Enhancing Practice Performance

Diagnose and solve common practice challenges: part two

Last month, we discussed two of the often overlooked and embedded challenges of practice management that can be barriers for your practice to the reach the next level of success and profitability ( ). In part two, we continue the discussion with four more common challenges private practices face.


This problem is often overlooked, because to address it requires confrontation. Favoritism takes many forms: overlooking late arrival for a work shift, preference in time off, being excused from difficult tasks. Actual favoritism and the mere perception of favoritism have the same result. The non-favorite employees become disillusioned, wondering why they bother to follow the rules or work hard. The result: low staff morale and a lack of happiness throughout the office — even patients pick up on it.

Consider these solutions:

  • Perform a staff morale survey. Ask: “Are all staff here treated equally?” Make the survey anonymous to encourage staff to be honest in their assessment.
  • Provide education on the negative impact of perceived favoritism and how to avoid it. Newer middle managers are easy targets if they have moved up the ranks and still maintain friendships with the staff they manage. Doctors have an understandable tendency to try to protect and reward their favorite staff — a tendency that should be discouraged.


Busy clinic days make it easy to overlook what should have been completed on the clinic floor or in the management suite. Acceptance of work not executed well or in a timely manner reduces the quality of care and financial performance. This leads other staff to say, “Why should I bother?”

Consider these solutions:

  • Create a culture of timely work completion. This starts at the top. If the administrator or managing partner delay assignments, everyone else will, too.
  • Teach managers to set reasonable deadlines. Managers should also know how to follow up to ensure staff are meeting standards. Staff prioritize what managers and providers prioritize.
  • Hold managers accountable. They should demand (nicely) that work from their staff is on time and complete.
  • Replace staff that do not meet standards. Although unpleasant at the time, the practice becomes stronger with a team that takes pride in timely, excellent work.


Superior practices address adverse provider behavior without fear, even if the doctor is an owner or a top producer. This habit sets up a virtuous cycle in which leaders are respected and high standards are reinforced. Average practices often choose to ignore issues (whether mild, like general rudeness or tardiness, or severe, like harassing behavior.) This results in a degraded patient experience, higher staff turnover and the creation of an environment where “anything goes.”

Consider these solutions:

  • Adopt a physician “code of conduct.” This clarifies professional behavior expectations and provides a basis for leadership to evaluate and follow-up on conduct concerns.
  • Provide professional coaching. Do not expect to change someone’s personality, but it is possible for you to change an offending provider’s behavior with fair and consistent feedback.
  • Focus on the positive. Increase the good aspects of a colleague rather than only decreasing the bad (as in marriage, you are unlikely to successfully change your spouse, but you can both put effort into the positives of your relationship).


Staff “turnover” is the percent of staff who leave the practice in a single year. Although a 25% turnover rate is what we see most commonly in our consulting work, we also see stressed practices with 50+% rates ... and others with 10% rates and lower. Measure turnover rate by dividing the number of lay staff who left the practice (for any reason) in the last 12 months by the total number of workers typically employed. If five staff members left and 20 are employed, that’s a 25% turnover rate; roughly the average in our field. Get concerned if it’s more than 30% and alarmed at 50% or higher.

Is a low turnover rate always better? Not necessarily. Although you may pride yourself on a single-digit turnover rate, this can be a sign that you are too lenient and are allowing weak or under-performing staff to overstay. Too low a turnover rate may signal a need to set higher standards. Just like human physiology, balance is the key. Too much or too little insulin can be fatal.

Consider these solutions for increasing staff tenure:

  • Boost workplace enjoyment. People work for love and money, so even if you pay at market rates, you have to provide lots of attentive care to your staff. Indeed, some practices are forced to pay well below market rates due to circumstances, yet have a low turnover rate because administrators and practice owners deeply engage with staff.
  • Have a buddy system for new hires. New workers joining your team should be bonded formally to a colleague for an initial 90-day period — usually a peer in their own department. This is in addition to their direct supervisor. After 90 days, new staffers will have made their own connections and found their own way in the practice.
  • Provide abundant feedback and accentuate the positive. Many surgeons, and by extension their managers, provide negative feedback when they detect an error and no feedback when work is at or above par. This is a recipe for low morale. Catch your people doing things right, and point it out often and publicly. Make sure this positive feedback is widely distributed, so that every staffer gets your message: “I admire and appreciate the work you do here.”
  • Scan for burnout. Very few disaffected staff leave their practices without advance signs of their unhappiness. Management should be on the hunt for these signs: higher absenteeism, late arrival, spending lunchtime alone and a generally dejected affect. If you want such staffers to leave, by all means accelerate them toward the door. But, if you sense that a good worker is a flight risk, address your concerns directly. OM