So you need a new health care team member ….

How many times do we knowingly or unwittingly hire the wrong person for our team? Why does this happen? How can we avoid making the same mistake over and over again?

One key to a successful hire is to have a clear definition of what your hospital expects from its health care team. Each team member (including the practice owners) living this tool is critical to reduced turnover and increased profitability. In addition, it is important to learn the candidates goals and if their vision of what makes a good practice aligns with that of the practice owners.

Creating the “What We Expect” document for your hospital is easier than you think. Just ask your current team members what it takes to be a successful coworker and what they want from the team. Use this information to create the “What We Expect list. This list will serve as the yardstick that measures contribution and individual performance. In addition, it will be used to determine the effectiveness of the departments and practice as a whole.

Your what we expect document may include statements such as:

We are independent thinkers and are constantly looking to prevent and solve problems. We share common goals and we have a sense of humor. The environment is one of hard work, accuracy, and fun! We always look for the good in people and situations. We do this so well that when we have to make tough decisions or choices there is a level of trust and support that everyone is willing to step up to the plate and choose the best course of action for the hospital.

We are constantly aware of our communication. We understand that the majority of our communication is in our body language, our delivery of words, our facial expressions, and LEAST of all in our choice of words. We project cooperation, teamwork, tolerance, and above all a positive attitude refraining from immature behavior. If we need/want something, we ASK for it. 

As individuals and as a group we are not overly sensitive. We are not easily offended and rather than make up stuff we ask for clarification. Above all we respect and care about each other and we address problems as they come up. We follow our golden rule – treat each other as well as we treat the clients and patients!

We are in continual motion – when it is not busy or we have a few moments – we offer our assistance to others. We do not wait to be asked – we anticipate the need and know that there is one team with one vision. We are creative with down time. Every team member takes the initiative to be attentive; to be busy rather than look busy, and remains conscious of team needs over personal needs. 

The “What We Expect” document becomes a valuable tool in recruiting. Hiring a new employee is a significant investment – estimated to be 30% of a full years wage. Although we all make hiring mistakes, sharing your vision statement and What We Expect document will help you make the best choices possible.

 The interview process:

During the entire interview process keep the What We Expect document in your thoughts. In addition, I feel recommend reading Working With Emotional Intelligence by Daniel Goleman Some Emotional intelligence competencies that we desire are: 

Emotional Awareness  -  the recognition of how our emotions affect our performance and the ability to use our values to guide decision making.

Accurate Self Assessments  – knowing our resources, abilities and limits. Self awareness is an invaluable tool for change.

Self confidence  – having a strong sense of ones self worth and capabilities. People with self confidence are decisive without being arrogant or defensive.

Self regulation  - especially self control under stress and the ability to adapt to change both of which allow calm in the face of those existential facts of work life - crisis, uncertainty and shifting challenges.

Although all work place competencies are learned habits they are also generally inherent and it would be our preference that the candidate already possessed some or all of these skills.

How to evaluate resumes:

Review resumes for employment history and experiences. It used to be that you looked for 3 – 5 years in each job to be good employment history but those days are OVER. In some situations employment of 4 or more years shows a lack of initiative and growth! You also must consider the age of the applicant and the types of jobs they have had. During school and the first few years after graduation many people bounce from job to job figuring out what they want to do. Your decision is whether or not you want to be one of their employers. Once these years are over if the candidate can’t keep a job for at least 18 – 24 months I would not recommend them for an interview.

Next, check for missing time between jobs. If it is more than a few months you need an explanation. Many times it is legitimate – military service, college, stay home parent, etc. What you are looking for are gaps where the applicant is evasive or does not have an answer – this often means incarceration or institutionalization. You can’t ask about mental or physical health but you can ask if they have been convicted of a felony. This should be on the application.

Group resumes based on your interest level.

Contact the candidates in the interested group and send them an e-mail with:

            An application

Job or Position Description

Compensation details

List of current employee benefits     

What We Expect document

Vision Statement

Let them know that once they read the information to please fill out the application and return it with references. Of course if you receive a resume from the perfect candidate you can call them to accelerate the process and let them know of your interest.

