Hiring for your medical practice's culture

Resumes for individuals applying for positions as nurses, medical assistants, billers and other medical practice staff may look similar within each job description. Applicants even might perform equally well in an interview. But experience has told you that a candidate who looks great on paper can turn out to be a disastrous hire.

Why is that? The answer, experts say, comes down to cultural fit, the ability of an employee not merely to be able to do the job, but also to have the attitude and personality needed to work with others and further the goals of the practice.

“Landing the person [who] has all the elements that you need is a difficult process to get right even on the tangible measures that you can verify and/or test,” said Geoffrey Patton, a practice management consultant based in Boston. “The intangibles, such as cultural fit, are the most difficult, and I challenge any manager with any degree of experience to tell you that they have gotten it right 100% of the time.”

The key, practice managers and consultants say, is to look beyond technical skills and find those who fit the practice’s culture and goals. Physician groups need to assess their own cultures, determine their needs and identify the employee characteristics that are most important because although getting cultural fit right is difficult, it’s not impossible.

Cultural fit is not about filling a workplace with employees of one ethnicity, race, religion, gender, sexual orientation, political affiliation or age. Looking at cultural fit that way probably would get a medical practice in legal hot water. Cultural fit is about identifying possible negative traits, such as who is most likely to irritate staffers and patients, and positive traits, such as who will make the practice more efficient. Most employees will work well in at least some settings, but will they work well in yours?

“What we mean by hiring for cultural fit is hiring for the intangibles,” said Gerrit Salinas, director of medical staffing for Snelling Staffing Services in Dallas. “It’s everything that doesn’t fall into a resume or job application.”

“If it’s not a fit, they’re not going to last,” said Kenneth Hertz, principal with MGMA Health Care Consulting Group. “You’re not going to be happy, and the patients are not going to be happy.”

Identifying a practice culture

The first step for those hiring is to take a look at the practice’s culture. The assessment should include identifying the vision, mission and values. What is it really like to work there? Most practices will say they have a compassionate team atmosphere, but what does that really mean?

“Not every practice has thought through this, but the really successful practices have core values,” said Allen Nissenson, MD, chief medical officer of DaVita, which has 41,000 employees at its dialysis centers across the country. “They’re really clear about what their own culture is, what they are trying to accomplish and how they do things.”

Does teamwork mean that staffers pitch in when appropriate? Or is it more that they work individually toward a common goal? Do staffers compete or collaborate with one another? Is it a tough competition or jovial? Is it a casual or formal atmosphere? None of these scenarios is necessarily wrong, but depending on the potential employee, it may not be a good fit.

“Some practices are very corporate, with very strong policies and procedures. They’re very structured,” said Peggy Pringle, associate vice president for practice management services at the Texas Medical Assn. “There are other practices where it is very family-oriented. People know each other’s families. It doesn’t mean it’s not a well-run practice. It’s just a lot more social.”

Other aspects that translate to workplace culture: Is it a small practice where everyone is required to juggle multiple tasks? Or is it a large one, where workers are expected to innovate but not push much beyond the limits of the job description? Is it a high-stress workplace, or does it have a slower pace? What kind of decisions are employees expected to make on their own, and when should they seek counsel? Do employees hang out together outside of work? Is work-life balance a priority? Do people clock in and out at set times, or are hours more flexible? Does the practice promote from within? How is achievement rewarded? Is this done at the group or individual level? How are employees held accountable? What are the lines of communication? Is it face-to-face or electronic?

“Communication is always something that every organization wants to say they do well, but people all communicate differently, especially these days,” said Michael Franks, chief operations officer of Naples (Fla.) Medical Center.

Practices also need to consider that the culture probably will vary depending on how separate various departments are from one another. The physician’s personality usually sets the culture for his or her staff, although that influence may differ depending on practice structure. Some physicians may give a lot of direction and want to control as much as possible. Others will give their staff more autonomy.

“Some [doctors] are very strong micromanagers,” Pringle said. “If the employee doesn’t like to be micromanaged and doesn’t need a lot of direct supervision, they are going to be driven crazy. The same is true for those who need a lot of direction but are working for a hands-off manager. This usually comes from the physicians themselves. They need to know what their culture is or at least what they want it to be.”

Meeting a practice’s needs

The second step, say those who advise medical practices on hiring, is to consider the group’s needs. A good cultural fit does not mean that all the people working in a particular setting are the same. Rather, they work together.

For instance, Hertz once worked with a practice that was performing poorly until it identified a new staffer who could fit in with the compassionate atmosphere but, unlike other employees, had no hesitation about asking patients to pay their bills.

“[The new staffer] loved the patients, and she loved asking them for money,” Hertz said. “She coached the others at the front desk to do the same.”

The practice might want to go in a certain direction but can’t without the correct mix of staff. Does the practice need more employees who work steadily to counter those who work more intensely but take more breaks? Maybe the practice needs more innovators to balance out those who follow orders well.

“It’s not just about what people work best with me,” Salinas said. “It’s also about what’s missing and what I need.”

Selecting candidates

The third step, after a potential candidate has been identified, is to ask him or her open-ended questions during interviews that may indicate fit.

“If the person is not the right fit, then the right questions were probably not asked in the beginning,” said John Fulcher, director of the Western health care division of Bauer Consulting Group in El Paso, Texas.

If compassion is a priority at the practice, have the candidates give examples of times they have been compassionate inside or outside the workplace. Ask for examples of how they worked in a team. How did they deal with challenging situations? How much experience do they have with a particular type of practice? Experience at only larger practices should not disqualify someone applying at a smaller one, but it may be worth asking how he or she will adapt.

“Find out what their strengths are regardless of what they have done in the past,” Franks said.

Applicants should have a minimum of two interviews, although more may be needed for higher-level positions. Additional interviews should include questions about handling potential stress and how applicants view autonomy. Are they looking for a position that will lead to promotion and more responsibility? Can the practice offer that? Or are applicants looking for a more stable job with less advancement? Does the practice’s policy on rewarding employees for good work match applicants’ expectations? How do employees manage their time and hold themselves accountable? How do they communicate?

The good news is that cultural fit does not have to be handled perfectly. A particularly bad match can increase turnover and reduce productivity and morale, but a slight mismatch may be addressed through additional training. The new hire does not always need to be let go. The key is to get as close a fit as possible.

“It just depends on how different it is,” Pringle said. “Some people can adjust into the practice. People can be brought around with coaching if it is not an extreme mismatch.”