Making Conversations Count! Developing True Relationships in Your Healthcare Practice Part I: Focus on Administrator and Staff

This article is the first of two parts.

We communicate with every action and reaction throughout the day, hopefully with respect and in the interest of collaborative patient care. Each of us has our own style and demeanor. From the recipient’s point of view, perception is reality.

This article offers recommendations, approaches, and strategies that can fully support and enhance your staff’s engagement and communication. Your “name” is on every conversation and correspondence relayed by every member of your staff at every level of care. You must ensure the message is conveyed clearly, safely, and compassionately.

The way you communicate is accepted as your standard. Something as simple as saying “good morning” (and the way it is said) can set a precedent for the way your entire staff responds.

What Messages Are We Really Sending as We Converse With Employees?

Whether you are speaking with one person or a crowd, being honest and sincere will show. Also keep in mind that the conversation most typically is about them, not you. Tip: This is also the perfect “in” to promote the practice mission and goals; if you live it and believe it, most likely, so will they. To further personalize staff engagement, employees should consider whether they would recommend the practice to a family member.

Gaining Trust Through Communication

For some of the most common forms of communication, such as e-mails and routine office tasks, there are basics that can assist with a polite and concise message:

• Include a salutation with a courteous tone affirming the recipient’s value and role. Even a “Thank you for your efforts” matters.

• Make sure your message reflects cooperation and commitment to teamwork.

• Consider defining the timing of tasks precisely with details and parameters. “ASAP” may mean “now” to one person but “in the next few days” to another.

Tips to Improve Communication

You can improve communication in your office by implementing a few simple guidelines:

1. Avoid never-ending chain e-mails. Take the time to look around the corner and actually speak with somebody face-to-face. Some of us don’t even read the second half of our e-mails. With face-to-face conversation, you may get it done in one-tenth of the time and avoid bothering the 35 other people who were included in the message and are not sure whether they are expected to respond.

2. When you look at a person, look the person in the eye and greet him or her fully. That person is your focus. You may need to walk away from outside stimulants to give your full attention to that person. Put your phone, computer, and iPad down, and face the person you’re talking to. If this leads to a confrontation with somebody, you may just have to walk away and resume at a different time.

3. Be a part of where you are. Engage in the conversation and in the meeting. You may have to resist the urge to check your e-mail 20 times, but doing that looks like you are not paying attention to the person who is talking to you. It’s that simple. Why am I here talking to you, trying to set up a payment plan, if you’re not focused on what I am saying? Or why am I, your staff member, trying to talk to you about how I can get better at my job when you’re not going to pay attention to me? I’m a good worker, and I’ll find a boss who will.

4. Break bread and bring chocolate! Have you ever noticed that when you share a meal or have a cup of coffee with someone, both of you relax just a little? This is a great “tool” that can actually help someone open up a little sooner. It can create bonds, and it’s delicious too. Try it! Bring some chocolate to the next staff meeting, talk about shared goals in a patient-centered culture, and watch the magic happen!

New Manager or New to A Practice?

As an employee establishing myself as the manager of the practice, one of the challenges is establishing physician trust, which is earned in different ways with each provider. It is essential to meet with each provider individually.

Afraid to Speak Up?

When communicating with staff, our approach directly affects their response. Staff can feel intimidated and hesitant to speak up in a dysfunctional environment. We are territorial creatures, and this is one way to protect our jobs. Fears such as, “I will be passed over for a raise,” “I will be picked on by coworkers,” or “I will be fired” greatly affect employees’ responses.

Begin With Trust and Affirmation

One of my best bosses told me her job was to support me in doing the best job I can. What a feeling! Every staff member should feel that strength, and that is what each of your employees should feel as they approach their work! This is also another perfect time to reflect on expectations.

Meetings You Can Count On

Consider each meeting a collective where we feed off each other’s ideas—and also as the foundation of your ongoing rapport. Establish individual and practice-wide needs and priorities. Display respect by beginning and ending on time. Be present and listen. Every employee has a voice.

Communicating During an Emergent Situation

If, for example, there is no power and you must get in touch with patients, who would you ask and how would they be contacted? Even with the most basic first step of a telephone tree, do not take it for granted that everyone knows their role and what to do next. This is no time for a dress rehearsal. Be prepared and improve timing by clearly spelling out delegated responsibilities and steps that staff—including physicians—should take during an emergency.

All staff should be aware of and confirm their roles in an emergency and take simple and effective steps to continue patient care and address the practice’s most urgent needs. A debriefing after an emergency can substantially improve processes when all minds are still in “What can we do better next time?” mode.

Trust

One Common Bond and the Trust Has Begun

Meeting for the first time with staff? Listen first—this is their time with you. This person must be your universe right now. Whether this meeting is an introduction or reviewing policies, any topic you think best is a good way to get started to establish “like” goals.

Take notes, ask questions, and write down the answers. Sincerity is essential. A forced concern or compliment is easy to see through, with the rest of the conversation possibly received with a grain of salt.