Some employers will have a packet at the front desk or on their website with all this information so that you only receive resumes and applications from serious candidates.  I would prefer to request contact by e-mail and then send out the packet rather than have all of the proprietary information on the web for curious consumption. 

 The Application:

The application will have information not contained in the resume such as reason for leaving jobs and salary history. My personal pet peeve is when applicants write SEE RESUME on the form and don’t even read the application to see that there are questions not answered by their resume. This normally puts them on the bottom of the consideration pile. It is considerate to let them know that you only need information on the application that is not on their resume.

Look for reasons why they left prior jobs. Ideally you want people who were happy with their jobs and employers and chose to move on for personal or professional growth, for increased responsibility or for relocation.

Lastly make sure the affidavit is signed stating that everything on the application and resume are true. This can be important if you find out they were not honest during the hiring.

Initial telephone interview:

 Regardless of the position you are hiring for you want to check out their telephone skills. With few exceptions all of your employees speak to clients and or vendors on the telephone. It is especially important with front desk and management personnel to have excellent telephone skills. Some things to listen for:

• If you get their machine – is the outgoing message friendly?
• Did they turn their TV/Music off or down when you called?
• If someone else answers the phone how did they treat them?
• Are they smoking? Eating?
• What is their tone of voice? Volume?
• Do they listen to you and answer questions accordingly?
• How is their grammar? Diction?
• Can you understand each other – language and accent?

 Inappropriate questions:

Under the Title VII of the Civil Rights Act questions regarding a candidate's race, color, age, sex, sexual orientation, religion and national origin are illegal. The Americans with Disabilities Act prohibits discrimination against individuals with disabilities, and The Employment Act protects against discrimination based on a person's age.

This is a partial list of inappropriate questions.

What church do you attend? What religious holidays do you observe?  What year did you graduate from high school? How old are you? Are you pregnant? Are you married? What provisions have you made for childcare? (Keep in mind that if there are special requirements for the job (ie: on - call), the employer may ask a question such as: To fill this position you must take call and when on call, you must report to work within 20 minutes. Are there any problem this presents?)

Are there problems with your credit rating? Have you ever had trouble with bills or collection agencies? What clubs or organizations do you belong? Are you healthy? How many days were you absent from work last year? Have you ever been hospitalized? Have you been treated for alcohol or drug abuse? Have you ever filed for Worker's Compensation? Are you a US citizen? (you can’t ask about their citizenship but you can ask if they are authorized to work in the US)

 Reference checking:

If you are interested in the candidate after the telephone interview send them a release form for their current and former employers. Even with this form it is possible that you will receive only the dates of employment and verification of wage especially if you call a large corporate company. You can e-mail a PDF of the form or send it via USPS. They can fax the form back for immediate use. You will need to have the original form for your files.

Why check references now – this early? Reference checking can be frustrating and time consuming. It is best to start early and hope that you have the references by the time all the rest of the interviewing is finished. Please make sure that the applicant knows that this is a part of the standard protocol and not an offer of a position.

 Department of Corrections website:

Check with the department of corrections in the state(s) where the applicant resides for an offender search. North Carolina’s can be found at http://www.doc.state.nc.us/offenders/. These sites are free and easy to use.

Personal interview:

Schedule an hour for each personal interview. It is a good idea to ask the same questions to each applicant. If there are a lot of applicants it is recommended that you keep a grid to record the basics. Were they on time, how were they dressed, eye contact, diction and other things that you can reliably measure and defend such as required education, experience, ability to be on call, work the hours, handle the physical aspects of the job. At the bottom of the grid you can have a place where you record the general impression of the interview. When the hiring process is completed attach this grid to the hired candidates resume and application. Keep the resumes and applications for the people you interviewed for three years.

