Practice Management: Setting the Standard

Developing behavioral standards and leading by example can help you bring out the best in your employees.
How to bring out the best in your employees.

Addressing Problem Behaviors

Once your practice has established an agreed-upon set of standards, the physician-leader must be the first to exhibit these behaviors because staff members will be watching. They will also be watching to see if you tolerate actions that fall below the expected standards.

Medical professionals have a tremendous capacity for empathy. Unfortunately, this can make them adverse to confrontation—a dangerous trait for a team leader. You may prefer that staff members work together and hope that difficult issues will simply go away. However, that will never be the case; these problems fester and ferment until they are addressed.

The way—and the speed with which—you address employee behavior that falls short of the expectations will define how well these new standards become ingrained into the culture of your practice.

It is important to confront the issue immediately. Do not wait until tomorrow or next week. As soon as there is a free minute, take the employee aside for a private conversation. Explain the shortcoming that you have witnessed, and give the employee an opportunity to comment and/or explain.

A good example is when you hear someone being disrespectful toward a coworker. Take that person aside and say “I need to speak with you about the way you talked
to Mary. Why did you roll your eyes and why were you so dismissive of her concern?” After you have listened to the employee’s response, help him or her understand why this behavior cannot continue and offer guidance on how to handle the situation in the future. For example, “How would you feel if I communicated with you in that way? In the future, if you are having a problem with someone, address it directly with them respectfully and in a private area.”

Then ask the employee to confirm that the behavior will not be repeated. “I need you to not repeat this style of communication. Do I have your agreement that this is inappropriate in our practice?” Use the language “I need” rather than “I would like” or “Please” to emphasize that you are serious about requiring the change in behavior.
After the problem has been addressed, reinforce that he or she is a valued member of the team and that you have confidence that the shortcoming will not be repeated.
This style of coaching will help to raise the bar for all team members to the expected level.

Maintaining What You’ve Built

It is essential that everyone in the office is held to the same standards. If you allow leeway to certain employees or administrators, you will create resentment among staff members, and the culture of your practice—not to mention your own credibility with staff—will be damaged.

A leader cannot have favorites in the office. For example, you may have a long-tenured employee—maybe even your first hire from years ago when you started your practice—who is used to doing things his or her own way. You may have even overheard staff say, “Oh yeah, he always acts like that, they’ll never do anything.” Once the new behavior standards are launched, all employees, including those who have been at the practice long term, must be in compliance with expectations.

Another challenge may be a superstar employee whose less-than-stellar attitude has been tolerated because the practice depends upon that person’s performance. These superstars also need to be coached into compliance with the expectations using the previously mentioned approach. In some cases, you may have a genuinely toxic employee on your team.

A toxic employee can sap the energy right out of your practice. These staff members tend to be overly negative; blame other people for their problems or shortcomings; have an “It’s not me, it’s you” response to all concerns; and may even withhold information or assistance that would help coworkers. The toxicity is insidious, and can drag you and your staff into an abyss of low morale and decreased productivity.

If you can change a toxic employee’s behavior through agreed-upon behavioral standards and coaching, you will demonstrate your leadership to all your staff, and it will have a huge, positive impact on the patient experience. Following are five steps for working with a toxic employee:

1. Set clear expectations for the behavior modifications that are required, and provide a timetable within which those changes must be implemented.
2. Document the discussion as well as your expectations, and email those notes to the employee after your conversation. Be straightforward about the behavior(s) that need to change.
3. Have weekly coaching meetings with the employee to provide feedback on progress and give the employee an opportunity to discuss progress from his or her perspective.
4. Be prepared to terminate the employee if there is no progress and the behavior expectations are not met. “Three strikes and you’re out” is a simple but effective approach. After the first discussion, give the employee a written warning. If the behavior is repeated, give a final written warning after your conversation. Termination follows a third strike.

Remember two things: Toxic staff members typically fire themselves because they are resistant to changing their unacceptable behavior; and your staff and patients will thank you for resolving problems with a toxic employee.

Every member of your staff plays a critical role in the patient experience, and your daily behavior guides your staff more than any other factor in the practice. Your example will lead your employees to become better team members and help them deliver the outcomes your patients seek.

David J. Waldron is executive director of the Dermatology Business Accelerator, a business community dedicated to helping physicians develop their leadership skills and business acumen. Contact him at

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