Let Go and Trust

As you work with staff and peers, communicate your respect by allowing them to do their job in a professional manner. There’s nothing better than being able to assign someone a task, knowing it will be done well in a timely manner.

You have taken the time to work with staff members, so reflect that and allow them to go for it!

Too Much Trust?

I was so proud that my lead physician trusted me to the extent that he would sign anything I gave him that needed a signature. I loved that he supported my decisions regarding the practice. But where should we draw the line? Along with checks and balances, it is our role to define the boundaries as well as maintain a level of equilibrium, not one-sided conversations, as we work together.

This does not weaken our stance and position as the leader of the practice. It, in fact, reinforces our role, because these boundaries display respect for providers who now look at us as peers. In thinking about your history with physicians and staff, consider the times or occurrences where you gained trust. What was the initiating factor? Had you done something specific, performed everyday operations, or both? Were you an already established employee? Was there a crisis? What was it that clinched it for you?

Our Role as a Leader Is to Affirm the Value of Each Staff Member

Hire the best. And keep them! Your best employees will look for progress. If they don’t find it with you, they will go elsewhere.

Performance Evaluations

In a performance evaluation, achievements as well as goals should be documented by both you and the employee. Use system reporting and other benchmarking to assist with future goals, and note successes accomplished in the last year. It’s always good to affirm each staff member’s role and value as well as holding the carrot out in front to entice the employee to improve!

This is the employee’s moment with you; there must be no disruptions so that this becomes an opportunity to truly communicate. This is also an opportunity to identify redundancies in job duties and to further define the employee’s role.

Conversations That Count

One of my model recommendations with every office is a slated time, at least twice a month and more often if possible, for the lead physician(s) and the administrator to review revenue cycle, cash flow activity, staffing, and patient issues. It is imperative that leaders learn how to communicate with each other frequently and with ease. When the hard conversations come up, we must be able to speak with respect and understanding. Watch communication improve as patterns and issues are identified sooner for a more proactive approach.

“If it’s important to them then it’s important to you.” Determining the priority from that point is up to you. I know it is hard to find the time. Please offer the “welcome mat”—a must for managers. If you are not available at that exact moment, but employees feel you are available to at least designate a time to meet, you are still present in their minds. You can determine the urgency. The point is that they feel you are accessible and supportive. That is big, and carries far with employee engagement, loyalty, and communication.

When you meet, consider comparing the attention you are giving to your employee to that you would give a patient—the approach should be the same when an employee needs you to hear something.

We all need to know exactly where we stand. What better place to have a conversation than where someone is the most comfortable and confident? Go to and spend time in their space. Listen and look for nonverbal cues. Let them show you what they do. Pride goes a long way! And as each one asks you questions regarding his or her role, be clear regarding the practice’s expectations and protocols.

Clear and respectful communication relays a professional trust that will only enhance the employee’s loyalty toward you as a leader and the practice as a whole.

Exit Interviews

Conduct an exit interview whenever you can. It is an opportunity for the employee to say what he or she may have been hesitant to say in the past. Employees often feel freer to speak as they are walking out the door, offering information that can be truly enlightening.

Personnel and the Manual

The employee manual offers ethical parameters that are appropriate for your practice and culture. Beginning with the mission statement, all the way through to professional attire and behavior, this is your opportunity to define how the staff interrelates in providing patient care. Spell it out! Have a professional review your manual for most current workplace topics and protections.

Although often disregarded, the manual is one of your most important communicators within your practice. Everything in the following list should be included:

• Your practice’s mission statement;

• Professional attire and behavior;

• Policy regarding concealed weapons on the premises;

• Gender identification rights;

• A clearly defined hierarchy to follow when reporting any issues and concerns;

• An anonymous way to report fraud and embezzlement; and

• Grounds for termination and how it may affect vacation and sick time accrued.

Employees read the manual, then sign and return a statement acknowledging they understand their responsibilities and the rewards and repercussions of performance.

Suggested Readings

• Carnegie D. How to Win Friends and Influence People. Simon and Schuster; 1936

• Bradberry T, Greaves J. Emotional Intelligence 2.0. TalentSmart; 2009

The Main Points and Goals

The following are examples of policies essential to communication, especially when there is a conflict or controversy:

1. Establish and clarify the most essential points of communication in getting the best message to the correct person at the appropriate point of care.

2. Establish a clear hierarchy.

3. Let go and trust.

4. Create a learning culture with regularly scheduled meetings that support communication with continuous access to peers and providers

5. Maximize staff members’ potential engagement by acknowledging their value.

6. Show respect. All conflicts should be addressed in private.

Let’s Talk! Exercises to Use with Your Team Members

• Please discuss the kind of meetings you have, who is present, and how often these meetings take place. Also, please note if nothing gets done how you would improve it, and if you do get things done, please share that.

• What is your preferred method of communication with staff?

• How would you respond to a compliment? How would the comment “You look very nice today” feel from a person of the same gender and from a different gender?

• How would—or should—you tell a staff member that they have body odor?

• What are some barriers to communication in your office? These barriers can be physical barriers, or barriers caused by communication style. (Anything that gets in your way of communicating can be considered a barrier.)