PCC's Chip Hart recently presented a webinar called Do You Work with the Wrong People? In it, he covered many of the H/R-related topics that pediatric practices struggle with: issues with hiring, firing, communication, and business partnerships. This post will explore some of the key takeaways from that discussion.
In any business, one of the most important things you do as an owner is hiring staff and choosing a business partner. And all it takes it one bad fit for all the problems to start. 
Think of your office as a workshop. Does someone use a saw to take a nail out? Does someone always work against the grain of what you're trying to accomplish? Having the wrong person working with you is like having the wrong tool for the job. And nothing drives down job satisfaction more than surrounding yourself with the wrong co-workers. More than clinical tasks, or trying to achieve PCMH, or attempting to attest for Meaningful Use, it's the people that can make your situation the hardest.
Hire Slowly, Fire Quickly
When considering who to hire, and who to let go, let "hire slowly, fire quickly" be your mantra. What does this mean? It has a lot to do with your practice's culture.
Office culture is a very important thing to consider in relation to your staff. You need to know what kind of culture your practice has and what kind of culture you want to foster, and hire accordingly. Does your practice run at warp speed, open early, and always have a ton of team projects on the to-do list? Then you probably don't want to hire a night owl who is better at working quietly and alone.
It's not enough to hire someone based on their skill set alone. They need to be a match for your workplace's culture. How can you determine this? How do you vet potential employees? First and foremost, hire slowly. Take your time with the hiring process. While you're doing this, you can:
- have multiple rounds of interviews.
- consider hosting an event where prospective employees can mingle with current staff.
- bring your employees into the interview process and get their input.
- have potential employees take personality tests such as Myers & Briggs or the CliftonStrengths to discover where they might fit best in your practice. It's important to have a collection of character traits across your business, so don't look for everyone to have the same exact strengths. Identify the gaps and find what you're missing; this can inform your hiring process.
Ask yourself, "Can I see myself working with this person?" Most people will have a 'gut feeling' and know the answer to that very quickly. Sometimes a new employee might not have incredibly strong chemistry with your staff right away, but still seem like the right choice to hire. If that's the case, give it 30 days. If after a month, it's clear that this is not the right match afterall, this is when you must follow the second half of the advice and "fire quickly."
When an employee is clearly not a fit for your practice, the best thing you can do is let them go immediately. The faster you can make this decision, the better off you are and the better off that employee is. Let them go so that they can find a better situation and so that your practice can let go of a dysfunctional dynamic. 9 times out of 10, that employee won't change and will simply continue to drag the company culture down as long as you let them stay.
If you're thinking, "I can't fire her/him because they are crucial and they've been here 30 years and it'll all fall apart without them... even though they are horrible to work with and they drag everyone down" then think again. According to Chip,
"No one has ever been so valuable that they shouldn't be fired if they are toxic. When that person who drags the office down is finally let go, there is greater cohesion and a sense of relief. I've never seen anyone regret firing that one toxic employee. Most of the time, they end up wishing they'd done it years ago."
Communicate Well and Communicate Often
As a leader in your practice, you can't communicate too often – it's so important. One aspect of good communication is transparency. When you are transparent about the various parts of your business, it can increase motivation and morale among staff. For example, you can break down the numbers for your staff and show them how much revenue you have to generate just to have your doors open each day. Then show them how much revenue is lost if a provider loses an hour's worth of income by leaving a bit early one day a week, or how much is income is lost when the front desk doesn't check eligibility and then insurance billing gets confused or delayed. Those little things add up over time to bigger costs to the practice down the road. Breaking it down in a way where people can see and understand how their actions impact the practice can generate motivation for staff to up their game.
The other part of communication that is crucial is that you must be clear about what you expect. If you're struggling to have good employees, the problem could be that you are:
- not training or explaining things clearly
- not defining what 'success' means to you and your practice
- not being clear on your job descriptions and what you expect
You also might not be paying well enough to retain the kind of top quality talent that you want in your practice. If you perpetually have trouble finding good employees, consider adjusting your pay scale if possible.
Like a Marriage, a Good or Bad Partnership Means Everything
Choosing a business partner is arguably as important as choosing a spouse. Your income, job satisfaction, career, and virtual child (i.e. your practice) are all caught up in your business partnership. In a bad business partnership, there is:
- no trust
- no understanding of what the other person brings to the table
- a feeling that you can't rely on that person
- a lack of communication - you don't consult with them
How do you know if someone will be a good partner at your practice? Chip only half-jokingly suggests,
"Ask yourself if you could go on vacation with this person! Is this someone you would want to spend time with outside of the office? Could you sit on a beach or go to a museum with them? Or do they tire you out simply by being in the same room?"
Chip continues,
"When is the best time to talk about your partnership? Is it when the house is on fire? Or is it before?"
The answer, obviously, is long before. When things are not in emergency mode, when you are calm and therefore more objective, that's the time to talk about your partnership. If you feel good right now, then now is the time to schedule the next partner meeting. Set time aside to just chat and see what is on your partner's radar. Talk about the small stuff before the emotions start to blaze. Not only can these discussions catch small things before they become problems, they can also foster connection and understanding. If you feel like you can't trust your partner's decisions, if you disagree with how they practice medicine, and if you feel contempt towards them as a result, your partnership is destined to fail. You can always fix things like your revenue cycle, or how you do recalls, but if you have a bad partnership you will remain miserable because of the amount of energy it consistently takes out of you.
What Can You Do About a Bad Business Partnership?
Get support. Go talk to other people in practices like yours. Share your experience. It's so easy to feel stuck and isolated in your individual situation but just having a conversation with someone can help you see what's normal and what's not. Join SOAPM, find a local medical group, join your local AAP chapter, or visit another pediatric practice. There are lots of ways to get support.
Fall back on your Partnership Agreement. 
When difficult circumstances arise with a partner, you should always fall back on the Partnership Agreement you signed in the beginning. For example, what if your partner suddenly announces they're not taking call anymore? Or they want to work 4 days instead of 5 but keep the same salary? You can try to talk it out, but if your partner refuses to budge, you need to execute your agreement. A Partnership Agreement allows you to say, "If you do this, this is what's going to happen. I'm going to do exactly what I told you I would do - no more, no less."
Remember – It's Not Personal
While it's great to be real friends and have a personal relationship, if it's not working out with your business partner, you need to make a business decision. Remind yourself, "It's not personal, it's only business." Chip's advice to pediatricians in this kind of situation is,
"A lot of pediatricians get caught up in their self-image being tied to their practice and they can't 'divorce' the practice even though it's making them miserable. Remember – it's just a business and it will all be ok. Sometimes you simply need to stop making each other miserable. Stop sitting around and complaining – get a new partner or quit the one you have – don't be stuck. Just do it."
Want to watch the full recording of the webinar this post is based on for even more actionable information?
