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AAOS Now

Published 4/1/2015
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Chris Dugger

Labor Management—A Balancing Act

How to manage staff loyalty while maintaining practice effectiveness

Busy orthopaedic surgeons depend on their support staff. The trust and loyalty between a surgeon and staff member that develop over time are integral to the success or failure of the practice. Physician/staff partnerships can span decades and are often characterized by an extraordinary level of mutual loyalty and respect.

As a result of these strong working partnerships, however, some medical assistants or surgical secretaries may feel superior to their peers. As the first-line support for the surgeon, these staff may feel that their job security is ensured and that the surgeon “has their back.”

Although this perception of special status usually does not create any organizational problems within the practice, awkward situations can occur if key support staff share interpersonal problems with other staff or want the provider to intercede in matters of performance or attendance. The physician’s loyalty and corresponding protective impulse can lead him or her to accept a narrative at face value and feel compelled to right a perceived wrong. Before taking action, however, physicians should consider the following important points.

There is always a back-story
One side of a disagreement, however compelling, is just that—one side. Surgeons should not immediately validate the narrative. Instead, they should tell the staff member that they first need to speak to management and understand all the perspectives on the issue.

In the end, there are no secrets
Exceptions to employee discipline or attendance policies rarely remain private for long and are often exaggerated as rumors make their way around the office. These policy exceptions can become significant morale issues for other staff who feel they do not have someone to intercede on their behalf with management.

Exceptions are also precedents
A basic concept that most managers grasp, although sometimes through painful experience, is that making individual exceptions to policies creates a precedent against which all future personnel decisions will be judged. No one who is in charge of managing and motivating front-line staff can say that he or she responds correctly to every issue every time. One of the most difficult challenges managers face is trying to perceive the truth when hearing widely divergent versions of the same incident.

A critical factor in a manager’s effectiveness is the degree to which staff believes the manager is fair and evenhanded in the administration of policies. Another basic factor is whether staff perceives the manager to be honest. Physicians, therefore, must be prudent when they intercede to change decisions regarding the management of their key staff. Once staff realizes that the rules are only the rules for some, but not for all, the physician runs the risk of undermining the effectiveness of the managers and administrators.

Chris Dugger is executive director of the New England Orthopedic Surgeons in Springfield, Mass., and the American Association of Orthopaedic Executives representative to the AAOS Practice Management Committee.