Q: What is the function of an office manager?

A: The primary function of the office manager position is the accomplishment of the goals determined by the owner of the business. The office manager should assist the owner in developing policy that would forward the purpose of the business as a whole. It is the office manager's job to see to it that all members of the group are fully contributing to the expansion of the business, and that a high level of communication exists between the group and the owner.

The office manager should run the day-to-day activities of the office and keep the daily distractions off the owner/doctor's lines. This would be accomplished by ensuring that the office manager, first of all, was trained in the handling of staff, and felt comfortable with the hiring, training and correction of all staff members.

The office manager should be a person who understands the importance of communication, and the power that wide open communication lines can generate within any group. The office manager should energetically lead the group toward accomplishment of the established goals. The office manager should be someone with good communication abilities and someone who can really care for the staff.

The office manager would ensure that all internal communication systems are strongly in place and operational, and that the staff is taking responsibility for keeping all unnecessary "traffic" from and within their own posts to a minimum.

To effect the above, the office manager should have a strong working understanding of the management tools such as statistical management, the establishment of a communication system that really works for the office, written communications, job descriptions for each position, written policies for the practice, and personnel management.

There are many, many other activities and duties that fall under the purview of an office manager. Hollander Consultants provides extensive manuals that give more specifics. back to top

Q: How should I address fee increases?

A: A common and workable datum in pricing initial appointments is simply to keep the fee for the initial appointment low but competitive. High first exam fees can scare new patients or clients away.

If you are looking at raising any of your fees in the future, realize that patients/clients can tolerate slight frequent fee increases better than sudden sharp ones. Review your fees every 4-6 months and, if you decide that you are going to raise them, do so gradually.

Generally, it is much easier to just increase your fees as much as 10% per year across the boards, excluding any "loss leader" items that you may use. (i.e spaying and neutering for Veterinarians).

Only discuss fee increases with your patients/clients if they ask. Then do so directly, not apologetically. Link your increase to rising costs and explain that they are for the client and patient's benefit. Tell your clients that you could use cheaper materials of less quality or do less thorough exams, but that you insist on only the best for your clients and patients and refuse to compromise; therefore the fee increase.

Always speak of your fees positively. Say that a fee is a substantial investment in the health, comfort and well being of the patient. Don't ever use words like "expensive" or "costly."

If you perform "no charge" services, list those on your statements to remind your patients/clients of the nice things you do for them but haven't charged them for. back to top

Q: What do I do if an employee resigns?

A: In the event that an employee decides to leave the practice or business, they should be requested to submit a letter of resignation with a minimum of two weeks notice. Employees who resign may be entitled to benefits such as extended medical and dental coverage. Even if employees do not give two weeks notice, they must still be granted earned salary to date, accrued vacation pay and other benefits according to your employee policy. Always follow the employee policy you have written. If you have no such policy, it is imperative that you get such policies put together.

Prepare a final paycheck for the employee's last day of work. State laws govern the required timing of the final paycheck; check with your attorney for the requirements within your state. If a pension plan is in effect, let the employee know when you will arrange for the transfer of funds from pension plans.

Have the employee do an "exit interview" prior to leaving. back to top

Q: What is the benefit of written office policy?

A: In order to function most effectively as a team, agreements must be known and adhered to for smooth, efficient coordination and cooperation. As long as people know what the rules of the activity are, and those guidelines are clearly presented as being in the best interest of the activity, the policies will be followed.

Policy that is understood, agreed upon and adhered to will strengthen the practice or business in the achievement of the goals.

Even those "policies" that are simply in your head, and you figure "everyone knows" should be put in writing. By putting all policies in writing, problems and confusions that could otherwise surface will be curtailed and even eliminated.

It is advisable to create your "General Office Policy" to address fundamental issues that affect every practice or business. You should maintain a Master Policy Manual. Each employee should have their own copy of the policies of the business or practice.

Although once a General Office Policy Manual is developed, the practice or business will continue to generate new policies as time goes on and new issues and situations present themselves. When creating a new policy, place a copy in the Master Policy Manual and distribute a copy to each staff member. Request that staff then send written compliance to the Office Manager that they have read and understand the policy and that they have placed their copy in their respective manuals.

We have a 400 plus page Office Policy and Job Description Manual that would be helpful for any practice to use in implementing office policies and job descriptions. back to top

Q: How do I safeguard against embezzlement?