Start the interview with some easy warm up questions. Let the applicant know that it will take 30 – 45 minutes. Once you get going if it looks like it will take longer ask them if they are OK with the timing. You want them to be comfortable and to talk freely. Ask open ended questions whenever possible to encourage them to speak. Use silence and open body language to draw out their experiences. Listen for what they are saying and also for what they are not saying. Ask questions for clarification such as: How did that go? How did you handle that situation? How did that make you feel? Did you feel supported by your supervisor? Once you ask a question be silent for 20 – 30 seconds. They are nervous and want to give you their best answer – give them time to think. Sit with open arms, palms up and leaning slightly forward. Maintain eye contact without staring and smile when appropriate. The applicant should do 85% of the talking in the first interview. Many people make the mistake of “selling” the job to the applicant and then being surprised when the person they hire turns out to be nothing like the person they interviewed. That is usually because they did too much of the talking or the person was VERY good at showing only what they thought the interviewer wanted.

Towards the end of the interview ask the applicant if they have any questions. Almost all of the basic questions would have been answered by the pre application information you provided.  The beauty of this system is that a minimal amount of time is wasted with the information up front and only serious candidates are in the pool.

 Volunteer/Working interview:

Select qualified applicants for a working day in the practice. Schedule time during this day for the applicant to meet with potential co-workers and have a tour of the hospital. This needs to be a working interview, not a stand around and observe. You want to see how willing this person is to jump in and do what they can. Make every effort to see that they are comfortable and welcomed. Let them know that you expect participation. Many if not all of the applicants may not have experienced a working interview before. If they are applying for the front desk have them greet a client with an uncomplicated appointment. Have them answer the phone, send a fax, file records, file records etc.. If they are applying for the lab or surgery have them set up a fecal, restrain (well behaved) patients, clean exam rooms, answer the phone, help put away food, draw lab samples (in house patient) and greet a client. If they are applying for the kennel have them walk (good) dogs, clean cages/runs, feed pets, collect a pet from a client and take pets up for discharge, clean a room or floor, help put away food and assist in the surgery area. You are not looking for proficiency – you are looking for how they think, can they solve their own problems, are they hesitant to perform a duty, are they comfortable around clients and co-workers and do they ask appropriate questions. Understand that they are nervous and continually let them know that you are glad they are there and any other non committal feedback you can give appropriately. Make sure that your team has the list of inappropriate questions above. Although you can’t ask any of these the applicant can bring them up in conversation. Regardless I would still recommend steering clear of any conversation related to these topics.

 At the end of the day meet with the applicant again for their feedback and any other questions either of you has. Let them know when you will get back to them and make sure to be on time even if you don’t have an answer. Ask your team for feedback – preferably in writing. Consider utilizing a working interview assessment form for consistent information.  

Whether or not to pay a “Working” interviews is up to the hospital. Most hospitals will pay the person that is hired with their first paycheck. Some hospitals pay a flat rate for a days working interview regardless of hire decision. If your interview and reference checking has been thorough the number of working interviews are very small and often the person is hired. Not every hospital does working interviews and I feel that is a mistake. Working interviews allow the team members to have a more accurate assessment of the new hires abilities rather than assumptions based on what they want or think based on the persons resume. Expectations are best handled with experience rather than assumption.

 Skills testing:

Skills’ testing is rarely done in veterinary hospitals and it has some challenges. If you do skills testing it needs to be fair and given to all applicants that are in the same group. My suggestion would be to use skills testing only on working interviews. Skills can be taught so this testing is not always a “deal breaker” as long as the applicant has basic reading, writing and math skills. Some of this can be covered early on by having the individuals you hire answer three of your interview questions in writing. Have them answer the questions while they are waiting for the interview.  Mathematical skills testing could wait until the working interview. Examples would be dosage and fluid rate calculations, cash drawer totals, change back, and basic math problems. Always keep in mind that any testing needs to be appropriate to the position and be fairly given – no trick questions.

 Orientation:

Having a thorough orientation is one of the best ways to get an employee off to a good start. Go over everything – where to park, how to call in, how to purchase products, make veterinary appointments, what to wear, hospital rules, social events, and everything else related to all employees. Hold benefits orientation on a separate date within the first sixty days of employment. This keeps part time team members from having to go thru the benefits orientation and does not overwhelm new employees with information. You will need to remember that a part time employee that converts to full time will need this orientation. Don’t skip or skimp on this orientation – it is important!

