Performance reviews important, even in small practices

A column about keeping your practice in good health

By Victoria Stagg Elliottis a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009. Posted Jan. 11, 2010.

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Performance reviews are often seen as bothersome. Especially in small practices, doesn't everybody already know where they stand?

Not necessarily, experts say. Periodic, formal staff evaluations are worth the time for even the smallest practice.

For one thing, this kind of documentation can prevent a lawsuit if an employee needs to be fired.

But on a more positive note, well-done reviews -- ones that talk about strengths as well as weaknesses -- can improve staff retention. Reviews can help identify staff members who have the potential for a promotion or the ability to fill other positions within the practice. Reviews also will help identify any staff member who needs additional training.

"Employees need to know where they stand, or the good people will leave," said Chad Shultz, a partner in the labor and employment law firm Ford & Harrison in Atlanta. "Your bad employees will haunt you for the rest of your life. This is very important for your business."

In setting up a review process, first identify what a staffer is supposed to accomplish. Any goals should be able to be measured objectively, and some businesses find it useful to tie individual goals to the ones for the practice.

Goals "should be specific, measurable, achievable, realistic and time-bound," said Natasha Terk, president of Write it Well in Oakland, Calif., who has written several books on the subject.

For some medical practice staffers, these goals can be obvious, according to experts. Those in billing can be evaluated on the amount of money they collect on a timely basis. The goals of other professionals may be a little less precise, but no less important.

Nurses may be reviewed on whether, after they see patients, physicians have everything in place to do their job. Were all the appropriate vital signs taken?

Receptionists may be measured on whether there are any patient complaints, or how long people wait on hold. Are patients greeted appropriately when they walk into the office?

There are some commercially available performance forms that practices can buy or download from the Internet, although many practices prefer to develop their own.

"We have developed a several-page form for all employees whether they are nurses or administrative people or technicians," said John F. Moore, administrator and chief operating officer of Austin Area Obstetrics, Gynecology & Fertility in Texas. "We use them uniformly, but nurses are a lot more difficult to evaluate than someone who is sending bills out. That requires some very thoughtful conversations." The practice has 75 employees, along with seven doctors and six nurse practitioners.

Most experts recommend no more than five goals for an employee. Progress on these goals should be written out, with copies kept in the personnel files as well as given to the employee. A meeting should be set to allow both parties to discuss results.

"State the goals and objectives. Then ask: What did you do to accomplish what you set out to do?" said Marty Rosenberg, senior vice president and one of the founding members of the health care management group EthosPartners in Suwanee, Ga.

How often should you review?

The frequency of formal performance reviews varies widely. Many practices do them for new employees shortly after being hired, usually at the 30-, 60- or 90-day marks. Reviews then tend to shift to an annual basis, although problematic employees may be reviewed more frequently.

Reviews typically are done at the start of a calendar year, on the employee's hiring anniversary date, or in the same designated month for everyone.

"Supervisors hated reviews on the anniversary date [of hiring] because they were evaluating employees all the time," said Deborah Hudson, the practice administrator of Tri-Cities Gastroenterology in Kingsport, Tenn. The practice has 40 employees and two physicians. Employees are now reviewed every April.

Moore's ob-gyn practice favors reviewing on anniversary dates, because it means that employees are always evaluated on a full year's work. It also means that managers can spread the workload of writing reviews through the year.

In addition to the manager's opinion, experts say, it is also important to ask employees what they think of their own work.

"You find out about some of their accomplishments and of what they are proudest. But they are also far harder on themselves than their managers are," Hudson said.

These self-assessments are usually read by managers after they finish their review of the employee's work.

Experts say it's important to give informal feedback throughout the year. Periodic notes should be kept on significant incidents to ensure that the final performance review covers more than the past month.

"Nothing in a performance review should be a surprise," Terk said.

Writing descriptive reviews is better than numeric grades, although these can be used in combination, experts say.

Many medical practices rate their employees' performance on a scale of one (unacceptable) to five (outstanding). The highest scores should not be unachievable, but they also should not be handed out too often.

"We have very clear definitions of how you get a five," Moore said.

Many performance reviews are connected to salary, although these discussions should take place at different times. This allows both parties to focus on performance improvement at the given time, experts say.

Victoria Stagg Elliott is a longtime staff member. She covered practice management issues and wrote the "Practice Management" column from 2009 to 2013. She also covered public health and science from 2000 to 2009.

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