Human resources management

HR management is about managing your employees and ensuring they meet the strategic and operational goals of the medical practice. Physicians rely heavily on office staff for day-to-day operations; therefore, it is prudent to hire the right people, develop and train staff that will meet the practice’s goals, and retain the right people.

Assessing staffing needs

Staffing is the process of selecting and training individuals, and charging them with specific responsibilities. In a medical office, a combination of four factors typically shapes staffing.

1. What is the medical specialty? The services that you offer may require a specific number or types of employees for adequate support
2. How many providers do you have? Whether you have two physicians or 25, medical providers need adequate staffing to support them in delivering quality services. Research other medical offices to get a sense of the typical number of employees per physician, and help ensure that you are not understaffed or overstaffed
3. What is the patient volume? The number of patients treated daily, weekly, monthly, and annually creates the workload and can dictate the staffing level required
4. What kind of productivity do you want to achieve? The ratio of staffing to services rendered, as well as the roles you have assigned, will affect your efficiency

These factors do not always remain permanent in a medical office. As they change, so can your staffing needs, so stay flexible. Staffing will also be shaped by the type of organizational structure you prefer (e.g., centralized or decentralized), and how much responsibility you want to delegate. There is no single correct approach. In assessing your staffing requirements, the goal is to have a team that can meet your expectations for serving patients

Defining your staff

You can think of staffing in three levels: leadership, management and direct service providers. A solo practitioner in a small medical office may need to fill all roles, while larger offices will have more delineation between the levels. In general, staffing in a medical office can encompass these roles:

• Licensed clinicians: such as a Nurse Practitioner, and other health-care professionals
• Office manager: responsible for the administrative/business side of medicine, while the health-care professionals take care of the clinical side
• Medical secretary: responsible for patient scheduling, medical report transcription, medical records management, and medical billing
• Billing specialist: responsible for managing the information related to OHIP, WSIB and uninsured billings
• Receptionist: responsible for answering the telephone, welcoming patients, and booking patient appointments

Keep in mind that in some settings, staff will perform multiple roles. In fact, cross-training can be advantageous to allow proper coverage in case of sick days, holidays, etc. On the other hand, specialization allows for undivided attention. The precise definition of roles is up to each office. 

The hiring process

Having determined your staffing needs, you must prepare to select the right candidate. Your odds for success can increase dramatically by following a systematic procedure, from creating a job description to hiring an individual.

A recruiting/hiring process checklist is available to assist you. Follow the steps outlined, and remember, as an employer you need to become familiar with and comply with several pieces of Human Resources legislation:

• The Ontario Employment Standards Act, which sets minimum standards for conditions of employment in most workplaces in Ontario 
• The Ontario Human Rights Code, whose goal is to prevent discrimination and harassment and provide equal rights and opportunities in specific areas such as jobs, housing and services 
• The Ontario Occupational Health and Safety Act, protects workers’ health and safety on the job. Under changes made in 2010, that include protection from workplace violence and harassment
• The Pay Equity Act, which protects the principle of equal pay for work of equal value 
• The Workers’ Compensation Act, which provides compensation and other benefits to workers and to their survivors and dependents 
• Accessibility for Ontarians with Disabilities Act, which strives to make Ontario accessible to all 
• Employment Insurance information for employers
• Information and Privacy Commissioner of Ontario, which upholds and promotes open government and the protection of personal privacy in Ontario

Creating a job description

A job description is a formal document that summarizes the important functions of a specific job on which job postings, job interviews, and performance appraisals are based. Job descriptions should accurately represent actual duties and responsibilities, as well as job specifications.

For each position, list all duties and responsibilities, ranking them based on the importance of the function and the percentage of the time needed to perform the duty. Clearly state all formal requirements, such as experience, education or special training.

These qualifications, along with the level of responsibility, will determine the salary that fits the job description.

Colleagues, hospital personnel administrators and employment agencies can give you guidelines for pay scales and benefits in your area.

Attempt to establish standards for each job function, which can later be used to conduct performance appraisals.

Establishing employment conditions

Job candidates are entitled to know about the position being offered, general working conditions, and your expectations for performance. Before you start recruiting and interviewing, establish the conditions under which employees will be hired.

Be realistic in creating these guidelines. If the conditions do not match expectations, and the job is not as described, you may lose candidates or staff and be forced to repeat the hiring process.

Recruiting and screening candidates

To solicit candidates, consider several options:

• Advertise through local medical societies, websites, newspapers, and community hospitals
• Contact the placement office at a community college
• Use an employment agency, which usually charges a fee based on the percentage of the newly hired employee’s salary (if you hire through an agency, be sure to obtain a time-related satisfaction guarantee)

The method you choose might depend on the time you have available to handle responses and make the hire.

Recruit as many candidates as possible. The more applicants, the better your chances are of selecting the right one. Ask for written resumes, and learn the art of reading them — ambiguous statements, frequent job changes and missing employment dates, for instance, can be warning signs.

Not everyone will match all of your requirements. You may not find the perfect candidate. But when you identify candidates with the appropriate work experience, training and personal characteristics, place them on your list for a telephone interview.

