PROACTIVE PRACTICE MANAGEMENT
 
"Performance Reviews. I hate doing them; and they're time consuming. Are they really necessary? If so, how do I conduct a meaningful performance review?"

Yes, they're really necessary. And conducting meaningful reviews are not difficult when properly planned and orchestrated.

But before we get started on the subject matter, let's go back to when the employee was first hired. A quick review of the steps to ensure a proper hire are to (1) request a resume with cover letter, (2) have the potential employee complete a thorough employment application and sign it, (3) conduct a brief preliminary interview to collect these items and to get to know the applicant. After the interview, research past work history of the employee by comparing time lines on the resume with the time lines on the employment application; but sure they are consistent. Contact previous employers and ask them the following questions to corroborate the applicant's information; and be sure to ask to speak to the doctor, or owner of the practice!

  • Confirm dates of employment: "When did the employee start working and when did employment end?"
  • Confirm salary range: "What was the rate of pay when the employee started, and what was it at the end of employment?"
  • Job duties and responsibilities; were they adequately performed: "What were the employee's duties and responsibilities? How well were they performed?"
  • Strengths, weaknesses: "What would you say are the employee's greatest strengths? What are the employee's weaknesses?"
  • Terminated or resigned: "Did the employee resign, or was the employee terminated?"
  • Re-hire: "If you had the opportunity, would you hire the employee back to your office?"

Confirm with the application and resume that the dates of employment match up; look for consistency in date ranges and identify any gaps in employment. For example, if the potential employee provided information showing he or she worked from January 2008 until February 2010, yet the previous employer shows dates worked from January 2008 through March 2009, make note and prepare to ask the potential employee about the discrepancy in employment time lines.

Rate of pay is important since you may be interviewing a candidate who is outside your normal range of pay for the position. And, the candidate may claim a higher rate of pay from previous employment to leverage better pay.

The reference may be reluctant to provide any information that may damage the candidates' ability to seek and acquire employment. Although, some states have passed laws that require a person must show "clear and convincing evidence" that the former employer acted in bad faith in providing job-related information. Ask the above questions confidently as they are standard and safe; and wait for responses that will help lead to a decision to hire or not.

In addition to the steps discussed here, an employer may find that conducting a background check of an individual, going beyond a friendly recommendation for hire from a colleague or other respected source. To be too trusting can be a detriment. Embezzlement and fraud in dentistry is rampant; careful hiring starts at the onset.

Once you have an employee in place, performance evaluations are a necessary management tool that will help people achieve and even exceed their potential. It also is the stronghold for an employer to keep tabs on business operations and essential in helping employees realize strengths as well as their shortcomings in order to improve performance. When orchestrated properly, these evaluations are powerful developmental tools.

The following will help guide doctors through a simple performance evaluation in order to gain the most positive experiences for themselves and their employees as well.

The evaluation assesses performance on a yearly basis, but there should be a plan set in place for the day-to-day process as well. This assessment would be applicable for any employee; new or established, especially when people are hired under the right circumstances. Best employment practices follow a standard for other employees to realize this is necessary for their continued employment.

This may feel unnerving to the new employee, but it helps keep expectations high, in the same way as keeping an existing employee from not becoming complacent. Therefore, for new employees, provide an evaluation at the end of a 90-day orientation period; yearly for the established employee. Both doctor and employee will come to the meeting with their ideas on performance thus far and ways to improve performance; usually this information is in the form of a templated employee review form.

If an event occurs that requires immediate attention, don't wait for the scheduled "Performance Review" to discuss this situation; address it immediately. If this is a repeat offense, the disciplinary process must be instituted. This process should be followed exactly as your Employee Manual specifies; usually an anecdotal write-up that a formal verbal discussion was held, including the employee behaviors and recommendations for correction that were discussed. If problems continue, a formal report listing documented incidents, recommended solutions, and disciplinary actions set forth should be made and become part of the permanent employee file. This report must be reviewed and signed by both employer and employee. When documenting employee behaviors, be certain that you remain objective. Never contain subjective documentation.

For a subjective example; 'Julie seemed aggravated and snapped at a patient'. An objective example; 'Julie stated "You have to sign this" pushed papers across the console quickly toward the patient and left the room. Upon leaving the office, the patient exclaimed, "Wow, that was rude!"'

