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Smart staffing in a changing health care world


While reimbursements are stagnant or declining, physician practices are being asked to assume new roles and responsibilities, such as value-based services, patient engagement and enhanced accountability. The success of these initiatives is often in the hands of the practice staff. It might seem that more staff are needed to carry out these new responsibilities. Fortunately, there’s a better answer — smarter staffing.

Making employment decisions

There are several principles to more enlightened management of practice human resources, which begin with thoughtful employment decisions. At times, management rushes to fill an open position, hiring the first qualified person who applies. Later, a mismatch becomes apparent, productivity suffers, morale declines and the employee is let go.

A better way is to establish detailed criteria for the position before beginning recruitment. That requires scrutinizing potential candidates so you find somebody that meets your requirements and fits into the practice culture.

Working at the top of their licenses

It’s become a cliché that practice personnel, particularly clinicians, should work “at the top of their licenses.” This means that each licensed person should concentrate on the highest level tasks that he or she is allowed to perform. If there are activities that both a physician and a nurse practitioner (NP) can provide, they should be handled by the NP. If there are duties within the license scope of a physician assistant (PA) and a registered nurse (RN), the RN should perform them. This often results in clinicians taking on greater patient care responsibilities — within the scope of their licenses.

In a cost-constrained world, it may make sense to employ more, rather than fewer, staff in different roles. The most effective practices often have greater staffing ratios for RNs, LPNs and advanced practice nurses (APNs). The cost of employing larger numbers of nurses recoups itself by allowing practices to see more patients and offer more attentive care.

It’s an established norm in forward-looking practices to use advanced practitioners, such as Physician Assistants (PAs) or Nurse Practitioners (NPs). A recent survey of 1,066 physicians and practice administrators nationwide by the Physicians Practice website found that over 60% of them employed at least one PA or NP. Physician recruiting firm Merritt Hawkins reports that the total number of recruiting searches for NPs and PAs surged 320% from 2012 to 2014.

Although the added cost of hiring more clinicians can be outweighed by the resulting improvements to practice efficiency and revenues, NPs also have a different approach with patients. They bring a focus on patient education and counseling, care coordination, and wellness promotion that’s often different from that of physicians.

Focusing on the patient

Depending on individual state laws, advanced practitioners are able to provide a range of primary and specialty care services that includes ordering and interpreting diagnostic tests, such as X-rays and lab work; diagnosing and treating acute and chronic illnesses; prescribing medications; and educating patients on disease management and prevention. This usually can be done independently or under physician supervision.

In summary, NPs and PAs help practices generate revenue by increasing patient volumes and allowing physicians to spend more time delivering higher-level direct, billable patient care. This new class of providers leverage their advanced medical training by focusing on more routine care and managing clinical tasks.

Job descriptions and regular feedback

To develop high-performing staff, you must tell them what you want them to do, and then follow up with feedback on when they are performing well or poorly. It’s important to prepare accurate, comprehensive job descriptions, give them to all employees, and update them whenever job content changes substantially. The description is the starting point for holding employees accountable for their work performance.

Get in the practice of routinely and informally commenting on employee performance. This is best done immediately after a relevant work event. Provide both positive and negative comments. Follow the rule, “Praise in public, criticize in private.” Critical feedback usually comes easily, so make sure it’s constructive. Look for legitimate reasons to compliment employees, preferably in front of coworkers. It will do wonders for everyone’s morale.

The bottom line

It’s critical that you look for bottlenecks and processes that can be simplified. And try to consolidate redundant tasks and train staff to take on more complex multiple roles. The outcome of these staff initiatives can transform a practice’s operations. Give them a try.