Interviewing

Having selected the most promising resumes, arrange the interviews. This will permit you to:

• Ask questions about the candidate’s job experiences
• Gain some understanding of their personality traits
• Form a first impression about their suitability
• Explain duties and responsibilities in detail
• Provide information on fringe benefits, hours of work, etc.

The types of questions you ask during the interview are important. Ask each candidate the same series of questions so that you develop a common basis for comparison. Focus on each candidate’s competence, character, and drive, and take notes about their strengths and weaknesses so that you can refer back when considering your final selection.

Confine your questions to job-related subjects. Government regulations and human rights legislation forbid you to ask questions about age, sex, marital status, religion, race and a host of other topics. It is advisable to contact the Ontario Human Rights Commission for guidelines on suitable questioning techniques.

Before the candidates leave the interview, obtain permission to contact their references.

Rating candidates

Another way of rating candidates equitably is to use an interview rating form. This lets you quantify the skills and personality traits you consider most useful for the job.

Evaluate the various categories with the job description in mind, only then can you assign meaningful weighting values. Fill out this form immediately after the candidate leaves the interview, which helps keep the rating system objective.

If you are not comfortable judging the skills required of a potential employee, just rate the candidate on other characteristics, and seek assistance regarding technical competence. For example, you could have your accountant interview and give an opinion on a potential bookkeeper.

Testing

After conducting the interview, you still need to assess and rank your candidates to make the best selection. Tests are one way to ascertain technical competence. Keep the tests with the candidate’s application and interview summaries — they will help you make your final decision.

Checking references

Do your homework by talking to references of the most suitable candidates. It is especially important to speak with the candidate’s immediate supervisor. The personnel manager may be reluctant to talk about former employees — often because they do not know them well — and may not provide more than “yes” or “no” answers.

Ask questions such as:

• In what area did the person work?
• What kinds of interpersonal skills does the person have?
• How was the quality of their work?
• What was their workload and performance like?
• What was the person’s attendance like?
• What were their best/worst attributes?
• What salary were they being paid?
• Why did they leave?

You may not get answers to all the questions, but you should be able to compare responses to the impression you formed from your interview.

Hiring

Once you determine that a job applicant meets the position’s requirements, it is time to make a job offer (with the assistance of a lawyer, as needed). The job offer should include a probationary period with

termination for any reason during that time. Background checks such as criminal and credit, education and license verification, and references can be done during this period.

The OMA recommends that physicians sign written contracts with all employees, and has a variety of templates available for this purpose. Contracts must be signed upon employee acceptance of the offer, before the first date of employment.

Please contact OMA Legal Services or your lawyer for further information on employment contracts and the hiring process.

Developing a policy and procedure manual

As you develop positions on a variety of practice and workplace issues, document them in a policy and procedure manual. These are the rules by which you operate. They will help you to train staff, ensure that the office runs efficiently and consistently, and maintain productive and clear working relationships.

Policies and procedures can cover a wide range of topics, such as the length of a probationary period, work hours, absenteeism, code of conduct, dress code, how to complete specific tasks, e.g. sending claims to OHIP, recording information in patient files, and much more.

Keep up to date with changes to the Employee Standards Act. 

Managing staff is really about motivating them. Every employee has different needs, goals and priorities. By understanding and meeting them, you can increase your staff’s effectiveness and job satisfaction, inspiring them to work to their potential.

Motivation and retention go hand in hand. Motivated employees are less likely to leave, saving you from losses like the costs of recruitment and training, and the disruption caused for the team. Here are some strategies to think about motivation and retention efforts.

Keep communication open

• Communicate your practice objectives and your staff’s role in achieving them. With a clear understanding of how they contribute to the success of the practice, staff feel a greater sense of accomplishment
• Discuss important decisions in advance, and hold regular staff meetings. Keep everyone informed about developments in the office
• Encourage staff to express their views on processes, job satisfaction, morale, etc. It is important for employees to feel that their opinions are welcome. Moreover, staff feedback can help you to improve your practice
• Foster open communication, not just between you and your staff but among staff. That helps to create a more coordinated and better performing team — a feeling of “we” and not “me.” Communication is a two-way process

Provide ongoing feedback

For employees to succeed, they need to know what they are already doing well and what they could do better. Provide prompt praise for good performance, constructive criticism on areas that need improvement (always privately), and updates on progress. This can happen through formal annual reviews and, just as important, through informal day-to-day feedback.

Set clear goals

Organizations and individuals succeed when they are working with a plan. Staff feel valued, motivated to improve, and part of the team when they have a clear idea of expectations. For each employee, set goals that are:

• Relevant: they mesh with your overall objectives
• Realistic: staff can directly influence them through their actions and behaviours
• Measurable: you have a way to determine if they have been

Create a satisfying environment

Staff are more likely to perform at their best (and to stay) when they are working within an environment that supports and stimulates them. That means providing employees with:

• A comfortable, safe, inclusive and respectful work setting
• A well-defined role
• The tools, time and resources they need to do their job
• The help and training to enable them to do their job well and develop new skills
• Interesting challenges
• Appropriate rewards 

Provide meaningful rewards

Salary is important, but it is not everything. Although remuneration and the promise of a bump in pay can be a motivator, rewards take many other forms and complement a good salary. Also, remember that not all employees are motivated by the same thing.

