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AAOS Now

Published 7/1/2007
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Steven E. Fisher, MBA

Bringing new staff up to speed

Don’t forget these issues in new employee orientation

Whether you are a solo practitioner or a member of a large orthopaedic group, your support staff is a critical component of your practice. Although you may not need to recruit and orient new staff frequently, it pays to have specific protocols in place. To bring new staff members up to speed quickly, consider the following guidelines.

Basic orientation is critical
At a minimum, your formal program to orient new employees should include three manuals: one covering personnel issues such as employee benefits, personnel policies, and performance protocols; one covering general operating procedures; and one specific to the position. (See sidebar on “Manual contents.”) Manuals should be on-line for quick, easy access and simplified updating.

Developing a set of orientation manuals will also demonstrate good faith compliance with federal and state regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) and Equal Employment Opportunity (EEO) laws. In addition, consistently following these policies and procedures can reduce the possibility of an employee’s filing—or winning—a lawsuit.

Additional knowledge enhances performance
In addition to the “basics” covered in the manuals, the following five areas should be considered a part of new employee orientations.

  1. What conditions do the doctors treat and what services do they perform?

    You don’t want your new receptionist to tell a caller who references a femoral neck fracture, “None of our doctors treats necks.” But it could happen, even if your new staffers have worked in a medical office before, if they’re not familiar with orthopaedic practice.
    Every new hire, no matter what his or her position, must have at least a basic understanding of what conditions you treat and what procedures you perform. AAOS has a number of resources you can use, including the patient education Web site “Your Orthopaedic Connection” (http://orthoinfo.aaos.org), which contains basic information that can be used in training new employees. Educational print materials and video programs may also be ordered through the AAOS Web site. “Training with the click of a mouse,” in the June AAOS Now (www.aaos.org/now), provides information on other online training resources. As part of the training, you can even develop quizzes to test new staff on their knowledge of important concepts.
  2. What is the business of orthopaedics all about?

    Your practice’s business manager should have a good understanding of the business of orthopaedics. But there are significant advantages when clinical and administrative support people also understand specific business concepts. (See “Can your staff answer these questions?” on page 24)
    Although some issues are practice-specific, others are more general. Physicians and senior level staff can take advantage of AAOS educational resources and then effectively train other office personnel. Nonsenior level staff don’t need financial details, but should understand how what they do translates to the overall well-being of the business.
  3. How are decisions made, and what is the chain of command?

    Clearly, a solo practitioner will make all the key decisions in the office. But more than half of all orthopaedic surgeons work in private practice groups of two or more doctors. These practices generally have a set of rules dictating how decisions are made. More important issues (as determined by their cost or impact on the office environment) usually require support from greater numbers of practice principals. Whether all partners have an equal voice or some physicians have a greater voice than others is very practice-specific. Your staff may not need to know the full details, only that pro-tocols exist and that you follow them.
    Regardless of your practice size, all staff need to understand the chain of command and be able to identify their direct supervisor. They also need to understand that “triangulation” (bypassing their supervisor and going to his or her boss) is not permissible and is counter-productive.
  4. What is the information flow in the office?

    Newly hired staff are often simply trained on their job duties, without an understanding of how their job affects other office functions. But everyone needs to understand how information flows and what problems are created if information is not accurately, properly, and timely collected.
    For example, front office staff must accurately collect and document all demographic information, including name, birth date, address, insurance coverage, employer, date of onset/injury. Inaccurate or missing information can result in delayed or rejected claims, which translate to lower practice receipts, leading to a less successful business and less money to reward well-performing staff.
    The bottom line is that people need to understand how they fit into the grand scheme of things; the better they understand this, the more productive they will be.
  5. What is the practice’s philosophy regarding “the care and feeding of patients”?

    Orthopaedic practices take different approaches to the way they treat patients. The most successful practices adopt a “customer-is-always-right” attitude that’s understood and practiced by everyone—from the receptionist to the clinical staff to billers and claim filers. As staff changes, each new person must be taught the office culture. Periodically, you should verify that everyone is comporting him or herself appropriately.
    Respecting patients, though, does not mean tolerating verbal or (worse yet) physical abuse. New employees need to be taught what to do when confronted with angry and/or abusive individuals. Equipping your staff with anger-diffusing tools and allowing them the freedom to distance themselves will enhance their feelings of safety and security and reduce the chance that you will be sued by a disgruntled patient or other person.

Take the long view
It’s important to orient your new staff to personnel policies, office procedures, and their duties. It’s even more important to provide them with a larger perspective regarding your business. Their success in performing their jobs will translate to your practice’s increased success.

You’ll find a sample “Orientation Checklist” on the AAOS online Practice Management Center (www.aaos.org/pracman). Using it will ensure that each employee receives training in the appropriate areas. (Note: AAOS Member login is required to access the Practice Management Center. Following login, proceed to the section, Private Practice Operations, then Information and Resources. The Orientation Checklist appears under the heading, “General Operational Guidance”. Or, following member login, you can type the words, “orientation checklist” in the search box.)

Steven E. Fisher, MBA, is manager of the practice management group at AAOS. He can be reached at (847) 384-4331 or sfisher@aaos.org

Manual contents
At a minimum, your employee, operations, and position-specific manuals should cover the following specific information:

Employee manual

  • Benefits practice staff are entitled to, including health insurance, dental insurance, vacation and sick leave, and pension/profit sharing contributions
  • How performance evaluations are handled, as well as hiring, promotion, discipline, and termination protocols
  • Personnel-related policies such as attendance; dress; prohibitions of tobacco, drugs, and alcohol in the workplace; and the appropriate use of communications equipment (phone, computer, and fax)
  • Practice philosophy and values, such as prohibitions on harassment (including sexual harassment) and statements of support for diversity and patient-centered care

Operations manual

  • All general procedures that staff are expected to follow on a day-to-day basis
  • Protocols for maintaining confidentiality of patient records, as required by the HIPAA privacy regulations
  • Steps to create computer and voicemail passwords and to change them on a regular basis
  • Standards for internal and external communications via phone, fax, and e-mail
  • Actions in the event of a medical or civil emergency

Position-specific training

  • A position description for every position in the office, delineating duties
  • A step-by-step “how-to-do” for every activity required in that position

In addition, before a new employee is permitted to work autonomously, he or she should work under the supervision of another employee for a defined period, ideally at least 2 weeks.

Can your staff answer these questions?
Every staff member in an orthopaedic practice should be able to answer the following basic questions about “the business of orthopaedics.”

  • How does medical insurance work (government versus private payors, employer-sponsored versus independent coverage?
  • What does “managed care” mean?
  • What is workers compensation?
  • What is the practice’s overall payor mix?
  • How do payors differ in terms of their reimbursement policies and amounts?
  • What are relative value units (RVUs) and how do they translate to payors’ reimbursements?
  • What impact do uninsured patients have on the office?
  • What’s the difference between “charges” and “receipts”?
  • Can you explain what an income statement is? A balance sheet? A cash flow statement?
  • What are our key profitability benchmarks to watch?
  • What are our five largest expenses? (See “Orthopaedic revenues and expenses keep increasing” on pg. 32.)
  • What is the “professional liability insurance crisis,” and how does it affect our practice?