Morale booster: Making employees part of the team

Doing little things to make fellow physicians and employees feel like the office is more than just a workplace can help practices solve some of their biggest issues.

By Jonathan G. Bethely — Posted May 21, 2007

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Physicians at Spring Road Family Practice in Carlisle, Pa., knew something was wrong. Employee turnover was increasing, and more patients were leaving and not coming back.

The stress level among the four physicians and 16 staff members also was going up and was sure to go even higher with a new electronic medical record system installation.

The problems, the practice determined, came from low employee morale.

"The morale is pretty evident," said William Kauffman, MD, one of the practice's owners. "You can kind of feel it without asking a lot of questions. People will either be chatty, or, if there's not much chatter going on, you can tell morale is not quite so good."

Almost every restorative step the four-physician practice has taken revolves around making sure employees feel like part of a team. Communicating about practice issues is encouraged. When problems arise, they are dealt with right away, Dr. Kauffman said. If, say, raises are not forthcoming, he explains why.

The practice also finds ways to make the workplace more comfortable. Practice administrator Kathy Bridge often brings in homemade cookies or other treats -- which she did even more frequently when the new EMR system was being installed.

Experts say Spring Road and other practices are right to pay such close attention to employee morale. Poor morale can lead to high employee turnover, costly administrative errors and patient dissatisfaction. The problems and solutions can be different from practice to practice, depending on the personalities involved and the size of the practice. But experts suggest that improving morale can lead to better staff performance and increased employee stability.

And experts say physicians set the tone for how the practice operates. How physicians react to morale issues can be a catalyst for change -- or a recipe for further problems.

"We set the tone as owners of the practice," Dr. Kauffman said. "We have to be careful that what we say is interpreted the right way. We're the figureheads. If we're down, people will wonder why. Little things can be misinterpreted. The doctors have a major role to play in morale whether we like it or not."

Identifying the problem

Kenneth Hertz, senior consultant for Medical Group Management Assn., said the signs of low or flagging morale can be spotted easily.

For instance, if the practice starts getting complaints about poor service or other specific complaints about how the staff is handling patients, that's an indication that either the staff is too busy to attend to patient needs or that poor morale is causing a general lack of concern for a patient's overall experience, he said.

Hertz said external factors also can contribute to employee morale. Without prying into an employee's personal life, Hertz said, physicians can show concern for their employees by taking a few minutes to ask and listen about things going on in their lives.

"This isn't brain surgery. You don't have to hire a consultant to figure these out," Hertz said. "We can't treat patients respectfully and [treat] each other disrespectfully. We've got to all be working together and pulling for each other."

Dan Merlino, a health care consultant and vice president of Seattle-based ECG Management Consultants, said some of the more common problems contributing to poor morale are a lack of organization and a lack of clearly defined job responsibilities.

Thomas Weida, MD, a family physician who serves on the board of directors for the American Academy of Family Physicians, said that when morale is good, the practice will function like a family, and the rewards will be seen in the daily life of the practice. "Good morale equals low turnover, which equals less costs," Dr. Weida said. "And it equals more satisfied patients, because they see the same happy faces."

Dr. Weida, medical director for the University Physician Group in Hershey, Pa., a practice affiliated with the Penn State College of Medicine, said there are some effective strategies that can help boost efficiency and morale simultaneously. First, he said, be aware of your approach to staff and how you communicate with them. It's important to create an environment in which staff members have a sense of belonging and involvement, feeling as if their presence means something, he said.

It's critical to hold regular staff meetings, Dr. Weida said. "They may not be the most productive. But if nothing else, you talk to each other."

Tracy Glenn, director of practice management consulting for PMSCO Healthcare Consulting, a division of the Pennsylvania Medical Society, said practices that don't have morale-boosting initiatives in place have similar characteristics, including increased absenteeism, reduced productivity and an increase in office disagreements among colleagues.

"You can kind of feel the negative energy," Glenn said. "Claims aren't being submitted, patients aren't being flowed through the office. Little things like phone calls being returned are missed. It affects the practice as a whole."