Consider the full range of what compensates and motivates staff – flexible working conditions, team-building events, the chance for advancement, varied work, bonuses, incentives, benefits, training and development, special projects, etc. Taking it all into account will help you to create a reward structure that all employees value. Each employee should see a link between their efforts and their rewards.

Performance appraisals provide an excellent opportunity to focus on an employee’s performance by highlighting examples of good work and discussing areas that may require improvement. Well-executed performance appraisals can make employees feel valued, useful, and challenged in their jobs. If done properly, it can be a positive experience, and a useful tool for improving employee productivity and contribution, as well as developing professional skills.

What is a performance appraisal?

A performance appraisal is a formal review of how an employee fares against objective criteria and is a tool designed to facilitate constructive discussion between the employee and his/her supervisor. This exchange can clarify performance objectives, provide feedback about the employee’s performance with respect to skills and behaviours, provide a framework for identifying the employee’s development plans, and to serve as a basis for merit increase decisions. The goal is to create a documented assessment of an individual’s performance, and a plan for future development (see Appendix I for a performance appraisal template which can be adjusted for the practice).

Why are performance appraisals essential?

Formal appraisals are vital for managing the performance of people and organizations. They contribute to effective management by helping you to:

• Identify areas of strength and weakness among your staff
• Develop individual training
• Monitor standards, expectations and objectives
• Communicate the aims of the practice, and align individual and practice goals
• Foster positive relationships with staff
• Determine annual pay
• Improve overall organizational

What is the appraisal based on?

Appraisals compare the individual’s performance to their job description, and to goals and standards agreed upon at a previous appraisal.

A job description may change over time to meet the needs of the office. Always make any change with the agreement of the employee (and perhaps seek legal advice too). If the job description changes, base the review on the current one. Note that employers cannot unilaterally change the job description; this is akin to constructive dismissal.

Which staff should be assessed?

Formal performance appraisals are generally conducted annually for all staff in the organization. Each staff member is appraised by their direct manager.

How often should appraisals be held?

Once or twice a year is advisable. Aside from these regular appraisals, managers should have one-on-one discussions throughout the year with staff regarding work progress, training and development, career goals, etc. Either the staff member or their supervisor can instigate such discussions. These informal talks will make the actual formal appraisal less stressful and uncertain, and more productive.

How should employees be rated?

Performance standards should not be unrealistically high, as the goal is not perfection but consistent striving for improved performance.

Terminating an employee is never easy, but is sometimes necessary. The rules on your obligations and the employee’s rights can be complex. For information, check the Ministry of Labour or call the Employment Standards Information Centre at 1-800-531-5551. It is always advisable to obtain legal advice before terminating an employee. Here are some guidelines.

What justification is needed to terminate an employee?

To terminate for “just cause,” an employer should speak with a lawyer specializing in employment law.

Demonstrating just cause can be difficult. Some steps that an employer may want to take in any case would include documenting non-performance over time.

Ideally, an employer should be able to demonstrate that they have followed “progressive discipline” procedures.

For example, give an employee adequate warnings, from an oral warning (recorded in their personnel file) to a written notice stating the problem and proposed solution. It is important to have the employee sign any disciplinary documentation placed in their file, and include any employee comments in response to discipline. If performance remains unsatisfactory, follow up by either a second written notice or termination.

What kind of notice is required for termination?

If the employee’s contract is limited to the Employment Standards Act (ESA), generally the employer must provide a written notice of termination, termination pay or a combination (as long as the notice and termination pay together equals the length of notice the employee

is entitled to). The period of statutory notice varies depending on the length of employment, from one week for staff employed between three to 12 months, to eight weeks for staff employed eight years or more.

If the employee does not have a contract limiting notice or pay in lieu of notice to the ESA, the common law will apply. Often, this works out to one month of pay for every year worked up to a maximum of two years. In these cases, the courts will look at a variety of factors, including how senior the employee was, how long the employee worked for the employer, how old the employee is, what the employee’s chances of future employment are and whether the employee was induced in any way to accept the position.

When calculating notice or pay in lieu of notice, it is recommended an employer speak with a lawyer.

When are employees not entitled to a notice of termination or termination pay under the ESA?

Examples include employees who are guilty of willful misconduct, disobedience, or willful neglect of duty that is not trivial and has not been condoned by the employer, employees on temporary layoff, employees who refuse an offer of reasonable alternative employment, and employees who have been employed less than three months.

Employers should contact a lawyer prior to making decisions regarding notice or termination pay.

What are the employer’s requirements during the statutory notice period?

During this period, an employer must:

• Not reduce the employee’s wage rate or alter a term or condition of employment
• Continue to make whatever contributions are required to maintain the employee’s benefits plans
• Pay the employee the wages he or she is entitled to, which cannot be less than the employee’s regular wages for a regular work week