Motivating Your Staff

09/04/2008
O ne thing that can sap the lifeblood out of a cosmetic practice (or any practice for that matter) is employee apathy. Worse than apathy is employee hostility or resentment — this can poison a practice overnight. While I haven’t perfected a system of keeping my employees motivated, I have tried a few things that have worked and more than a few that have not. In addition, I have had the good fortune of working with consultants who have been invaluable. I have also had the help of Charlie Finn, M.D., and Sue Ellen Cox, M.D, who have shared their secrets for success. Finding the Right Incentives Yes, there are some stellar employees out there who will do everything they can to help your practice succeed because that is the way they were brought up, but these individuals are rare and worth their weight in gold. But even the best employee can get jaded if there is no material reward for exceptional performance. Incentive plans can help keep the staff motivated. In my practice, I utilize several rewards including health insurance, retirement accounts, paid vacations, paid employee trips and bonuses. Unfortunately, most of these are now taken for granted, and when I discuss employee salary, the only thing remembered is the hourly or annual rate rather than the entire compensation package (which should be included in each employee pay stub at least quarterly). Coming up with the right incentive plan that really works can be challenging. The Bonus Plan One popular plan is to establish year-end goals with bonuses tied to performance of the practice. If you choose to go this route, try establishing several important parameters at the outset. The first parameter is that bonuses are not “Christmas” or “holiday” bonuses — they are year-end performance bonuses. These bonuses can range from nothing to whatever number you decide is appropriate. Figures I have seen run the gamut from 20 hours to 80 hours of pay. Actual payment typically depends on a matrix. This matrix includes on-time and attendance records, input from the physician, input from patient surveys and profitability of the practice. It’s important that you separate profitability from income and explain the difference to your employees. While it is not their business to know the actual practice revenue numbers, it’s important to explain that there is a difference between collecting $100,000 and having a profit of $100,000. Too often, employees watch daily collections and assume that since the practice collected a certain amount that it was profitable. Be sure that they understand some basics associated with cost of goods (e.g., Botox, Restylane and other consumables). Once established, explain the matrix at a staff meeting. In my practice, we use a fixed maximum amount based on each person’s hourly rate or salary and then factor in the variables mentioned above. One problem with this system is that the employees sometimes feel that they are paid because it is a holiday and they may lose sight of this bonus for 11 months of the year. To counter this, I have tried to include a paid staff vacation in the summer months. Of course, this also can be taken for granted. Setting Goals Some other physicians I know have taken a new approach to employee bonuses by involving the employees in their own bonuses and making the system transparent and fun. The physicians and employees work together to create daily, monthly and yearly goals. Revenue and profit targets are established based on annual figures for both. A 5% increase is built into each year’s goals. This is a reasonable expectation for most cosmetic practices (many well-run practices can grow by 10%). Daily goals are established by taking the total revenue and dividing by the number of actual days worked. Monthly goals are established the same way. Once the daily goals are met, a gift certificate or dollar amount is added to each employee’s pay, and the focus moves to monthly goals. Monthly goals are rewarded by adding 50% of the daily amount to the amount awarded. If three monthly goals are attained consecutively, the bonus is doubled. In a practice that sells products, sales should be closely tracked and posted for the employees to see. Sales goals should be rewarded with a graduated reward structure that pays between 10% to 20% of product sales based on weekly goals. If sales of the minimum goal are reached, 10% of sales is added to employees’ pay checks. When higher set goals are reached, 15% and then 20% are rewarded. This will help motivate employees to understand your products and take the time to explain them. The actual percentages used to reward must be determined based on your practice and its profit margins. Emphasizing Quality Care In order for this to work, it must be transparent and consistent. It must conform to state and federal guidelines for potential violations of anti-kickback statutes. Remind your staff they are not selling used cars — they must consistently emphasize quality care and increase revenue by providing the best care possible rather than by loading patients with products they don’t need. The employees should remind you and other physicians in your office to code correctly, suggest ways to improve efficiency and do everything possible to help the appointments run on time. Suggestions for new office hours (nights, weekends) are also welcome. Empowered employees can make the difference between a practice that is driven and one that has employees that feel and act as if they’re being pushed. Education Perks One additional way to motivate staff is to educate them. This can include paying for online courses or education at a local community college. Some practices pay for this while others share the cost. Paying for employees to attend meetings such as the American Academy of Dermatology or meetings for coding or practice administration is another way to reward and motivate them. A more educated staff will also benefit your practice. Working as a Team I’m still learning how to motivate my employees — who are a group of really good people. I think it can be hard for my employees to stay as motivated as I do because their rewards are not as significantly tied to the success of the practice as mine are. And I know that sometimes it’s difficult to work for me (like a lot of other dermatologists) because I am very detail-oriented. In light of these issues, I’m still trying to work out a motivation system that can make coming to work fun and productive for my employees and one that will keep us on the same page.