Business
By the book: Rules of the worker's road
■ Putting the rules for your practice in writing helps ensure everyone gets the same message. But don't try to write your first employee manual by yourself.
By Carrie Printz, amednews correspondent — Posted Aug. 15, 2005
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Many practices are sure that their staff knows the office rules. But many others figure that it's a good idea to put those rules in writing.
Those are the practices formulating and handing out employee manuals, or employee handbooks, or whatever they want to call the document that stipulates such information as expected time of arrival, dress code, vacation policy, or whatever else a physician group deems necessary for the office's smooth operation
The physicians and staff of Bluegrass Orthopedics in Lexington, Ky., wouldn't think of living without their employee manual.
"I think it's critical to have a manual," said orthopedic surgeon Greg D'Angelo, MD. "It's very nice when things are written down, and there's no ambiguity. Also, it's a nice reference tool -- if you have a question about something, the answer is right there at your fingertips."
An employee manual can come in all sizes. Offices of five or fewer employees probably can get by with a one-page description for each employee that summarizes benefits, evaluations and raises, said Steve Peltz, a practice management consultant in Brewster, N.Y.
For larger practices, he said, manuals can range in size from five to 45 pages or more, depending on the details included.
"Ninety percent of employees function best when they know what's expected of them," Peltz said. "If everyone has the same set of rules that apply to them, then everyone will feel more comfortable."
Health care attorney Thomas Hess of Columbus, Ohio, understands that some practices eschew a manual because they think it will detract from a "family-like, less formal tone to the work environment."
That's one reason that Deborah Bublitz, MD, says her 43-physician pediatrics practice in Littleton, Colo., doesn't have one, instead relying on a strong practice manager to keep things in line. "She's the glue that holds us all together," Dr. Bublitz said. "We even ask her if we can have a day off."
Still, even Dr. Bublitz's practice has a checklist of tasks, rules and expectations that new employees receive at orientation, which functions as a quasi-manual.
Writing it down
Consultants estimate the cost of producing a full-fledged manual can range from $1,000 to $3,000, not including printing costs. That includes the cost of attorney review. Dr. D'Angelo cautions against physicians attempting to write a manual without assistance. With so many consultants and resources available now, it's simple enough to get a basic framework put together and then have the physicians review it, he said.
Practice manager Cynthia Dunn, also a consultant affiliated with the Medical Group Management Assn., wrote Bluegrass Orthopedics' manual, with physician review and input.
Peltz said manuals should explain such items as: sick and vacation leave; what to do in inclement weather; pensions; how to resolve conflicts among employees; entitlements under federal and state law; how employees can be fired; the expectations the practice has for each employee; professional development; an organizational chart; and more. Job descriptions, he says, should be separate.
In addition, "you always want a page that an employee signs, saying that they have read the manual and agree with it," Peltz said, adding that there should be a disclaimer statement noting that the policies could be subject to change.
Some manuals also will include a description of the process a patient actually goes through during an appointment so that all employees understand what happens during each stage of the visit, including scheduling the appointment, filling out forms, creating a medical chart, taking the patient to the exam room, the physician seeing the patient, and, lastly, billing. Some even include sample scripts for each employee.
Dunn calls Bluegrass Orthopedics' 35-page manual a "road map" for every employee.
"Employees need to know they'll be treated fairly, with the same expectations and standards as everyone else," she said. "A manual also solidifies a group. You want everyone to feel that we're all working for the good of the patients and for the practice."
It's also recommended that manuals include some policy to reflect current legal trends. For example, "nowadays, in addition to the basics, you'll need a sexual harassment policy and an Internet policy," said Jeff Sinaiko, president of Los Angeles-based Sinaiko Healthcare Consulting. That also means that a manual is always an evolving document. Dunn said Bluegrass Orthopedics reviews and adjusts its manual on a regular basis.
"An employee manual can be put together by a physician and office manager and can have a human resource consultant [or attorney] come in periodically to do some training and ensure that the manual is updated," Sinaiko said.
A physician manual
But manuals don't have to be just for staff. One area that few medical practices have considered is the concept of a separate policies and procedures manual just for the physicians, said C. Kay Freeman, president of Health Systems Strategies of Atlanta. The majority of employee manuals, she said, apply mainly to the staff, leaving no specific guidelines for physicians other than their contracts.
"Almost all physician employment contracts have a line that says you will abide by the policies and procedures of the practice but [don't] list what they are," Freeman said. "The first time a physician learns there is a policy on a matter is when it gets violated."
Policies in such a manual can range from those dealing with "call schedule changes" to "protocol for seeing another physician's patient" to "accountability for confidentiality." Freeman's group has a template for the manual, and they then conduct a fact-finding session with the practice to address specific issues and concerns before finalizing the document.
As in staff manuals, the benefit of a physician manual is that with terms and conditions spelled out, Hess said, the practice "can minimize the potential for unnecessary litigation."
Consultants stress that employee manuals need to be kept simple and "user friendly" and are clearly distinct from corporate compliance plans, which outline a practice's course of conduct, and how it will operate and abide by state and federal laws. One example of an item in a corporate compliance plan might be: "We do not accept gifts from vendors or suppliers."
"You don't need the most detailed, elaborate document," Sinaiko said. "There's an inclination to make it too perfect, and then it doesn't get done."