A: The following procedures recommended by an accountant should be part of your normal routine as safeguards against embezzlement:

1. Have a written policy that no balance write-offs or account adjustments are permitted without written Doctor approval.
2. Start a patient sign-in sheet listing services done that day. Compare this on a daily basis to a counter-collections report, looking for inconsistencies. Spot check by phone call with patients who are reported to not have paid a portion due that day. Implementing this policy, if nothing else, will make it appear far more dangerous to attempt embezzlement.
3. Firm policy that every patient gets a receipt whether they pay or not.
4. Have one person collect patient portions over the counter and another person post balances. Have a third person do bank deposits.
5. Spot check daysheets against patient charts, ledger cards (or patient account records) and the schedule book at least once a quarter, looking for any discrepancies. That you do this - sporadically - should be overtly promoted to the staff.
6. Review your accounts receivable aging report monthly. Look for changes from the last month's report that don't make sense. Scrutinize any balance over sixty days old as its existence normally does not make sense and minimally means a dropped ball by someone if not hanky-panky on collections.
7. Routinely check with visiting patients who have balances over thirty days old - and with past-due patients you are calling - to ensure they've received a statement from you. The idea here is to look for incidents of the collections person throwing statements out versus mailing them in order to cover a payment embezzlement.
8. Each quarter, compare the amount of your collections that was cash. There will be some fluctuation, of course, but if it goes low one quarter, it is suspicious.
9. Become suspicious if you find you are all of a sudden paying a lot of refund checks to patients.
10. Remove daysheets from the office each quarter, and store them at home or in a safe deposit box.
11. Always change the locks immediately when a key-holding employee leaves employment.
12. The last thing to remember is to assume that if someone can rip you off, they will - and take steps to prevent it; and if your antenna goes up on some circumstance, you carefully check into it.

back to top

Q: What is the best way to terminate an employee?

A: Of the many responsibilities of the office manager, having to terminate an employee is one of the most troublesome and difficult. Termination is the final step of investment protection, one in which the return on investment is wholly inadequate, justifying ending the investment. However difficult, it is part of the job and must be done in as timely and humane a manner as possible.

The materials that follow will help you make a better decision and, hopefully, provide face-to-face communication guidelines for handling the situation as confidently and gracefully as possible.

A major issue over which the office manager has a great deal of control and influence is whether the employee is motivated to fight back after being discharged, or will that employee simply move on to a new endeavor. We cannot forget that after the bad news is communicated to an employee, many thoughts rush through the employee's mind, provoking varying levels of feelings. These feelings about the situation, and how it was handled, determine if the employee will even call a lawyer and begin legal action against the practice. In other words, taking action against the practice depends on the employee's frame of mind and perceptions surrounding the entire termination process. Those perceptions are well within the ability of the practice to mold and influence.

How a termination decision is made, how the organization handles problems before termination, and how the news is conveyed face-to-face, all impact strongly on the employee's perceptions and consequent motivation to move on or to fight back.

MAKING THE TERMINATION DECISION
Deciding to terminate an employee is serious business for all involved. Considering the increase in litigation over terminations and the losses incurred by employers who have made unwise decisions, the termination must be based on a reasonably thorough assessment of the employment relationship. After all, that is what is being terminated, not merely the employee or the position.

Work is an investment relationship. However different or lopsided, the employee has invested something in the job and practice, and the practice has invested in the employee. Termination ends that investment. People don't abandon investments unless the return is unfavorable. Remember, the employee's investment is more risky (bills to pay; life to support), so he/she will have a hard time understanding why the company's "investment" is being withdrawn and this will present a greater challenge to the office manager to communicate.

BASIC GUIDELINES TO BE AWARE OF IN MAKING THE DECISION TO TERMINATE:

1. Protected Group: If the employee belongs to a protected group (minority), the likelihood of legal action is increased. Have all your documentation and facts clearly prepared.
2. Defensible Paper Trail: Make sure that the decision to terminate is backed in writing by specific, detailed documentation.
3. Risk Potential: Is the law clear or fuzzy regarding the facts of your case? Second opinions from labor lawyers are probably advised.
4. Public Image: Can your practice withstand any adverse public exposure through the spreading of the bad news in the community?
5. Organizational Culpability: A "failed relationship" usually has plenty of blame to spread around. To what extent has the practice "failed" the employee? Does the practice have a clear definition of its responsibilities to marginal or unsatisfactory employees?
6. Continued Damage Potential: Assuming the employee is not terminated and situation doesn't improve, can you stand continued "repeat performances"? What is at stake if improvement is not forthcoming?
7. Remaining Morale: Management credibility is really on the line in termination cases:    a. What impact would failing to terminate have on morale?
      b. What impact would terminating have on morale?
   
