Turn around your practice’s culture

A case study on how to face some of the most challenging staffing problems.

Courtney recently started work in an ophthalmology practice as an administrator who handles personnel issues. While she had some medical management experience, she knew that her new role could be challenging. During the interview process, the owner-physicians openly discussed many of the issues she would face, particularly with staff.

Once she started, Courtney quickly realized the primary issue: poor practice culture led to many challenges, including chronic absenteeism, poor communication, low morale, and a general feeling of dissatisfaction among staff. While Courtney considered these problems significant, she faced many of these issues at some point in her career and was confident she could “turn things around.” Backed by a commitment from the physicians, Courtney set out to develop an action plan to improve the practice culture by focusing on one area at a time.

Courtney knew that her practice could circumvent most staffing issues by building a strong, positive practice culture. In a practice where culture is on a firm foundation, staff work together as a team, poor behavior stands out as aberrant behavior, and employees can correct each other when a staff member fails to perform up to expectations.

Here is how Courtney developed a meaningful culture in her practice.

Define and recognize the good.

To improve the company’s work culture, Courtney openly discussed with her staff what a positive work environment looks like. During the meeting, she helped the team understand that staff morale is up to all of them, not just she and the physicians. While culture “starts at the top,” each team member must participate in building and maintaining staff morale throughout the practice. She challenged them on what areas of the practice they would like to improve, and they helped her outline the areas that were important to them. They included removing bottlenecks in patient flow, making surgery scheduling more efficient, and starting and ending work days on time.


Encourage teamwork.

Courtney and the staff wanted to improve teamwork by having regularly scheduled meetings. Without time to adequately communicate, they could not solve issues and make improvements.

Courtney worked with the physicians to set up designated times for managers, work teams, and departments to meet on a regular basis. She also set up a plan for the entire practice to meet quarterly to review goals and progress.

Build staff morale.

During one-to-one meetings with staff, Courtney learned that low staff morale stemmed from a common perception that employees were treated unfairly. For several years, the practice allowed certain employees to be chronically late or absent without any correction. Staff members who reported faithfully to work on time were disgruntled and grumbled that the practice was not “fair.”

Courtney knew that avoiding these issues was a disservice to all employees. For several chronic employees, she took immediate action and notified them that they were in violation of the practice’s policies and procedures. She stressed the importance of being on time and that coming to work was a job requirement. Courtney started the documentation process and let these staff members know she needed to see improved performance for them to remain on the team.

Encourage employee engagement.

As Courtney focused on culture, teamwork, and morale, she noticed small — but meaningful — improvements in employee engagement. For example, managers started having productive, open communication with their teams. Courtney set up a schedule for managers to perform rounds throughout the clinic so they could check in with physicians and staff. These meetings squelched gossip, helped with flow and efficiency, and provided corrective feedback before serious issues developed. These changes did not happen overnight, but she remained hopeful and optimistic they would occur over time.

Ask for accountability.

For continued improvement, Courtney introduced her favorite training and motivational book, “QBQ! The Question Behind the Question” by John G. Miller, which addresses personal accountability. The book was a quick, easy read that presented lessons such as “make no excuses,” “do what you promise,” and “be flexible, put people before policies.” Her physicians agreed to buy a copy of the book for every employee in their practice, and Courtney led the organization in an organized study. After reading the book, staff met to discuss how each of them could be more accountable for their actions in the practice.

Hire right.

As Courtney managed out poor performers, she needed to backfill several critical positions within the organization. While it may be tempting to hire the first person who walks in the door, Courtney asked her team to “please hang in there and help me make sure we hire the right people to work here.” She developed an interview process that allowed her team to meet prospective hires and ask for her team’s feedback to ensure that the new hire would be the best cultural fit possible. She taught her team how to perform behavioral interviewing (i.e., listen to a candidate’s previous experience and how that might benefit the practice). Slowly but surely, the managers — and staff — began hiring quality individuals who looked like good fits.

Tweak the employee handbook.

As Courtney hired new employees, she noted that the employee handbook was dated. During monthly meetings with her managers, she asked them to help her update the policies and procedures. Then, she worked with the practice’s attorney to ensure the policies were compliant with state and federal labor laws.

After finalizing the employee handbook, she introduced the document during a staff meeting, highlighting the major changes. She also asked staff members to sign statements indicating that they received and read an updated their copy of the handbook.

Document office protocols.

Once the employee handbook was in place, Courtney turned to process improvement. While this may not seem like a “staffing challenge,” Courtney was keenly aware that many staffing problems arise when employees do not understand what is expected of them. By having defined written protocols for functions throughout the office, employees come to a unified way of performing tasks. Also, new staff members can use written protocols as training documents.

When her team completed the process of writing down how they performed individual functions in the office, they found several new efficiencies, eliminated many unnecessary steps, and created impactful “double checks” for important tasks moving forward.

“All in”

Courtney works hard to be the best leader possible, and she constantly reminds herself and her employees that they can tackle anything as a team. By being “all in” as a team, they can rewire their practice’s culture and generate positive results as a group.

Slowly but surely, they worked through their major problems one at a time and developed a culture-based group of which they can be proud. OP