QUESTION:  How do I go about organizing my clinic staff?

ANSWER:  In your role as the director of your office or clinic, you will work with many people.  The quality of these people and your relationships with them will be a central factor in your professional and financial success.  First and foremost, you must assume full responsibility for the operations of your clinic, be in charge, and work to build trust and high-performance standards with all employees.  Here are some points to consider:

Measure your staff needs in terms of time spent and functions.  Know what needs to be done and the amount of time it should take.  The best way to learn these kinds of things is to do them yourself for a time.  When you are starting out, when patient traffic is slow, never hesitate to shoulder the burden of support operations yourself.  During the first phases of startup, it is actually possible to run an office entirely by yourself.  No one would suggest this as a permanent situation, but having done it gives you a position of unquestionable authority with any employees you will later have.

Having done each operation in the clinic, you know that it can be done, how it is done, how much time it takes, and if absolutely necessary, that you can do it by yourself.  A corollary to this is that you must never give anyone a job to do that you do not fully understand yourself.  Many chiropractors have come close to disaster by assuming that the intricacies of insurance billing were self-explanatory, that staff would figure them out or that they were too busy to deal with those sorts of details.  Big mistake!   This policy will usually fail in one of the following ways:

·         Your C.A. does not learn the job well.  Services go unbilled, claims are rejected, and uncollectable accounts receivable mount steadily.  This situation is usually uncovered when the C.A. quits.

·         The employee learns the job, but you don't know enough to say whether the job is done well or not; the C.A. controls you.  It becomes very difficult to supervise employees who have an extensive knowledge base that you do not fully understand.

·         This is the worst scenario of all.  The person that you hire is wonderful.  He or she takes immediately to the challenge of learning the work or formerly worked for a successful chiropractor.  Your billing is done flawlessly, no errors, nothing rejected.  He or she continuously learns more, resulting in your business growing quickly.  One day your C.A. tells you that his or her spouse is being transferred, or that they are leaving for some other reason.  Having based your entire operation on this one person, you will be crippled without him or her.  Provide for back-up systems for all essential operations. Remember that there is only one person who can never leave you and on whom you must depend completely, yourself.

Be very clear on your directions and expectations.  Put things in writing when necessary.  Never assign an employee to do any task with the vague instructions, "Learn this".  Good managers find solutions, send the employee to necessary seminars or to other doctor's offices, ask for updates when they return, and never leave the instruction of the staff to chance.

If you have the resources, start your office with one person helping.  This accomplishes several goals:

·         It keeps your overhead low.

·         Being busy will help to keep your enthusiasm high.

·         You will be forced to learn all aspects of the business.

·         The employee that you hire at this stage will learn all operations in the office and learn how to do them efficiently.  This is the best education for a future office manager.

Add staff as your needs and resources grow.  Continue to train each new addition in all phases of office operations and procedures.  Avoid any situation that encourages one employee to sit idle because his or her main job has been done.  Avoid limiting titles like X-ray tech, receptionist, and others that too narrowly define a position.  The term C.A. should be used in a way that covers all duties.

Where can you find good staff prospects?  The least expensive advertisement that will bring the most people to your office is a want ad.  Be prepared to spend the time it will take to find the right person for each position.  It is always tempting to take the first "acceptable" candidate.  Look for the "best" prospect.  You will be glad that you took the extra time.  

Also, know the employment laws in your jurisdiction.  For example, it is illegal in the United States to discriminate against those over 40 when hiring.  It is also not good business.  Many times older employees are more stable in their family situation, more realistic in their demands for benefits, and able to add maturity to a new office.  Consider involving family members in your practice, but move carefully and only when you are completely confident that a family member will fit your needs, respond to your direction and contribute to, not detract from, your business environment.  Many practices very successfully employ family members.  Others have created very difficult situations by moving too quickly and thoughtlessly to do so.

There is no ultimate way to pick the ideal employee but there are a few guidelines you may follow:

·         First impressions DO count.  This person will strike your patients as he or she strikes you: cheerful, sincere, caring, attentive, intelligent and well spoken.

·         You should expect some clerical skills.  The ability to type quickly, file and use basic office equipment is a minimum.  Computer skills are a tremendous asset.

·         Experience is not always necessary, assuming the clerical skills are there.  Be cautious in hiring someone who has worked in another chiropractor's office and might be reluctant to let you develop your own style of practice.  Check references.  This is especially true if the applicant has worked for another chiropractor.  You may discover that he or she was let go for a good cause.  Don't hire someone else's headaches.  On the other hand, don't let valuable experience go to waste.

·         Provide for a trial period to see how they work out.  Set a time frame and then evaluate their performance before offering permanent employment.