Building practice teamwork is an everyday activity

A column answering your questions about the business side of your practice

By Karen S. Schechter amednews correspondent— Posted Nov. 21, 2005.

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Question: My partner and I own a four-physician family medicine private practice with 18 employees. We have a fast-paced clinic, and the employees appear to be working hard and relatively productively. However, there is so much tension and a lack of teamwork that many days I dread having even to go into the office. The office manager has tried counseling individuals, holding regular office meetings, etc., but nothing seems to work. Can you provide me with some guidelines as to how I can handle this situation?

Answer: Focusing on customer service and trying to run an efficient cost-effective practice is a challenge for all private medical practices -- especially in today's managed care-driven environment.

The medical practice's staff typically consists of a diverse group of individuals with different ideas, backgrounds and experiences.

Just because they all have a common employer does not mean that they automatically become a team. Team building is an ongoing and deliberate process that, if successful, creates a work culture that values collaboration.

To make teamwork happen, several actions must occur.

Practice leaders need to develop the practice's mission and goals. What is the reason for the practice's existence, and what is it striving for in the future?

The mission and goals should be grounded in the values of the practice leaders, and teamwork should be one of those values. The mission, goals and values should be formally written and shared with the staff on a regular basis.

The practice's leaders, along with the office administrator/manager, must consistently communicate the clear expectation that teamwork and collaboration are expected. No one completely owns a work area or process.

All employees should understand the impact of their actions on the entire work process. If the front desk clerk does not get up-to-date insurance information, or does not make a clear copy of the card, then the person in charge of entering the data has to take extra steps to complete the task. That could delay the billing and ultimately the timely receipt of payment.

The physicians and practice leaders should model teamwork in their interaction with each other and the rest of the organization. If the clinical staff is short-handed one day, then physicians should find ways to share the available staff, or perhaps take on some of the clinical responsibilities that are usually assigned to their assistants.

When the front desk is short-staffed, the office manager should find ways to get it the necessary assistance, including having the office manager pick up some of the slack.

Teamwork needs to be rewarded and recognized. Many practices have moved away from setting benchmarks for and giving bonuses and rewards to individuals. Instead, they give these bonuses and rewards (at least part of them) to the entire staff.

This supports the belief that an individual player, even if an excellent producer, is valued less than the person who achieves results with others. Compensation, bonuses and rewards depend on collaborative practices as much as individual contribution and achievement.

There must be a performance management system that not only evaluates employees on the quantity and quality of their work but also places emphasis and value on teamwork. Employee surveys are another good tool to identify weaknesses in the collaborative environment that is trying to be achieved.

Team building is not something that is learned at a seminar or in-house training session. It must take place every day. There are several ways to do this.

Hold regular office meetings to provide updates to the staff and make sure employees continue to be focused on the practice's mission, goals and values. Review projects and progress to obtain input and to coordinate shared work processes.

If staff members are not getting along, examine the work processes they mutually own. The problem is usually not the personalities of the people. Instead, it's that they often don't agree on how a task or process should be performed, or the steps required to get something done. Once there is agreement on the process and expectations associated with it, then the personal issues should disappear.

Form teams to solve real work issues and improve real work processes. Provide training in systematic methods so the team expends its energy on the project, not on figuring out how to work together to approach it.

In a real-life example, there was a practice that was having difficulty locating charts that had been taken off the daily appointment shelf. Three self-appointed staff members from different areas of the practice met and developed a solution. Their idea was implemented, and it gained full support from the rest of the staff because the idea came from the employees themselves.

Build fun and shared occasions into the practice's agenda. Hold potluck lunches; take the staff to a sporting event. Be sure that the physicians attend some if not all of these occasions.

Use icebreakers and time-limited fun team-building exercises at meetings or as a voluntary activity. We conducted an icebreaker at a recent medical office staff meeting. The activity was limited to 10 minutes, but it helped participants laugh together and get to know each other.

Celebrate group successes publicly. These celebrations could be semiannual or annual, in the form of a profit-sharing program. But it could be as simple as purchasing everyone the same T-shirt or hat. Another idea is to place team members' names in a drawing for merchandise and gift certificates when the staff attains a specific goal.

Team building is creating a work culture that values collaboration. In a collaborative environment, people understand and believe that thinking, planning, decisions and actions are better when done cooperatively. In any industry, it is hard to find work places that exemplify teamwork.

But by following the suggestions above, your medical practice has the opportunity to begin to change the tone of the office environment and make it a place where you and everyone else (staff and patients) want to be.

Karen S. Schechter amednews correspondent—

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