8. Twelve Strangers: How would 12 people completely unfamiliar with you, your practice and the employee judge the termination? With the record you have, would they conclude the action was reasonable?
9. Consistency: How have like situations involving other employees been handled? If differently, what differences justified such treatment?
10. Shooting From the Hip: Are you just trying to get rid of someone you don't like or does the evidence justify dismissal?
11. Procedural Consistency: Have published guidelines for company disciplinary procedures been followed to the letter up to this point?
12. Skeletons and Pretext: Sometimes companies try to cover up the "real" reason for termination and offer something that sounds plausible. Cover-ups usually unravel at very inopportune times, like with investigators and judges.
13. Motivation to Organize: Terminations can impact on seeking representation for employees. Do all the factors guiding your decision and your company's termination policies provide adequate "protection" against the perception of unfairness?
14. Receptivity to Help: To what extent has assistance been offered and how has the employee responded? Demonstrated willingness to cooperate and improve? Evidence?
15. Influence of Personal/External Difficulties: Are there any off-job problems which, in not being resolved, create or add to on-job performance?
16. Track Record: Why consider termination now? Does the employee have a history or track record of problems or is this something new?
17. Undeveloped Potential: Does the employee have potential for success in another job or part of the company? Working for a different supervisor?
18. Pre-termination Conference: Having followed the pre-termination warning and gotten nowhere, have you talked with the employee and given full hearing to his/her side of the situation? Assuming the stories differ significantly, have you accounted for why the differences exist?

GUIDELINES TO FOLLOW WHEN TERMINATING

1. When to do it: The best advice is to communicate the decision as soon as possible to the employee.
2. Time of day: The end of the workday is preferable when everyone else has left; this saves embarrassment.
3. Witness: Do have a witness present. This offers protection as well as evidence that various things were or were not communicated.
4. What to tell others: Simply let your staff know that ____________ (name) is no longer with the practice. If anyone has questions, tell them it is company policy that they would have to ask the person themselves.
5. After the News: It is wise to escort the employee out of the practice or else the anger often present could result in some destructive actions; necessity depends on the person and particulars of the situation.
6. Reasons: An employee deserves the respect and the dignity of knowing why they have been discharged. To fail to communicate or to try to cover something up with the employee is sure to provoke more outrage on the part of the employee. Convey the reason very simply; do not engage in a long discussion about it. Communicate it with respect. However, you need to use caution in what you communicate; we are in a litigious society and you don't want to give them grounds for a wrongful termination suit.
7. Firing Your Friend: This is hard to do, but has the built-in trust that will allow communication between you and your friend to help them understand. This does require you to be tough, as it would not be good for you to continue to carry a friend in a job when their performance is disastrous.
8. References: The safest policy to use as your guideline is the work history, their statistics, their performance review results, written warnings and reprimands, etc.
9. When the Employee Begs: If an employee begs for a second chance, you have got to be tough and be willing to explain things, yet without the slightest indication that you don't stand by your decision.
10. Arguing The Reasons: Don't argue with the employee. Indicate that you have the specific documentation supporting the reasons. If, on the other hand, the employee's arguing convinces you something has been overlooked, then indicate you will check it out immediately or as quickly as possible.
11. Breakdown: Do nothing unless your safety seems to be at stake. Let the catharsis run its course, then resume appropriate discussions. If the breakdown continues, let the employee know that you understand and that you will give a moment to regain their composure before completing the meeting.
12. Written statement: Providing a written termination statement for the employee is a bold communication that relays your ultimate confidence in the matter. Understand that the written statement could become part of the legal record and must be clear and strong enough to stand up in a legal arena.

