The staff members in a doctor’s office will usually include administrative personnel first, and direct or auxiliary care providers second (if at all). Both employee classes need boundaries, guidelines and policies in order to be effective employees. A good distinction to draw is the difference between the social and the cultural. A social agreement in a business is anything written that describes rules and agreements. A cultural agreement in a business is the unwritten and usually unspoken set of shared values that dictate behavior. Moving towards a socially rather than culturally run organization is a worthwhile goal.
A track to run in
The basic document that describes the social agreement in a business is the employee policy handbook. This document describes the rules of being an employee in your company. It has to cover basis like how and when pay is delivered, benefit structure and eligibility rules, time off whether paid or not, etc. It should also cover the code of conduct of being your employee is specific detail. Arrival times, dress codes, out-of-office conduct, misconduct rules, use of company property, attendance and reliability, workplace safety, Industrial injury rules, etc.
Should you really have to tell your employees in exquisite detail how to conduct themselves? In a world where we all share the same cultural values, the answer is no, but that is not reality for better or worse. The fact is that if you do not address these things in detail as a condition of hiring, you will address them later in the form of employee/employer conflict. If you ever think to yourself, “How could he not know that it’s not OK to [fill in the blank], it means that you are missing an important policy piece.
Rules and hierarchies
Yes, this means imposing a hierarchy. However, a better way to think about this is that you want to give all employees a track to run in. If not, you end up doing the wait and zap approach to management. It goes something like this:
- Anyone with the common sense of a high school kid would be able to figure out what reasonable conduct in this job consists of.
- I won’t “micromanage” or insult my employees’ intelligence by telling them how to behave and what to say and do.
- I won’t set guidelines or boundaries.
- When they screw up and do something wrong, illegal or unethical, I will zap them with appropriate punishment.
…you want to give all employees a track to run in. If not, you end up doing the wait and zap approach to management.
A hierarchy means that employees report to you or to a higher level other employee if you are big enough. The concept of a hierarchy is uncomfortable to many doctors, particularly younger doctors, but it is a benign concept in and of itself. A hierarchy means that you answer to someone, and all players are not on the same level. Think of it this way: you answer to your licensing board, your insurance preferred provider panel, and a host of other regulating agencies. By virtue of having a license, you are by definition a part of a hierarchy. This does not mean that you are incompetent or childish, just that the greater good and the overall welfare of the stakeholders require this sort of structure. In order to provide consistent and high quality service, your office requires the same thin on a smaller scale.
Structure types
The work of Clare Graves outlined a description of structural types in a “first tier” way. This subject is complex and will be detailed in future blog posts. Briefly for use in your organization, here are some developmental levels. The color codes are a shorthand and do not correspond to any other types of color-coding.
- Red: Rule of the tyrant through fear and intimidation. Might makes right. Examples: Attila the Hun, Donald Trump’s, “You’re Fired!” (By the way, wasn’t he bankrupt and disgraced 20 years ago? How did he get to be an authority on anything?)
- Blue: Rule of law, reason and tradition. Greater good, collective cohesion, due process. Examples: Mother Teresa, Thomas Jefferson, Descartes, Thomas Watson. Almost all of law, medicine and government is based on blue principles. Understand what’s expected, follow the rules, be a good team player.
- Orange: Rule of individual achievement. Examples: Bill Gates, Steve Jobs, Thomas Edison, Watson and Crick. Most capitalistic and innovation achievement principles are orange principles. Get out of the box, get out of the comfort zone, challenge authority and tradition, build a better mousetrap.
- Green: Rule of egalitarianism. Everyone is essentially equal. Perceived differences are due to biases or attempts to control other people (see types just listed). All stories are equally true, whether “factual” or not. Facts are conceived things, a product of our interpretations. Examples: Eleanor Roosevelt, Ghandi, ML King. Most non-profits, social service and human rights organizations are run on green principles.
The take-away thought on this is that a successful doctor’s office now will run on a firm blue, rules-driven basis, with opportunity for orange innovation and personal excellence.