The subtle art of staff retention

Money attracts employees, but some less obvious efforts can go a long way toward keeping them.


Retention and engagement of top talent will greatly help your bottom line. New employees have quite a lot to learn at first and make mistakes, which can be especially costly in the areas of billing, coding, and data entry. The constant retraining of new employees could lead to a large number of denied or underpaid claims. In addition to these costs, high turnover rates can negatively affect your patient satisfaction: Patients notice when they see new faces every time they visit. This can raise concerns about the quality of the company and the competence of new staff. If your constant flux of new employees impacts patient retention, it could lead to a decrease in revenue.

Before my days as an administrator, I sat in a negotiation with my own administrator. I had received a lateral job offer with slightly higher pay from another employer. My administrator, who was always very direct with me, asked: “Why are you leaving for a few more dollars an hour? Money attracts, but it does not keep.”

I launched into an immediate explanation why I could use the money. She listened to me carefully and then asked what I really wanted out of my career. Any request for a raise should be accompanied by an offer to take on more responsibility, and this was my desire — I shared with her that I wanted more leadership duties. Along with a small salary bump, my administrator granted my wish by expanding my role. She began funneling administrative duties to me, brought me in on business development meetings, and allowed me to be use my creativity with tasks such as creating policies or marketing. Because of this, I stayed at the company for several more years, helping to develop the company, while also fulfilling my personal goals.

When I took over my role as practice administrator of Kumar Eye Institute in January 2018, employee retention and engagement were at the forefront of our issues. In June 2018, we had a 56% retention rate. By June 2019, that rate jumped up to 89%. Our ratings went from 2.5 stars to a full 4 stars as well. This was by no means a luck of the draw when hiring. It took daily effort to create, implement, and sustain a thriving culture.

When we think of ways to improve employee retention, strategies like increasing salary, time off, and bonuses come to mind. While these can be effective, we need to consider some more subtle (and less expensive) strategies that can be just as effective. Below are the top strategies I use to solve the employee retention and engagement issues that are not always the most obvious.

Set the tone early

In the competitive world of ophthalmology, our patients have many choices. The bigger the city, the more practices they have to choose from, so we must find ways to stand out. This should pertain to potential employees as well. Valuable candidates know they have options; they research your website, Indeed reviews, and social media to see if you are a good fit. Think about what sets your company apart and put it out there for the public to see. For example, use your social media pages and websites to showcase the fun activities you have, such as potlucks and parties, and celebrate your people when they receive a promotion or professional license.

Also, avoid being contrived in your efforts. Authentic content is vital if you are trying to “sell” your company to top talent. For example, post content true to your company culture. At our office, we love our staff outings. When we share them on social media, it comes from a place of genuine enthusiasm that can easily be felt. These efforts will show a level of commitment to the job before candidates come for their first interview.

Create a democracy, not a dictatorship

In his book, “Good to Great,” James Collins and his team examined various factors that launched some companies into greatness despite the odds. One company found that an elimination of hierarchies and unnecessary rankings led to profound productivity and a strong work culture.

How would that look in an ophthalmology practice? At the end of the day, the doctor’s orders are the most important and we all should follow them. However, outside of patient care, everyone’s voice should hold the same weight.

Let your staff be heard by offering regular employee satisfaction surveys, plenty of chances to speak up during staff meetings, and the option to cast votes when possible. For example, we took group photos for our website and asked the entire company to cast their vote on the best picture instead of leaving it up to the administrator. It was a small thing, yet it showed that we valued everyone’s opinion on the development of our company and allowed staff to take ownership and feel pride in our growth. When we feel like something is our own, we feel less inclined to walk away from it.

Master the art of radical candor

Even when we are fully committed to building a company culture full of positivity and success, it is sometimes necessary to give negative feedback. Constructive criticism, if presented the right way, can lead to an increase in innovation and high-quality service. We will still disagree with staff members’ ideas and sometimes (hopefully not too often) have to discipline them. But, how do we get the message across without causing tension, tears, or embarrassment?

Before these kinds of conversations, write down general notes of what you plan to say. Otherwise, if emotions get high, you may be thrown off from your original intention for the meeting. Also remember, as the leader, you have a responsibility to remain confident in what you say while treating the employee with dignity the whole time. Say what needs to be said succinctly and with tact. Be consistent in your feedback with everyone. Sometimes it is helpful to preface with, “I know this may not be easy to hear, so I am going to keep this short and to the point for you.”

You should also be mindful of the other person’s needs. If an employee cries or argues, we may feel the need to “fill the space” with more words and explanations. This is where we, as leaders, can get tripped up, say too much, or say the wrong thing. In these instances, it’s better to end the conversation with, “I know this wasn’t easy to hear. Take some time to digest it, and I’ll be available to talk to again later.” This will preserve your staff’s dignity as well as your professionalism.

Like it or not, after these kinds of conversations, your employees will confide in their peers. How you give feedback to individuals will greatly impact your company culture and your employees’ desires to stick around long term.

Establish rituals

The use of rituals can help create a meaningful environment for staff. For example, consistently announce your employee of the month during your staff meetings; or, set aside a specific time to go over and celebrate the “shout outs” your employees received from their peers and patients.

Lastly, our company made our logo a symbol of pride. We issue fleece jackets with our logo after an employee is at our company for 90 days. We even implemented a fun team chant to initiate the new member as they don their new jacket for the first time. By celebrating their official joining of the team, they gain a sense of meaning with us.

Facilitate growth

One of the most common statements I’ve seen for employees’ reasons they left the previous job is, “I wanted to seek an opportunity to grow professionally.” So, how can your company be the one to do that for them?

Employee development plans are an effective tool that will facilitate growth. During annual evaluations, you and the staff member can create a development plan together. This can be as simple as setting goals to become more proficient at refracting or more adept at answering prescription questions. The plan may include more long-term goals, such as being promoted to clinical supervisor.

By creating these plans with your team, you will learn more about your staff members’ professional goals and can help them see how sticking with your practice helps to achieve those goals. For example, if an employee voices that she would like to be a clinical lead, you can encourage her to attend ophthalmology conferences both locally and nationally. If she voices that she would like to be a scribe, you can offer reimbursement for educational materials and certification costs.

Employees who have a desire to grow professionally make outstanding long-term team members. It’s important to show them you are just as serious as they are about their growth.

The bottom line

Gone are the days when we all worked for a paycheck simply “because we have to.” As the workforce changes with the next generations, we need to create environments where our employees can take pride in their professional and personal development. We must also consider our employees’ personal values, lifestyle, and goals. These are the less obvious factors we think of when we tackle retention, but they are increasingly becoming the most important ones to consider. OP