GOALS FOR A CONSTRUCTIVE FACE-TO-FACE TERMINATION

The person doing the termination will be less likely to get distracted by emotions if the goals are kept in the forefront during the process. Concentrate on what is being attempted, not just the fact that you have to convey bad news, and the anticipated fear and discomfort usually can be minimized.

Five goals could provide direction for communication when announcing the termination:

1. Convince It's Best For Everyone: If the guidelines for making a termination decision are followed, you will probably have a good termination. Most employees who are in trouble know there is trouble but for economic reasons just can't admit that a termination might be justified. They are usually quite unhappy in their work and, were another job to be readily available, would probably (maybe at least in their own minds) thank you for the termination. In short, they know it's a bad relationship that is extracting costs that are probably even more troublesome. Your goal is to try to help them understand that larger perspective; the relationship isn't working out and should be terminated.
2. Minimize Possibility of Legal Action: How the employee is treated during communication of the termination makes a significant difference in his or her state of mind immediately following the announcement. In short, how employees are handled can encourage or discourage them to "fight back" or move on with their lives. You want them to "move on". Treat them with respect and understanding, yet firmness throughout the process.
3. Provide A Positive Exit; Build Self-Esteem: Few people are total washouts. Termination represents ending a relationship as opposed to indicating that the employee is a failure. Focus on this fact in an effort to make him/her feel worthwhile. Avoid anything that smacks of humiliation since you don't intend to decrease his/her self-esteem.
4. Minimize External/Internal Adverse Impact: Employees who are terminated usually have friends left behind; how you handle the termination can impact on the morale of those people. Your goal is to minimize injuring that morale. How you convey the bad news can demonstrate a caring, sensitive organization or one that is arbitrary, uncommunicative, and insensitive. The employees left behind will have perceptions one way or another. You want them to be positive.
5. Facilitate Orderly Departure: Tools, uniforms, etc., have to be turned in and various documents must be processed and signed. The employee's cooperation is needed to do this; therefore, communication must not give the employee an additional motive for obstructing an orderly departure.

THE FACE-TO FACE TERMINATION

Knowing that this is a "good" termination does not make the face-to-face encounter less difficult. It is intense. It is a task few people want, much less perceive as a constructive learning and growth experience for the employee. A reasonably humane, sympathetic attempt to end the painful encounter as quickly as possible is tempting.

However difficult, termination can be a relatively productive experience if handled properly, with finesse, tact and directness. Some situations will make the attempt at being positive, forward looking, and constructive out of the question. But the attempt should be made.

The ideas listed below offer ways of making the difficult encounter a reasonably productive one:

1. Indicate Intent - Be Direct: "Sally, the practice has made the decision to terminate your employment here (don't' say 'terminate you'). The decision has been reviewed, but we need to discuss a number of issues. I hope we can do so in a reasonably friendly manner. You have a right to be upset, etc., and I will understand."
2. Don't Apologize: Don't say:
   "It's hard for me to do this" or
   "I really hate to have to tell you this" or
   "We have tried to help you, but it just hasn't worked" or
   "You have left us no choice" or
   "I'm sorry" or
   "The doctor is making me do this."
   
   All of these phrases just make matters worse and make the practice look cheap and blameless. They add fuel to the emotions already operating and serve no constructive or situation-strategic purpose.
   
   
3. Allow Ventilation and Catharsis: If the employee starts swearing, yelling, bad-mouthing, crying, etc., just sit there and don't respond. He / she needs that emotional release for any constructive discussion to take place later on. Do not be tempted to put your arm around their shoulder, pat them on the back, etc. These innocent actions could be misconstrued as sexual harassment, even female to female.
4. Explain Reasons Specifically: Don't say things like "poor attitude" or "insubordination" unless you can cite the specific behaviors. Generalized statements leave too much room for interpretations and argument. You don't want that now, so have the hard evidence or documentation in hand.
5. Avoid Counseling: Trying to help him or her understand "where he / she went wrong" is productive if placed in the context of how it could be avoided elsewhere in a future position. Anything short of such a context not only won't work, but probably will add to the employee's emotional upheaval, or even begging for another chance, saying they'll change.
6. Discuss Remedial Actions: Offer Direction: Tell him or her how to apply for unemployment compensation, vocational training for skill development - anything which gives the employee hope for the future. Indicate that although the relationship hasn't worked out, you still feel a social/moral obligation to try to help the person adjust to the situation.

back to top