United States: Smart Staffing In A Changing Health Care World

Last Updated: January 5 2016
Article by Amanda Gutierrez

Physician practices are being asked to assume new roles and responsibilities; even the success of the practice is often left in the hands of the staff while reimbursements are stagnant or even declining. It seems that more staff is needed to carry out these new responsibilities. Some of these responsibilities include value-based services, patient engagement and enhanced accountability. There are more efficient ways to address the concerns such as staff rations, patient focus and job descriptions.

There are several principles to a 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. In time, a mismatch becomes apparent, productivity suffers, morale declines and the employee is let go.

One improvement to avoid such scenarios is to establish detailed criteria for the position before beginning recruitment. This would require scrutinizing potential candidates so that you find somebody that meets your requirements and fits into the practice's culture.

It has become 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.

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 is an established norm in forward-looking practices to use advanced practitioners, such as PAs or NPs. A recent survey of 1,066 physicians and practice administrators nationwide by the Physicians Practice website found that more than 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 is often different from that of physicians.

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.

To develop high-performing staff, you must provide them with a clear vision and objectives and then follow up regularly with feedback on their performance. It is important to prepare accurate, comprehensive job descriptions and give them to all employees. Update staff whenever job content changes.

Give the practice routine and provide informal comments 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 is constructive. Look for legitimate reasons to compliment employees, preferably in front of co-workers. It will do wonders for everyone's morale.

It is critical that you look for bottlenecks and processes that can be simplified. 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.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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