A performance review guaranteed
to pay dividends

The time you take to do it right could be the most important
30 minutes you ever spend on your practice

By David Elkins

Performance reviews — and why they're essential to the smooth running of any practice — were covered in the last issue (NRM Feb 15, 2004, Vol 1 No 3). As promised, in this issue, the focus is on how to actually conduct a successful one. You may believe that it's just a matter of sitting down with an employee and having a chat. If that's the case, you may also think the only question you have to ask your staff is, "So, how's it going?" How wrong you'd be. A proper performance review is as much a science as it is an art. You want to be certain that both you and your employee come out of it with valuable information that, if followed up on, will improve practice life for everyone — staff, patients, and yourself.

Here are a few things to consider before you begin:

• Keep the focus on how the job's being done, not on the personality of the person who's doing it.
• Focus on specific duties, not on the job overall.
• Be open, stick to details and, it goes without saying, be objective.
• And — an absolute must — do it in writing.

Base your review on a job description that lists, briefly, the duties that the employee is expected to perform. If you haven't done this in the past, there's no time like the present. Job descriptions don't need to be complicated. A receptionist's job description could be as short and sweet as: answers phones, keeps practice appointment book, greets patients, tidies reception area, handles mail, files patient records, orders supplies. Another approach, especially if you've never established job descriptions, is to have employees write their own and then go over them together to make sure you agree on what the duties actually are. One warning: given the opportunity to write job descriptions, it's human nature to pad it out here and there. In going through it, make sure you both understand the descriptions and how much time and effort are required for each. You may find that certain things being done aren't really necessary or that excessive amounts of time are spent on tasks that have low priority to the overall health of the practice.

When the time comes for the annual review, list the duties on a sheet and consider each one in order. Assign a score to each item. The rating system should be established in advance and be clear. Many practice management consultants favour a one-to-10 scale. Using the system, five is average, a 10 is the best you can be, and a rating of one likely means instant dismissal. A three, on the other hand, suggests that there is considerable room for improvement short of a firing. At the other end of the scale, a seven isn't a terrible score but it's nothing to crow about either — better work is needed to be considered outstanding.

THE RATING SYSTEM
Be judicious in using the scores. A 10 should only be awarded for exceptional performance. Caution is called for at the lower end as well. A series of scores of five or less sends a message to the employee that maybe it's time to start looking for another job.

A word about what to say when performance lags: praise is a far better motivator than criticism. Make sure you show that you appreciate good performance and don't stint on giving credit where credit's due.

Here are some of the questions to ask after the fine points have been covered:

• Do you enjoy your job? What part do you like least/best?
• If you could improve anything about your job what would it be?
• Do you have everything you need to carry out your duties efficiently?
• Are you making progress professionally? Where would you like to be at this time next year? In five years?
• What kind of training, if any, would help most?

The answers to some of these questions may cost you money — extra training, for example. Though this may go against the grain, generally speaking, training boosts self-esteem and, provided it's chosen carefully, efficiency as well. Employees may request additional office equipment, a new computer or an upgrade on the copier. Other non-monetary items may also arise: flexible hours, for example, a change in office layout or workstation location. And then there's the big one: raises. The time to grant salary increases is at the annual performance review. If you've decided that you're not giving any raises this year, announce it beforehand to the whole staff — and stick to it. Otherwise, award salary increases on the basis of merit.

In larger offices, it's customary for the physicians to review the office manager and have the manager conduct further reviews beginning at the top and working down.

Pull this one off and you'll see quick results in overall staff morale.