 Training:

The January 2005 Veterinary Hospital Managers Association Newsletter contains an excellent  article on training. I  wanted to mention it here because the lack of training is the NUMBER ONE reason new employees are unsuccessful. Training is an ongoing project – not reserved for new employees only.

What Are the Different Types of Managers?

Confusion surrounds this question. What is the difference between an office manager, a practice manager and a hospital administrator? The Veterinary Hospital Managers Association guidelines for the general duties of each position are listed below. These basic duties are an excellent tool to develop a program that fits the style and needs of your practice.

Office Manager: Generally, the office manager is responsible for day-to-day operation of the front office, employee scheduling and accounts receivable. The office manager is also responsible for performance evaluations of the receptionists and is the liaison with clients concerning problems or complaints. One of the most important responsibilities of office manager is to ensure the consistent application of client/patient service policies.

Practice Manager: The practice manager has all of the responsibilities of an office manager and has direct authority and decision-making responsibilities over all business aspects of the practice. The practice manager's realm of responsibility includes accountability for staffing, benefits management, marketing, budgeting, accounting, fee structure and collection, equipment management and facility management.

Hospital Administrator: Hospital administrators are distinct from other management positions in that they have complete and final authority over the operations of the business and the practice in accordance with the practice owners' directives. Hospital administrators are responsible, either directly or through supervision, for completion of all the duties listed above. In addition, they are responsible for professional (veterinary) staffing and supervision. The administrator should have a working knowledge of quality assurance and professional performance of veterinary medicine. S/he may also help establish the medical protocols of the practice. Once the protocols have been established, it is the administrator's responsibility to ensure their consistent application. Administrators use their talents and experience to combine the business and medicine of the practice to ensure quality care and profitability.

Certified Veterinary Practice Manager (CVPM): The Veterinary Hospital Managers Association launched their CVPM program in 1991. This process certifies individuals as competent in the six major areas of practice management: human relations, marketing, finance, organization, ethics and law. Individuals that pass the CVPM exam can be hired with the assurance that they possess the technical ability to manage any practice effectively. The CVPM certification indicates that the individual has had at least four years of experience in all aspects of practice management, that s/he will acquire 24 hours of continuing education each year and that s/he is most likely a career manager.

Contract Managers: Contract managers are new to the veterinary field and may be the solution to the long-term problem of need vs. justification of the expense. In general, a practice grossing less than $750,000 a year has few available dollars for dedicated management personnel. This situation has caused most practices to operate without a manager and has put a great deal of strain on the practice owner. In our competitive and heavily regulated profession of today, there is even more pressure to keep up with management skills than in the past. Contract managers can keep your practice up to date and progressive, while keeping management expenses within acceptable limits.

Contract managers can be used for short-term projects, such as implementing a safety (OSHA) program, recruiting a new employee or conducting periodic audits. Their services can also be used for more intensive, long-term projects, such as management of employees, financial analysis, budget implementation and strategic planning. The goal in using a contract manager is to have the benefit of his or her experience while keeping the total management expense in the 3.5%-5.0% range.

Do You Need a Manager?

The financial success of a practice depends on many things, with the ability of the practice's veterinarians to provide services being the most important. Can you be an effective practitioner when you are concerned about employee reviews, an OSHA inspection or when to schedule interviews for hiring a receptionist? On the other hand, can you be an effective manager when you have worked a ten plus hour day as a veterinarian, or do you cut your practice schedule to provide time for management? Aside from the professional activity, what time is left for family and personal needs? How much professional burnout is caused by veterinarians trying to do it all? If you do not have a manager now or your present manager is not effective, consider your options:

• Hire a manager.
• Share a manager with 1 or 2 other non-competing hospitals.
• Train (or have trained) a promising staff member.
• Have a contract manager hire and train and office or practice manager.
• Use the services of a contract manager.
  

How Do You Justify the Expense of a Manager?

Common belief holds that spending money on a manager reduces the net profit to the practice owner. That can prove true if the owner does not use some of the time formerly spent managing to generate additional income. However, if having a manager allows the owner five additional professional hours per week at an average of $250 per hour, this alone would increase the annual gross income by over $50,000. Realistically, the additional available hours would be more like ten to fifteen each week when you consider the time available and reduction of stress.

