In Part 1 of this blog series, we explored the issue of untimely processing of a clinician’s work, namely locking progress notes and signing off on lab reports and other documents. This time, let’s look at attendance and punctuality challenges that certainly vex many an administrator. Remember that we’re looking at this issue from the standpoint of the employed physician.
In the last installment, we touched on the importance of setting, complying with and enforcing policy. The first reason is that policies provide the framework for the standards of your practice. They also allow the administrator (or office manager) a norm to which you can hold your provider accountable. We frequently find, especially in practices that are transitioning from small to medium-size, a lack of established expectations, which makes it difficult to enforce a standard.
Don’t sweat the “policy” boogeyman. Something simple – one issue per policy – that spells out what you expect is sufficient. In the case of time, we expect our providers to be at work on time, ready to see patients at their scheduled appointments. Include the notice you expect – barring emergencies, of course – when a provider will be out for the day and the method of notification. The last thing you want is a clinician to email you if you’re not checking emails first-thing in the morning. One manager we know likes a phone call, not even a text message, at least two hours before the start of a shift. She wants to actually hear the employee’s voice on the line! Also, make sure your policy mentions any sanctions for repeated last-minute sick calls.
The next thing – and we can’t stress this enough! – is to keep track. The same holds true for any employee who calls in sick. One method is to use a calendar sheet for each employee. Lest you think this is overkill, consider the busy practice with a large staff: you might know someone’s out today but you may not recognize a pattern of sudden absences across one or more months. Some type of tracking system will reveal the individual who seems to always call out on Mondays, or after a holiday, or on Fridays. Also make a note of last-minute requests to leave early so you can observe any trends.
If your payroll system allows you to run a report of absences, and differentiates between a day off requested in advance and a sudden sick call, great! The point is to monitor easily and be quick to discuss any abuses. When staff calls in sick, administrators flex their team and perhaps deploy floaters to cover under-staffed areas. When a provider calls out, it’s a domino effect of scrambling to cancel the day’s schedule and trying to find new slots for all the displaced patients, who are understandably unhappy about the change. If your schedule is fully booked weeks in advance, it could jeopardize patient care and patient satisfaction when rescheduled appointments are delayed.
So, to summarize: set your policy and make sure it’s communicated throughout the organization; track tardiness and absences for all staff members and look for patterns of abuse; and finally, have “the talk.” The calendar (or payroll report) comes in handy for guiding a conversation with the practitioner; just show the person his or her pattern of absences and explain that the practice can’t continue to experience this level of absenteeism. You might learn that the provider is experiencing a family crisis – for example – and a temporary change in work hours might help all parties get back on track. Remember to document your conversation for the personnel file so you can refer to it at a later date, if needed.
In Part 3 of this series, we’ll explore scheduling disagreements. Hope to see you then!