With Excerpts from Coaching and Mentoring for Dummies , Marty Braunstein, IDG Books Worldwide, Chapter 6, “Setting Performance Plans the Smart Way”.
As the practice owner (or manager), one of the most powerful points of leverage you have for having your practice be effective and successful is your staff. While you are ultimately responsible for virtually every aspect of the practice’s operations, and you could view your job as single-handedly accomplishing all of it, in the day to day reality of running your business, you have staff to accomplish most of those tasks. They act as your proxy and operate at your direction.
A common shortcoming of business owners and managers is an insufficient level of communicating clear direction and expectation to the people that work for them. If your staff isn’t crystal clear about your expectations, there is a very good chance the job they do won’t fulfill your expectations and won’t get done to your standards. When that happens, you can only look to yourself as the source of the shortcoming.
The question then, is how do you have your staff operate at a level of performance that is consistent with what you would expect from yourself? Given that your staff interacts with your patients far more than you do, this becomes a vitally important question for the success of your practice. Does your staff know what you expect from them? Are they clear about the standards of performance you are holding them to? Do they have achievable goals they are working toward while they are handling the day to day business of running your practice.
Creating performance plans – clear, specific and measurable – is one method for giving direction to your staff and insuring that they are working on what is consistent with your intentions for the practice. Further, it gives you and them something against which to measure to assess their effectiveness in getting the job at hand done. This provides you, the practice owner or manager, invaluable feedback on how your staff is doing and where they need development. Taking the time to put performance plans in place is a worthy investment for the future success of your practice.
Marty Braunstein, the author of Coaching and Mentoring for Dummies , speaks of performance plans as one of the “five pillars for building commitment” – the commitment you need to elicit from your staff so that they are accomplishing the tasks at hand consistent with the performance standards you set and to which each staff-member commits.
Braunstein writes of the “doer approach” to management – supervising staff that are working hard and are always busy, but not accomplishing what is needed to have your practice run at peak efficiency and effectiveness. This is what management often devolves to without performance plans in place.
Key ingredients of Performance Plans:
There are four key ingredients to successful performance plans:
- Goal (or Objective) – A performance effort you want to accomplish or a target to reach;
- Standards – Standards go along with goals, but speaks to a behavior expectation, or standards of work exhibited in pursuing the goal;
- Action Plans – The design, the roadmap, for reaching the goal;
- Measurement – Measurable milestones and endpoints to allow everyone involved to know when the goal is reached.
The first two, Specific Goals (what to accomplish) and Standards (how we will behave as we pursue the goals) are the core of performance, and the second two are the tools for knowing how to accomplish the goals and how to know when we’ve reached the goal.
Braunstein next outlines tools for creating effective plans. He speaks of the SMART way:
S = Specific and Clear – A one-sentence description of the goal or standard;
M = Measurable: When a statement of the goal or standard is read, the reader can tell that the results sought can be measured, and it will be clear when the goal or standard has been met;
A = Action-oriented: Action verbs lead and drive the goal or standard statement. Here are some examples with the right pizzazz for goals: develop, achieve, implement, create, produce, and maintain. Remember though, the action should have a measurable outcome;
R = Results-focused: This answers the so-what factor – what are you hoping to gain, what is the reason you want to do this, what are you looking to accomplish? What difference will it make for the practice? After you and your staff comprehend the results focus, the “aha” kicks in (Aha! Now I get it). And writing goals and standards becomes easy to do, and it will become easier to get your staff’s commitment aligned with yours.
One of the keys for success in performance plans is to make them results oriented, rather than action oriented. An example would be describing a goal as “Remind each patient about their co-payment amount at appointment scheduling, reminder call, and when arriving at the office”. This wording is more appropriate for an action plan. The goal oriented wording could be “Collect co-payments at time-of-service for 90% of patients with co-payments collectable at time-of-service” (excluding Medicare patients with supplemental insurance).
T = Time Frame: The “By When”! If you are implementing a new standard such as the 90% co-payment collection, it may not be achieved instantly. If the practice is currently collecting only 50% of the co-payments, the time frame may be worded “60% at the end of month one, 70% by the end of month two, 80% by the end of month three, and the goal of 90% by the end of month four”.
Measuring Achievement of Goals and Standards:
Here are some of the ways to monitor the achievement of the goals in your plan:
Quantifiable : Quantifiable means measurement by numbers: patients seen, eyeglasses sold, frame upgrades sold, lens upgrades sold, appointment slots filled. These numbers are usually key indicators that practices count and track, so goals in these areas are often easy to measure. And thanks to computers, the sta tistical reports showing the results are often at your fingertips.
Feedback and survey : Constructive feed back on performance is another measure of how someone is performing. This feedback, to measure a performance goal or standard, can come from you and from other sources, such as internal (other staff, physicians) and external (patients) customers. A survey is a more formal means for gather ing customer feedback and a great way to measure customer satisfaction with the service you are working to deliver
Audit, Test, Inspection: An audit is the use of external data to measure performance. An example would be the comparison of the operating room logs compared to surgery charge data to measure the effectiveness of surgical charge capture. A test is an independent measure of the effectiveness of work – for example, random re-refractions of patients refracted by a technician to measure accuracy. An inspection could be a review of a random sample of patient histories taken by a technician. An extreme, but effective test, used by Medicare to uncover or confirm suspected fraud, is to send a “test” patient to an office, with a programmed history. A practice could also use a test patient to assess the entire patient flow system in a practice.
