In radiology as in every sphere of gainful activity involving people in groups, poor staff management can hurt morale, weaken performance and stifle productivity. And that’s just among the physicians. When it comes to support staff—who generally can ditch unsatisfying jobs much more readily—the effects can be even more pronounced.
Where it often hurts the most is in the pocketbook: According to the Society for Human Resource Management (SHRM), the average cost to replace an employee is six to nine months of the individual’s salary. This adds up to $30,000 to $45,000 in recruitment and training costs for a support-staff member whose annual salary was $60,000.
Fortunately, there are tried, tested and even innovative ways to prevent a revolving door from spinning so fast that it blows a big hole in the bottom line. Here are 15 suggestions in six categories from experts whose experience base is centered right in radiology.
FEED(BACK)ING THEM WELL
1. Speak up soonest.
Jennifer Kirkman, MHA, interventional radiology supervisor at Cone Health Wesley Long Hospital in Greensboro, N.C., finds it’s best to deliver constructive feedback as soon as possible rather than delay it to spare employees’ feelings or for other reasons. Her rationale: Employees want to be successful, and a misunderstanding of expectations is easily corrected. Additionally, staff will grow resentful and disgruntled if feedback is regularly given without sufficient time to make changes.
“Quick action shows the leader’s engagement in his or her team and also will keep other team members from frustration because of the poor performance,” Kirkman tells RBJ. “Delayed corrections send mixed messages, which can have a negative effect on the department.”
2. Dial “s” for specific.
General feedback is worse than no feedback at all because it only serves to confuse people and engender resentment. That’s why Kirkman firmly believes all feedback—positive as well as negative—should be as to-the-point as possible.
“If I tell an employee, ‘Great job today,’ he or she may not know that I meant, ‘You did a great job making that patient feel comfortable during a difficult exam,’” she explains. Highlighting specific actions helps the employee to understand which behaviors to continue and which to stop.
3. Eliminate emotion.
In constructing feedback messages, Kirkman imagines herself watching video footage of the employee with whom she will share it. She asks herself multiple questions, such as: What are they doing? What am I hearing? What impact did the behavior have on the patient and/or department?
“Staying focused on actions removes any emotion from the feedback and prevents employees from feeling like their character is under attack,” Kirkman explains. Only when individuals grasp the issue as framed in objective terms (as opposed to subjective opinions) can they begin working to correct any suboptimal behaviors.
4. Go formal and frequent.
Proper performance appraisals are essential. “Employees need time with their leaders to review performance, highlight successes and discuss opportunities, as well as to share future goals,” Kirkman says. “It’s challenging to commit to these conversations without a formal process.” (See more about this from radiologist Peter Kalina here.)
For Kirkman, formal means regularly scheduled. She prefers quarterly over annually. But either way, predictability helps assure staff members that the meetings are, among other good things, a safe place for them to discuss their own concerns. “I don’t want anyone to have anxiety about having their performance reviewed,” Kirkman says.
5. Bend the rules.
The adage that it’s better to give than to receive doesn’t apply when it comes to communications between supervisors and their subordinates. Asking support team members to share their perspective and ideas not only makes them feel more valued—and less likely to seek employment elsewhere—but also can inspire changes that have a positive impact on employee morale and other aspects of the practice. Just ask Marc Rothenberg, MS, the CEO of Princeton Radiology in Princeton, N.J.
First a bit of background. Princeton Radiology merged with Quakerbridge Radiology in Hamilton in 2014 and Freehold Radiology in Freehold three years later. After the second merger, leadership sent a first-ever employee satisfaction survey to all employees.
The aim was to find out “what they were thinking, how they were feeling and what changes they would recommend,” Rothenberg explains, adding that practices of any size would benefit from a similar move whether or not they have been involved in M&A activity. Rothenberg says he wishes Princeton had pursued the same strategy following the first merger, as it would have smoothed out the initial consolidation.
The survey results made it clear employees wanted better access to the practice’s leaders, so quarterly staff meetings were instituted. Rothenberg attends these meetings with Princeton Radiology’s managing partner. In addition to making suggestions about additions to the agenda, employees are free to ask questions privately or in front of the entire group. The outcome of the meetings has been the open exchange of ideas, which has increased goodwill.
“Some of the best ideas come from inviting employees to give suggestions and make comments—really, to offer any feedback at all,” Rothenberg says. “You have to be open to that to be an employer of choice.”
6. Maximize input value.
When a project designed to reduce breach incidents in MRI zones got underway at Mayo Clinic Arizona, leadership collected staff feedback “to identify if the agreed-upon goals were being met and if there were any unexpected consequences” as new policies were implemented, recalls radiologist Laura Parra, MD. Such a strategy, she adds, “allows for optimization of the policy or implementation and emphasizes the value of support-staff input.”
The initiative included improvements to online training modules for personnel who need MRI access and the addition of hands-on training. Feedback about the value of the hands-on training led to a decision to repeat the exercise annually rather than simply offer it to new staff.
7. Oust objections.
Engaging support staff in doing more than their jobs may seem like a lot of work, but the payoff is substantial. If management doesn’t want to “buy in,” there are counterpoints to the argument that can be used to bring them around.