Glenn said that although morale-boosting initiatives have been used in practices across the country for years, some practices still have a "why do we need this" attitude. One thing that might get physicians to jump on board is the prospect of losing your best employees because of morale issues, he said.

"The biggest investment is time," Glenn said. "It doesn't have to be dollar-driven. Money is tight for many practices right now. It's important that physicians take time to buy into a staff morale plan that works. They have to be active participants."

One of the biggest misconceptions about morale-boosting efforts is that they are often tied to monetary incentives. Not so, Glenn said. Before you start throwing dollars around, experts suggest trying non-monetary incentives. Glenn said larger practices might want to offer their employees flex time. A smaller practice might start an "employee of the month" program with a premium parking spot as a possible reward.

Many morale-boosting initiatives focus on simple gestures of kindness, Glenn said, such as publicly announcing a job well done, or simply greeting the receptionist in a pleasant tone.

"Letting someone know that they're valuable goes a long way toward morale," Glenn said.

Keeping morale high

Once you start a morale-boosting initiative, don't expect to see results the next day, experts said. Consultants hired to measure morale say it can take anywhere from three to six months to measure results. Those results should then be monitored from year to year, with adjustments and tweaks made along the way.

Two years ago, Dr. Weida said, morale was so low at his practice that turnover was creating staffing problems. That's when Dr. Weida's group of 12 physicians and about 60 staff members set out to improve morale. They started an employee satisfaction committee to come up with initiatives to improve the practice's mood and work environment. They also set out a suggestion box.

Since then, Dr. Weida said, nursing turnover has dropped to zero, and the practice has seen improvements in patient satisfaction scores.

"The physician needs to inspire trust," Dr. Weida said. "I hear time and time again where a staff person would stay things like, 'The doc never said hello, never said thank you.' Little stuff means so much."

Dr. Kauffman said his Spring Road practice is still waiting to see whether its efforts to boost morale have made an impact on the practice. But the practice is ensuring that its focus on morale doesn't stop.

"I think about morale every day," said Bridge, the practice's administrator. "I try to start the morning out by saying 'good morning' to every employee. I feel that this is a daily process, and we've been doing this every day. Anything that I can encourage staff with, I do.

"If my employees can't get along in front of patients, we're going to have difficulties," Bridge said. "We have to have that close relationship, and we have to be able to know when to speak and when not to speak. We form a bond with these patients, and they trust us."

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What employees say

One key to good employee morale is a strong boss-worker relationship. Florida State University's College of Business surveyed 700 workers from various jobs about their bosses.

Complaint Reported by
Failed to keep promises 39%
Failed to give credit when due 37%
Gave the "silent treatment" in past year 31%
Made negative comments about them to other employees or managers 27%
Invaded privacy 24%
Blamed others to cover up mistakes or minimize embarrassment 23%

Source: Florida State University College of Business survey

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The CDC handling its own morale issues

In the midst of one of the largest reorganizations in the history of the federal Centers for Disease Control and Prevention, spokesman Tom Skinner said morale issues have crept up as employees increasingly have voiced their concerns about the agency's future.

In response, the CDC decided to hire a permanent ombudsman, an action recommended by two interim ombudsmen hired last fall. The agency hired the interim ombudsmen -- former agency managers Joseph McDade and Gerald Naehr of Georgia-based Carter Consulting -- on a one-year, $250,000 contract that began on Oct. 1, 2006.

"We wanted to create a safe place where employees can go and talk about issues that impact their abilities to do their jobs as well as a place where people can go to make suggestions," Skinner told AMNews.

But few are using the ombudsmen. Those who do raise employee compensation, supervisor-employee relationships, and service and administrative issues as being among the sources of complaint, though the report noted no pattern in the grievances.

In a letter to CDC Director Julie Gerberding, MD, MPH, Sen. Charles Grassley (R, Iowa), the ranking Republican on the Senate Financing Committee, questioned whether CDC employees trust the ombudsmen. He has requested a meeting with them. Skinner said there have been meetings with the senator's staff, but they are still in the process of arranging a meeting with Grassley himself.

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