Review your staff performance reviews
Start the new year off on the right foot by giving your employees feedback
By Sam Solomon
Parkhurst Exchange, January 2009
When Jivi Khehra, a medical practice management consultant in British Columbia, arrived recently to start a job evaluating a six-physician practice, she asked the doctors how they handled staff performance reviews. “They had never done them,” she recalls. “They only met with their staff once a year, just before Christmas, to give a pay increase. It was just walking down the hallway, saying, ‘Hey, Julie. This year we decided to give you a 50-cent increase in your pay.’” They were dealing with their staff in much the same way as so many other Canadian doctors: poorly. No wonder the practice was so bloated and inefficient, thought Ms Khehra.
But it doesn’t have to be that way for you. By scheduling regular staff performance reviews, your practice can become the well-oiled machine it should be rather than a jury-rigged pile of rust.
If you’re looking for a New Year’s resolution you can actually keep this year — admit it: the exercise regimen and the fad diet won’t last — then do yourself and your practice a favour and resolve to improve your staff performance reviews.
MEDICAL MANAGEMENT
Doctors are notorious for being too busy to deal with all the management aspects of their business. “It is a minority of physicians who actually look at their practice like a business,” says Ms Khehra, who has 18 years of experience as a healthcare executive in BC and now owns and operates Winds of Change, a Vancouver management consulting firm. “When it comes to operations, they just get by. ‘Can I get somebody in to man the phone? Can I get somebody in to take the patient to the exam room?’ And that’s about the extent of it.” The result of that attitude, she says, is inefficiency. Most physicians are aware of the problems — they see the effects every day, after all — but don’t feel they can do much about it. “They’re at the point now where there is so much burnout that they are making do.”
Chief among the management tasks left by the wayside is the annual staff performance review. “Performance reviews are something that fall off the priority sequence very quickly,” Ms Khehra says.
To improve your practice, an effective staff is crucial, says Dr George Carson, the co-chair of the Saskatchewan Practice Enhancement Program. And to keep your staff at the top of its game, performance reviews are necessary.
“Providing feedback is the first thing,” says Dr Carson, who performs assessments of other physicians’ practices across Saskatchewan. “We find this with respect to physician performance and we would expect that physicians would find it with respect to the performance of their staff.”
Not convinced? Just consider the example of that six-physician practice in British Columbia that hired Ms Khehra. Before they took her advice to start doing staff performance reviews, they employed 11 office workers. After she got them to examine their business more closely, which included doing staff performance reviews, they managed to cut back to the equivalent of fewer than 8 full-time employees by eliminating inefficiencies, thereby saving themselves tens of thousands of dollars.
HOW TO REVIEW
The first step in doing performance reviews is to set up regularly scheduled meetings with your employees. “If it’s regularly scheduled, you don’t have to be quite as apprehensive about it,” says Dr Carson. “Not, ‘My goodness, what did I do?’ It’s just, ‘It’s time to go have this talk.’”
The scheduling may differ depending on your practice and your staff, but Dr Carson has some basic advice. “With new staff you probably want to do a review after three months,” he says. “With long-established staff you probably don’t need to do it any more often than every couple of years, but it’s better to have it scheduled.” Be proactive: don’t wait until something unsatisfactory happens to set up the meeting. And don’t put off the review if a staffer seems to be doing just fine. “If they’re doing something very well you’d want to reinforce that.”
There are different theories as to how the review itself should be carried out. Ms Khehra favours a guided self-evaluation model in which the physician gives the staff member a list of topics in advance of the review and asks the staffer to arrive ready to discuss his or her performance in those areas. Nine out of 10 people will accurately identify what she euphemistically calls their “growth areas,” she says. As well, self-evaluation can make the process easier on the employees. “Performance reviews trigger up a lot of fear, a lot of nervousness,” she says. “Even the name itself is very evaluative — ‘We are evaluating you’ — but that is not what performance reviews need to be about. I think they need to be about self-evaluation, so you are managing yourself but the physician or manager is giving guidance to them.” Asking staffers to evaluate themselves reinforces the need for them to be responsible for their own work. “It pushes the accountability back on the individual, which makes them more likely to act on it — not based on fear, but based on them being accountable.”
Dr Carson espouses a different method. Self-evaluation “may actually produce something very interesting,” he says, but he’s less sanguine than Ms Khehra about employees’ abilities to identify their own weaknesses. “If there is problem and people aren’t aware of it, then you’ve identified the basis of the issue,” he says. “[If the employee says] ‘You know, I think everybody loves me’ but everyone says you are obnoxious, there’s a disconnect there that needs to be addressed.” What you should do, he suggests, is provide “reasonably objective, well-documented feedback.”
Both he and Ms Khehra agree, however, that a successful performance review hinges on constructive criticism. Ms Khehra calls her technique “appreciative inquiry.” “What have they have done well?” she asks. “And can they transfer anything from there into their growth areas?”
When discussing areas for improvement, keep in mind that employees generally want to do a good job, Dr Carson says. “If the opinion from the patients is this person is awfully abrupt speaking on the phone, I’m willing to bet that person didn’t get up in the morning and say, ‘Who can I annoy on the phone at the doctor’s office?’ So we generally find that when people are given information about their performance they improve it themselves.”
REVIEWING RAISES
One of the longstanding debates among management experts about performance reviews is whether the results should be tied to salary increases.
Dr Carson says they should. “It’s perfectly fair to say that a satisfactory standard of performance is a condition for employment and certainly for the possibility of any increase in pay.”
Ms Khehra, however, is in the ‘no’ camp. “My daughter is 15, and if she brings home A-pluses and I say to her every A-plus she brings home she’s going to get 10 bucks, I’m teaching her a reward-punishment type of task. But she is actually doing it for herself: those As and A-pluses are for her, not for me. It’s very similar in an employer-employee relationship. The ambiance of the performance review needs to be, from the employer’s perspective, that I am supporting your future growth.”
Whether you decide to link salary increases with performance reviews, it seems, depends on your management philosophy.