An effective manager will increase the gross income and the net profit of the practice. Even using conservative figures, funds would be available for management personnel, the practice would benefit, and the owner's quality of life would improve.

All of the above is wishful thinking if the practice hires an unsuitable manager. Actually, it could be a disaster. This and loss of control are two fears that keep practice owners from hiring managers. Most veterinarians do not have the training or the time to thoroughly interview prospective employees. If the owners are to delegate some or all of the control of the practice to a manager, they must be certain to select a qualified applicant and to implement systems for checks and balances.

Who Will Do What?

Before you hire a manager, take some time to decide what you want the individual to accomplish for you, how you will transfer control and how to structure his or her compensation. Lack of clear communication regarding your expectations can spell disaster and frustration for you and your manager. Transferring control and responsibility is probably the most difficult aspect to consider when hiring a manager. The compensation package can be somewhere between 2%-5% of the gross revenues of the practice. An office manager would cost in the 2% range, while a hospital administrator would cost closer to 5%. This 5% should include your entire management expenses including the administrator or manager, office manager, bookkeeper and the owner’s compensation for management duties.

Figure 3 shows a partial example of how to structure the transfer of control. This schedule is based on the expected abilities of a staff member having been promoted to practice manager and the assumption that s/he will be developing the necessary skills. The practice manager can perform all these activities. The practice owner must approve final decisions in advance until the transfer date has been reached and the owner has confidence in the employee. The most important aspect of communication is having a system of how to measure performance and expectations in a way that is clear and fair to all concerned. A system similar to the one below can go a long way toward a successful relationship. Complete a similar list for each management area and each department (e.g., Client/ Patient Production, Financial, Administration, Facility, Strategic Planning, Accounting, etc).

Figure 3. Schedule to delineate timing of transfer of responsibility for personnel management functions.

 
How to Find a Manager

When recruiting management personnel, you have two choices: You can hire from outside or you can expand the responsibilities and training of a current staff member.

Management personnel can move your practice beyond what you and your associates now accomplish.

It would be worthwhile to contact other practice owners that have managers to learn of their experiences. If you have a practice management consultant, ask him or her for a recommendation. You may also want to consider asking your consultant or contract manager to assist you with the interviewing process.

Grow Your Own

Most practices develop a manager from within their own staff. The best way to achieve success with this person is to invest in his or her training. Training opportunities are available through the Veterinary Hospital Managers Association, Mark Opperman's (VMC) School of Veterinary Management, Veterinary Management Institute and regional or national conferences with veterinary management programs. Your local community college offers inexpensive but valuable courses in accounting, finance and business management. These activities constitute a large investment in the individual.

The Employment Agreement

Always retain your manager with an annual contract of employment, including a non-compete clause to protect your interests. Another possible safeguard is to have the employee take out a line of credit or a five year loan to pay for any advanced training in management and have a written agreement for your reimbursement as long as s/he is employed by you. If s/he leaves your employ or is terminated before the end of the five years, s/he is responsible for the payments. A certain level of mutual trust and respect is necessary for this arrangement to work. An employment agreement can be very beneficial to the individual while protecting the long-term interest of the practice.

It’s Worth It!

Being a CVPM and career manager, I admit to a biased opinion on the need for management personnel. I see veterinarians whose home life and personal happiness are suffering because of the demands and stress of being a practitioner and a manager. These activities are difficult to combine effectively in a growing and developing practice. Consider the potential for growth in your personal and professional life if you could concentrate on the practice of medicine and share the burden of management with a trained manager.

About the Author: Ms. Pam Stevenson, CVPM is the director of Veterinary Results Management in Durham, North Carolina. She is a co-founder of the Carolina Veterinary Managers Association and a long time member of the Veterinary Hospital Managers Association. She received the designation of Certified Veterinary Practice Manager in 1995 and has over 22 years of hands on veterinary hospital management experience. In addition she has over 15 years of experience as a non-licensed veterinary technician. These experiences have produced a seasoned individual with a vast diversity of experiences in the veterinary profession.