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AAOS Now

Published 4/1/2009
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Jackie Ryan, MPA

How to avoid a “staff infection”

7 steps to better morale

Low morale spreads quickly and is highly contagious. No one is immune. Left unchecked, poor morale can poison an entire practice, leading to a “staff infection.”

Low morale is destructive to a physician office because it leads to an entire set of issues hazardous to quality patient care. For example, a byproduct of low morale is that attention to detail slips. As the work environment becomes increasingly negative, employees struggle to keep focused and patient care may suffer.

Extrinsic issues that can lead to low morale include layoffs, money, benefits, and work schedules, but more often low morale is triggered by intrinsic issues such as a lack of recognition and praise, work that is not meaningful, and a feeling that staff is not appreciated or respected.

The simple “morale pulse check” (Table 1) can help identify whether your practice needs help. If morale in your practice is low, you need to move quickly before it spreads out of control.

The following steps—which have worked for other practices—may be just what you need to resuscitate morale in your practice or take it to the next level.

1. Morale starts at the top
Employees take emotional and attitudinal cues and clues from the physicians and the practice executive. Practice leadership must make conscious, continual efforts to play a constructive role in addressing staff needs and cultivating cooperation.

Improvement tips: Hire the right people so there is a good fit for the job and the practice culture. Implement daily “walk-throughs” and ask employees to complete a workday assessment. Set the example with a positive attitude and role model behaviors and expectations you want the staff to emulate.

2. Place a priority on communication
Good communication and clear expectations are essential for high morale. Show your employees that you trust and respect their need to know about issues affecting the practice, and in turn, their livelihoods. Employees feel competent and tend to perform better and are more productive when they know what is expected.

Improvement tips: Implement an “open door” policy. Conduct monthly all-staff meetings in addition to separate administrative and clinical meetings. Conduct “check-in” meetings with staff members approximately every 3 months.

3. Praise more than you criticize
Employees want to feel appreciated. Often, the little “thank yous” make a big difference. When offering praise, make sure it is TRUE (timely, responsive, unconditional, enthusiastic).

Improvement tips: Share positive feedback with employees. When patients make positive comments about their experiences with the practice or a particular staff member, share them immediately with the staff; consider sending a personal thank-you note to the staff member’s home. Establish a reward and recognition wall, with a different theme each month, and involve staff in decorating the wall each month.

Establish a reward and recognition program based on customer service standards. Allow everyone to recognize another staff member for exhibiting one of the service standards. Staff can receive a token gift and become eligible for a random drawing for an additional reward.

4. Encourage involvement
Every staff member wants to feel involved and important to the success of the practice.

Improvement tips: Conduct employee surveys on an annual basis to identify areas that could be improved. Establish volunteer committees on issues such as process improvement or activities such as social events. Implement cross-training and job-shadowing programs to help improve flow and overall operations; such programs will also give front office and back office staff a better understanding of the other’s role and contribution to the success of the practice.

5. Create a patient-friendly experience
Orthopaedic offices are high-pressure environments. Often patients are in pain and fearful of their diagnosis. Small things can make a big difference.

Improvement tips: Implement a “no pointing” rule. Staff should escort patients, not just point, where they need to go. If patients must wait to be seen, make sure you keep them informed of the reasons for and approximate length of the delay.

To turn a poor experience into a positive one and alleviate patient disappointment, one office uses the “ACT” acronym: Apologize, Correct the service, and Take action to make amends.

6. Work hard, play hard
Everyone likes to have fun—and happy people have high morale. Take time out of the work schedule for employees to interact and have fun on a regular basis.

Improvement tips: Hold contests where staff gets to vote for various categories such as cleanest desk, kindest to patients, most helpful, best smile, or best laugh. Establish an employee appreciation week with different activities each day. Celebrate reaching a goal and/or acknowledge the staff’s collective efforts during a busy time with a special staff breakfast or lunch.

7. Remain alert to the morale factor
Morale changes, sometimes daily. Stay in touch with day-to-day events and watch for changes in morale. The following are warning signs of low morale:

  • Lack of attention to details concerning patient care
  • Missed deadlines
  • Low productivity
  • Negative attitude toward patients
  • Resentment toward physicians and other coworkers
  • Talking about people rather than with people
  • Keeping secrets or withholding information

The pay-off
No one action can turn around morale, but little things can add up to a positive result.

High morale can seem like an abstract and elusive concept, but it’s vital to the health and competitiveness of your practice. Help your employees stay motivated and innovative by recognizing achievements, showing appreciation, and promoting teamwork.

For more information
Visit the AAOS online practice management center (
www.aaos.org/pracman) for more morale building ideas that work, the morale pulse check assessment, and a department workday assessment form.

Jackie Ryan, MPA, is a practice management program coordinator in the AAOS practice management group. She can be reached at ryan@aaos.org

Special thanks to the following members of the American Association of Orthopaedic Executives for their contributions to this article: Brian Bizub, Palm Beach Orthopaedic Institute; Max DeFilippis, Connecticut Children’s Medical Center; Constantine Solomos, MBA, CMPE, Mercer-Bucks Orthopaedics; Sami Spencer, CMPE, CMM, Missoula Bone and Joint & Surgery Center; George Trantow, MHA, Orthopaedic Associates of Aspen & Glenwood; and Milt Wood, Southern Bone & Joint Specialists.

Just released: Human Resources Management Primer
How much do you and/or your practice executive know and understand about human resources (HR) management? To help you know and understand how to leverage human resources management to build a successful orthopaedic practice, the AAOS practice management group has developed a practical guide to align your human resource management functions with the other business operations of your practice.

This primer includes the following sections that focus on a specific aspect of HR management: HR in the big picture of practice management; dos and don’ts; importance of HR to you; key HR handbook elements; HR and practice governance; overview of regulations; hiring the right people; HR management checklist; position descriptions; glossary of HR terms; performance evaluations, and additional resources.

An electronic version of the document is available in the online practice management center (www.aaos.org/pracman) and is free to AAOS members.