop it.

Another problem that I have is how important the employee is. Now, if I had a dime for every time someone told me "No one is irreplaceable..." But, some employees are irreplaceable. I mean you could say the same thing about Tom Brady or Jerry Montana. Tom Brady can be replaced. No he can't! Sure, you could, but your team will suffer.

I always have to look at it in that light. My CMA is probably the best there is. Period. She is unbelievably good. She is practically a nurse practitioner with an incredible work ethic. She treats every patient with complete respect. Problem is she disrespects me. At times. It isn't like its five times a day. But, I do have staff that I would have no problem terminating.

So, I guess there are a lot of variables. Is the person that is being talked to someone you feel comfortable talking with? You could say, "I notice that Mary comes back and talks to you a lot. I will talk with Mary about it, but I really need you to refrain from talking to her. Just tell her you are busy."

OK, on the serious side. I think it is really hard to pick out one employee and admonish them. They many times will just think to themselves "Well, so and so is just as bad! Why isn't she in here ?" I have learned it is more productive to hold an office meeting with all the staff and raise your concerns to everybody. If you say something like, "Gang, I know we all like to come to work in a pleasant environment and there is nothing wrong with having a little fun here as well. But there is a time and a place for everything and getting the work done and done right comes first. There have to be some boundaries or the entire practice suffers. I am concerned because I feel some of you are crossing those boundaries. Here are some things I think we need to work on..... I would like to see these things change or my only recourse will be for me to make changes which none of you will like." This also gives the other employees the opening to say to the incessant talker and giggler, "Sorry, So and so but I can't talk to you right now. I have to get this or that done or, like Doc said, there will be Hell to pay".
Regardless, make sure you document completely any of these encounters with the employees singly or en masse. If you end up having to fire one and they file for unemployment benefits or charge you with unfair discharge then you can show that you did indeed discuss their behavior on several occasions prior to dismissing them and gave them warnings regarding their poor performance.

Thanks for great tips. Like mentioned above, sometimes we just have to accept the imperfections, look on the positives and make it work. It adds to my work but I just end up keeping an eye on everything. It is my luck that have had hard time finding "the one" we have been looking for.

We had three 55+ y/o junior high school girls working for us. Unending drama. Had a Staff meeting with a rah rah we're a team theme! Solved!
Right, next week "they are more mean to me than ever!" (quote accurate)..
Took one to part time, no help. When she went on FMLA (husband) we did not bring her back (we are too small to be subject to FMLA ). Replacement staff -- went through a couple before finding what looks to be a good one.
The comments about task being dropped are universally true, I believe. IF something does not get done, and you let it go (too busy to correct the "error", or do it yourself) then you have just given permission to make it optional. So guess what?
Some days I long for return to active duty in the Navy when my orders might actually have meant something.

I have found that without an office manager, it is difficult in a small practice to be the doctor, boss, owner and discliplinarian. It is just hard to work so closely with three or four employees where any feedback at all has powerful repercussions.

And, the pendulum has swung so far toward the rights of the employee, it is like they have unfireability insurance. I figure now it costs me about $10,000 to fire an employee. Hell, it costs the same to hire one who quits.

I am sure there are better employees out there. The challenge is to find one and keep her. Despite working harder in 2015 than in 2014, I made less and it is very hard to pay them more or afford an office manager. It costs to check eligibility, benefits, do billing, get PAs and referral authorizations and it is only getting worse. I find that some of the girls going to school to work in medical office do not have the commitment and devotion that is required. Just yesterday, at the end of a busy day, some of the employees left without finishing the work (placing orders for all the labs) as it was getting late. I am glad the remaining ones realized orders were not taken care of.

Again, difficult to comment sometimes due to the automatic objectivity one has when they don't know the other person's employees. That is why any helpful hints would be great. But, sure, it would be simple to just say, "Naeem, someone just didn't do it because they were lazy?" That's a huge offense. But, it isn't that simple.

In my case, we have great employees. Part of the problem is they are GREAT, I mean REALLY GREAT on the most important part of their job so that replacing them would be very difficult. My receptionist does things or doesn't do things that should be cause for reprimand, but you will not find anyone, anywhere who is better on the phones, scheduling, checking people in, checking people out. I have never seen her get upset with anyone in six years, and I sat there from behind a corner while a mother was screaming at her. She just smiled and said, "I am sorry you feel that way." I had to intervene. But, she is an amazing receptionist as far as her most basic job description.