“Employee engagement ties heavily into retention, because it makes people feel valued to know they have a say,” observes Tina Rudisill, owner and president of Marketing Works in York, Pa. “People who aren’t engaged—and don’t feel valued—will go looking for new opportunities.” And if they don’t find any, their prickly attitude may rub off on co-workers, who themselves will feel the need to look for greener fields, notes Rudisill, a repeat RBMA presenter whose firm has begun offering healthcare transformation assistance under the banner of MW Healthcare.
Another argument for pushing support-staff engagement: “Stakeholder buy-in is a necessity for sustainability of an intervention, as it transforms the intervention or policy from something that is being imposed to a jointly agreed-upon goal,” Parra says. When the increase in zone breach incidents within Mayo Clinic Arizona’s MRI suite first came to light, the lead MRI technologist was invited to participate in a multidisciplinary task force charged with addressing the safety issue. This ensured that staff concerns were being fully addressed and that the solutions created by the task force could indeed be implemented by those doing the day-to-day work.
As a bonus, the invitation and the formation of the multidisciplinary task force made it possible to keep support staff, some of whom had some involvement in the breaches, alert and aware of the safety issue without causing anyone to feel scolded.
8. Opt for organization.
Princeton Radiology reports notable success with organized engagement endeavors, saying these can shape engagement and maximize participation. To those ends the practice has an engagement committee, a process improvement committee and a recognition committee. The engagement committee is charged with arranging opportunities for employees to get to know each other better and have fun within and outside the work environment. It recently planned a pre-July 4 in-office picnic (for which Rothenberg himself did the shopping), and, when RBJ spoke with Rothenberg, an excursion to a hatchet-throwing establishment was on the schedule.
Meanwhile Princeton Radiology’s process improvement committee is working on initiatives aimed at improving office efficiencies and enhancing the patient experience. The recognition committee spearheads efforts like “dress for a cause” days.
RATCHETING UP RECOGNITION
9. Give generalities the boot.
Steering clear of generalities when recognizing support staff for their performance is as important as being specific in giving them feedback. “General recognition—in other words, saying things like ‘you’re great’ or ‘this employee is great—does little or nothing to make people feel appreciated,” says Anthony Gabriel, MD, co-founder and COO of Radiology Partners, the national practice based in El Segundo, Calif. “Even if it’s during a casual ‘happy hour’ update, go into detail. Whoever is doing the recognizing should talk about what the staff member did to help the practice improve or carry out its mission—that type of thing.”
10. Get personal.
While nearly everybody likes to be recognized for a job well done, some prefer that it occur in private. “Not everyone finds value in standing in front of the department at a staff meeting,” Kirkman notes. For this reason, she has all staff members complete a recognition form to let her know how each person prefers to be recognized.
11. Teach your management—and yourselves—well.
Gabriel says conflict with management ranks among the top reasons support-staff members leave their jobs and seek out new employment. “Studies show that when people don’t like or have a relationship with their boss, they definitely see less of a reason to stay around,” he observes.
Radiology Partners combats problems of this type with boot camps in which managers can see behavior being modeled. The practice also invests in developing better leaders through programs like its RP University classes.
12. Stress self-improvement.
The more support staff know about a radiology practice’s culture and mission, the less likely they are to leave the fold, Gabriel believes. In September 2019, his practice launched RP Prep, a day-and-a-half program that orients incoming workers on the mission and culture of Radiology Partners in all phases of its operations.
Some RP University classes cover how leaders can be better employees themselves so they’re in tune with support staff trying to do the same. Under the auspices of the practice’s RP Foundation, support staff on the operations side can get primers on things like P&L statements and variance analyses.
13. Go up with upskilling.
The term may sound like jargon—it just means teaching or learning additional skills—but many believe upskilling can be a powerful retention strategy. Support-team members often want to expand their skillsets, and investing in a more educated workforce offers big potential to minimize employee attrition. In fact, a survey published last year by the PwC Healthcare Research Institute reveals that 75% of U.S. workers are willing to learn new skills or completely retrain to remain employable. More than one-third of healthcare employees who participated in the survey said it is “very important” to find an employer who would help them and their colleagues prepare to meet future work demands, while another 41 percent said it was “somewhat important.”
Investing in upskilling support staff will be especially critical as technology evolves, Andrew Hajde, senior industry advisor at the Medical Group Management Association (MGMA), tells RBJ sister publication Cardiovascular Business. He adds that competition, along with developments in and increasing reliance on data analytics, is boosting demand for educated support employees with expertise in benchmarking, efficiency and process improvement. Such demand, Hajde says, will remain the status quo in healthcare.
BREAKING OUT OF THE MOLD
14. Count on accountability.
Everyone—including physician leadership—should be held accountable for espousing the practice’s culture so as to decrease the potential to turn off support staff. “Managers shouldn’t get a hall pass when it comes to accountability in living a practice’s culture,” Rudisill asserts. “If they can’t buy in and lead by example, they should just be quiet.”
15. Say ‘so long’ to troublemakers.
Radiology practices and hospital radiology departments are often reluctant to terminate longtime support personnel who do their job well but are seriously lacking in interpersonal skills. In a word, they’re toxic. “Letting go of employees who are making others miserable isn’t always the easiest thing to do,” Rudisill says, “but sometimes it’s the right thing to do because it can be the only way to keep the employees you want to keep.”