In addition to documenting objectively, make sure that the date, time, and patient initials are included so that during the performance review or disciplinary process the facts are clear.

Structure the evaluation as part of an ongoing process, rather than a solitary event.
Although formal performance evaluations are structured to occur on a scheduled basis, as stated previously, employee behavior and job performance should be evaluated daily. This is an ongoing process; tedious, yes, but valuable. It will be the keystone in the continuous supervisory cycle of refining job descriptions, setting goals, providing constant feedback, and coaching. Doctors must be actively engaged in these supervisory duties and not take the path of least resistance. If gone unresolved, unacceptable activity or behavior that causes stress and frustration may fester not only with the doctor but with other staff members. Eventually tempers flare.

Make anecdotal notes during the period.
When staff members perform well, make a written note of these events as well as when poor performance is observed. Write down specific actions, results, and dates in an informal file. Use a spiral notebook and label it "Anecdotal Notes", have a space for each employee, and keep it in a locked desk drawer. These notes are not part of the "official" personnel file. Over the course of a year, since one has developed a trained eye for these matters, there should be dozens of written anecdotes that will assist in accurate recall.

Have available the date, time, and specific issue or behavior that occurred. Here is an example of an incorrect note:

"Sometime before lunch last week, overheard employee cursing under her breath; showed anger in front of patients."

"Observed {Staff Member} being a team player."

Here is an example of a correct note:

"1/9/2011: 10:35 a.m. Used the profanity 'shit' within earshot of patients, slammed down telephone receiver."

"2/12/11: 9:30 a.m. Overheard {staff member} ask other team members, "I'm all caught up with my work; is there anything I can do to help you?"

Focus on the relationship and specific job duties; not the paper evaluation form.
Don't let the written evaluation form become a restriction; use it as a guide. Consider adding questions not listed on a form that pertains to the individual's job description or duties. This may provide for a more meaningful evaluation for the team member.

Schedule the meeting in advance; provide a blank copy of the evaluation.
Block out time in your day to conduct performance evaluations. Yes, productivity is sacrificed; but these meetings are important and are vital to the future performance of the practice. Remember the management edict, "Work ON your business (dental practice), not just IN your business." Give a blank copy of the evaluation and ask the employee to evaluate his or her own performance. Attach a copy of the job description for reference. Suggest the employee consider assembling notes on the following:

  • Achievements and/or successes
  • Ways to improve upon performance (including perceived barriers to change)
  • How well the employee believes they work with others
  • Special skills acquired during the period that add value to the practice
  • Plans to enhance performance through continuing education of interest in the coming year

Let enough time pass before the evaluation for both the employee and doctor to assemble their information; usually a week will suffice. Be punctual! It sends the wrong message to employees when performance reviews are late or cancelled.

Keep it private.
Conduct the review in a private area of the office. Focused communication as well as confidentiality is required. If the facility doesn't have a private place, consider a neutral site that is quiet where interruptions are avoided, other than a true emergency.

Be objective; "Just the Facts"; listen carefully.
Make sure that the information you give on an employee's performance is strictly objective. In other words, provide only the facts as you have documented them during the period. Keep your language forthright and clear. If the performance is outstanding or unacceptable, say so. Computer management reports may aid in demonstrating exceptional or poor performance; use them if applicable. Allow the employee to share his or her views of performance, listening carefully to the other side of the story. This helps the employee take an active role in the evaluation without diminishing the authority of the employer.

This part of the session is the most important part of the evaluation. Again, it is extremely important to view issues objectively with evidence.

Eventually, the employment review will end with the two performance evaluations signed by both parties. An action plan agreed upon by the employer and employee that will help the employee improve performance and focus on the future goals of the practice must accompany the signed documents.

Both the employee and employer must sign and date the evaluation. This will become a permanent part of the employee's personnel file. At this time, introduce a merit increase, if applicable, or bonus for exemplary performance. Remember that the act of conducting a performance review does not imply a merit increase or bonus.

Performance evaluations can be stressful. And, some people shy away from this important personnel management tool in order to avoid confrontation. The evaluation must be truthful; otherwise if a problem employee is dismissed and all evaluations showed good quality performance, the disgruntled employee might find justification in pursuing legal action because of wrongful termination.

Use these tips to become more proactive in handling performance reviews, and create an environment that reduces stress during the evaluation. Continue to work on ways that will enhance people and practice performance.