One thing I have over them that is an incredible motivator is the ability to schedulre their Internet use. Due to their, not misuse, but complete abuse of Facebook and every other social media, I obtained software which allows them to only have access to certain sites, and then they can use any site during lunch. It is scheduled automatically. But, if you take it away, rather than their acting upset, they trade the 23 inch monitor for their 4.7 inch iPhone screen.

But, Bert, you can make a rule that they can't use their phones. And, on and on it goes. Now staff act like they have to have their phone in cases their kid needs them as if our actual phone number isn't good enough. They will sit their with their heads buried in their phone texting. Again, from where the person who is reading this is sitting, it seems so simple. Just take it away. Or write them up. And, it is that easy. I just hate confrontation. One more stressor. Sitting there thinking, they know I pay them well, they know they get an hour of free Internet, they know I am too nice to them. Yet, they don't care.

Again, don't get me completely wrong. This is a great staff. My CMA is the best in the U.S. And everyone else is great.

I have watched this thread with interest. I do not have the answer.

I have tried bonuses, but then it's more work on me to tally up and keep track of the items we are bonusing. I even tried tying the group to individual bonuses thus if one person did not do something everyone lost out, still too much.

I have tried moving duties to other employees. All are good at some things, some are good at others. Sometimes you need to find the right fit. This has helped but still things do not occur.

I have been trying to get my staff to take pictures for several years. For a while I did them all. Finally I just gave up. (WARNING diverting the topic) One issue with pictures is that they have to be resized and that's a difficult task for the staff to get their heads around. Anyone have a good answer for that?

Don't worry. I have one staff member whose job it is to check the board and alert me and divert, if possible, any hijacking, lol. She doesn't do it. So you are safe.

But, on a serious note, I thought the one person would be Wendell to have the answer for this. Or to not even have the problem. It is just the sheer shirking of tasks they are supposed to do that drive me crazy. Or, I guess the tasks they won't do.

I had a meeting with one of my employees who was missing a lot of days. It turns out, poor thing, she is going through a lot. Th meeting ended with me feeling bad for her. I learned that sometimes listening to there side of the story and realizing what is going on in their lives when they are not at work has a major bearing on their work performance. It has given me a different perspective of the situation.

I am the office manager and get to be the clinic police of the cell phones, dress codes, patient flow, etc. It is the part of my job I hate the most but is a necessary one. We also have great staff so I let them get away with a little more than I usually would but I am pretty clear on the cell phones. And there is no social media allowed during work hours. If I see something I say something right away and address the individual rather than punish everyone. I try not to embarrass and make it a big deal unless it is the 2nd or 3rd time I have had to bring it up. I would write them up if there was a 4th time and probation after that. I feel for offices who are smaller and the providers have to be the punisher. I am sure every office has their problem child. If they are good employees try to work with them as you may end up with something worse. Just my two cents.

No, great two cents. Unfortunately for my employees, the only way to stop social media was to install Currentware/Browse Control to keep them off Facebook. So, this meant punishing everyone for the sake of one. But, everyone did it anyway.

But, the answer to the discipline question is to have an office manager.

I have used write ups before, but then I have to have a plan as to what to do with the write ups. It is kind of like dealing with a child. You have to be willing to go through what you have said you were going to do. I simply have two employees that are damned near irreplaceable. And, I feel like I have to say to them, "You fired! Would you like that $xx.xx now or later as to your "Hostile Work Environment" suit you are going to file within the next two to three months. And, yes, if you wait, it will have compounded interest.

I don't hate lawyers, I hate contingency fees. Well, I also hate lawyers.

One thing I've learned over the years, Bert, is THEY ARE ALL REPLACEABLE. If they are not following the office policies concerning use of technology, they are opening your business up for viruses, and they are stealing resources. Those are not the kind of employees I would want regardless of whatever skills they have. Thankfully, my employees try hard to please me and they are damn good. The best in 5 years. How long will it last?

Until you catch them on Facebook.

Thanks though.