Documentation: Reports, plans, correspondence, and other documents can be records that a planned result has occurred. Patient forms such as HIPAA privacy notices, Medicare Advance Beneficiary Notices, Medical Record Releases, etc., are all examples of documentation. Another example would be a compliance plan, the completion of which was part of a performance plan for a staff-member. The plan itself would be the documentation of completion.
Timelines: Again, the “by when” part of a component of a plan is a key measure of success. Any component of a plan without a by-when is not likely to be measurable for completeness. Some tasks, specially large ones, will require interim milestones, as well as endpoints.
Work Products and Samples: This is simply a spot review of work. For example, the manager takes a random sample of EOBs and reviews the accounts to determine the accuracy and completeness of payment posting.
Observation: This is the act of moving through the practice and observing various departments. Watch how the front-desk functions. Follow patient flow. Observe the billers. These activities can be invaluable in determining how various staff-members are performing in achieving their plan.
You can use some or all of these means to measure goals and standards. It may be useful to define, for yourself, how you will monitor each goal and standard of each performance plan as the plan is agreed-to by you and the staff-member.
Here are some sample performance plan components:
Sample # 1
Goal: Create and implement process improvements that reduce the current cycle time for month-end billing system closing activities from four days after month-end to two (50%) by July 1, 2003.
- By March 15, 2003, document current processes for handling month-end-closing activities and the average time for each process.
- By April 30, 2003, gather input from other staff in the department and draft a plan for a streamlined process.
- After reviewing the streamlined plan with management, perform a test run of the process improvements for May’s month-end closing.
- Evaluate the test results and make necessary modifications to handle June’s month-end closing.
Primarily, the cycle time for month-end close, starting June, 2003
Secondarily, the documented process improvement plan
Goal: By July 1, 2003, develop a Refractive Surgery Marketing Kit that provides the LASIK coordinator and the physicians with tools that they find useful in increasing their effectiveness in scheduling LASIK procedures.
- By Feb. 15, 2003, survey the physicians and LASIK Coordinator to assess their needs for marketing literature and other items that will help their sales efforts.
- By March 1, 2003, gather samples of marketing materials from other practices and LASIK marketing firms.
- Working with marketing communication vendors, by April 1, 2003, draft literature and create product samples and other necessary items for a prototype marketing kit.
- By May 1, 2003, conduct focus groups of practice staff, physicians, and select patients to test the value and usefulness of the marketing kit.
- By June 1, 2003, complete necessary modifications of marketing kit based on feedback gathered from the focus groups.
- Conduct training sessions with the physicians and LASIK coordinator to familiarize them with how to use the marketing kit in their presentations to patients , completed by July 1, 2003.
The goal of the performance plan is to encompass the staff-member’s total performance – that is, every aspect of their job
SMART performance plans are meant to encompass the person’s total perfor mance. How employees spend their time – the tasks and activities they are doing – is tied to the results or outcomes they need to produce. You don’t want your employees spending time in areas that don’t produce the results needed. If they’re spending time in something that you think is important, make sure a goal or standard is set to capture that area of performance, not just the fact that they are “busy” for eight hours a day.
Therefore, goals aren’t something extra in an employee’s performance. They are the focus of the employee’s performance. Everything each individual works on and all the key job-related behaviors needed are aimed at producing meaningful results. They are part of the total performance plan.
When you manage by plan in this way, you help your employees make the shift from an activity focus to a results focus. They can see their jobs on the br oad-perspective level; that is, how what they are seeking to accomplish helps the practice be successful. (It’s as though you are saying, “Sorry, you are no longer being paid to shuffle paper and mindlessly fill out forms. Now you have to accomplish goals that serve patients well and run processes efficiently.”
You join in this shift when you manage as a coach with performance plans because how your employees spend their time becomes much less important than the results they are producing; how they do their jobs becomes less important than the outcomes they are achieving . For example, with a receptionist, when you make the shift, your focus swings from things like whether the employee is spending time with personal phone calls to whether the desired number of patient appointments are being made, empty appointment slots are filled, and co-payments are being collected.
Effective performance plans can include:
- Output targets;
- Quality indicators;
- Service expectations for patient satisfaction;
- Major projects;
- Important solutions or changes needed;
- Key duties and skills to be used to produce results;
- Areas for performance improvements;
- Key job-related behaviors for reinforcement and for maintaining results;
- Attendance targets;
- Professional development.
A plan should have five to eight goals and/or standards, no more than ten. Plans with goals and standards in the double digits become unmanageable for both the administrator and the staff-member, or, you have a task list and not a results-focused plan.
A tip in getting used to designing effective plans is to begin with your own plan.