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Urgent care centers are service businesses whose long-term viability depends on patient loyalty and word-of-mouth. That’s why, for instance, urgent care entrepreneurs spend tens of thousands of dollars in selecting the right locations, equipping them with the latest technology, and then devising creative marketing campaigns to bring new patients through the door. But while these investments all contribute to urgent care success, they’re still minor compared to the one that makes the greatest impression on patients—the front-line staff.

The “front-line” includes any staff member who regularly interacts with patients—in physician offices this typically refers to front office specialists, medical assistants and technicians who support physicians and other providers.

The following points demonstrate why the attitude, efficiency, competence, sense of urgency, attention to detail, and communication of the front-line staff impact a patient’s willingness to return to the center and tell others to do likewise:

  • The majority of a patient’s interactions are with the front-line staff, not medical providers.
  • Front-line staff enables the medical services for which the center exists.
  • Front-line staff assures the center gets paid for the services it provides.
  • Front-line staff controls communication between patients and providers.
  • Front-line staff controls patient flow and documentation.
  • Front-line staff knows most intimately patient expectations, impressions, and satisfaction.
  • Front-line staff is typically the largest expense item on the center’s profit and loss statement, after medical providers.

Consider how a registration specialist greeting a patient walking through the door contributes to that patient’s lasting “first impression.” No matter how well clinicians treat a patient—a disengaged or disgruntled registration specialist can still undermine the entire operation. Because most medical visits are reimbursed by insurance, errors or shortcuts in benefits verification and data entry at registration can result in costly re-work by the billing function, patient frustration with the collections process, and ultimately, in the center going unpaid for services administered. Yet despite their obvious importance, all too often registration specialists are viewed as an expense to be “controlled.” Because they’re typically the center’s least educated and lowest paid employees, they’re often excluded from center meetings, their opinions on how to improve operations are frequently overlooked, and in extreme cases, they may be treated as “disposable” and easily replaced.

Anyone who debates the value of the front-line staff should consider the operational impact of a practice manager taking a day off—the operation will continue without a supervisor—but when a center is short-staffed, everything can spiral into chaos. Moreover, when the needs of front line staff are ignored, consequences include:

  • Frequent turnover—contributing to periods of short-staffing, high unemployment premiums, and increased recruiting and training costs.
  • Poor quality service—contributing to patient hostility and negative word of mouth.
  • Non-compliance with internal policies and external regulations—contributing to mistakes and legal liability.
  • Conflict and power struggles between staff members, staff and managers, and staff and patients—contributing to the development of subversive subcultures.

Two Mechanisms to Establish Authority

As an urgent care leader, there are two mechanisms to engage staff around the center’s mission and values and to get staff members to enthusiastically follow:

First is authority by title—“I am your boss and therefore you must do what I say.” Such managers derive power from their ability to scrutinize, question, punish, harass or even terminate an employee. The result is staff who questions the manager’s competence, resents the manager’s interference in their work, ignores the manager’s commands, goes over the manager’s head, or who simply does the minimum work required to avoid the manager’s scrutiny. Staff rarely trusts a manager whose authority comes by title.

The second mechanism involves “winning the hearts and minds” of the staff. If you want to motivate someone to act, you have to establish affinity with that person. Affinity is a liking, agreement, or resemblance to another person that is the basis of becoming “real” to somebody. Until you establish affinity, being “non-real” is the same as being “non-human.”

And one cannot effectively lead if he is an “object” and not a “person.” Is there any wonder why surveys show that up to two-thirds of American workers do not trust their bosses? Affinity establishes a leader’s “personhood” and thus willingness for staff to follow.

In order to establish affinity with front-line staff, urgent care leaders cannot be wishy-washy. They must have a firm understanding of the values that guide the center and be personally committed to those values. Managers get exactly what they focus on. So if an urgent care operator believes, for instance, that patients are human beings who are invaluable to the center’s success—he will develop staff that treats patients with respect, compassion, and understanding. However, if the operator believes that patients are merely a means to an end—such as the center meeting its financial objectives—staff will begin to treat patients as “objects” to be “processed” or in extreme cases, “annoyances to be dealt with.”

Fortunately, unlike other service industries like retail and hospitality where front-staff “happens upon” employment without thought to their values and beliefs—many individuals choose health care professions because they sincerely want to “help” people. A successful urgent care leader will tap into the staff’s innate desire to provide a welcoming, compassionate, and skillful experience to every patient served.

Establishing Affinity with Front-line Staff

“Winning the hearts and minds” of staff entails helping them feel that they are important to leader and to the organization. Through the leader’s authentic communication, staff comes to understand the humanity of the leader, realizes that they actually do share the same values, and believes that the leader has everyone’s best interests at heart.

By contrast, activities that limit communication, rely on formal structure for authority, or puts staff “in its place” results in attitudes that the manager is self-centered, is without feeling, and is undeserving of the staff’s energy and passion.

Which of the following multi-unit urgent care operators do you think is more effective in motivating staff to deliver a first-rate patient experience?

  • When one operations director arrives at the center, he spends most of his time cloistered away with the center’s supervisors discussing staff-related issues. He paces the hallway with his cell phone, text messaging and talking with his superiors, and when he does look up at staff members, he neither acknowledges them nor calls them by name. After his departure, the center’s supervisor “slams down” the staff for everything the director observed that was wrong.
  • Another operations director makes it a point to spend one day a month at every center, to memorize every employee’s name, and to actively listen to employee concerns and suggestions. She purchased a portable charcoal grill to personally make hot dogs and hamburgers for the hurried staff. As staff members take their breaks to grab a bite, the director learns their names, hobbies, interests, and workplace concerns. The act of humility of not only buying—but actually preparing and serving—lunch to the staff creates a strong affinity between the staff and the leader.

In order to create an emotional connection with the center’s front-line staff—to get the staff to like and trust you as a leader—consider the following activities.

  • Suggestions for establishing affinity with front-line staff.
  • Know and use the first name of every staff member.
  • Make eye contact with staff members and acknowledge them by name when passing.
  • Smile and be happy to see staff members. Ask how their day is going or how their weekend was.
  • When choosing between helping an employee and finishing a report, choose to help the employee.
  • When choosing between answering an employee’s question and socializing with a superior, choose the employee.
  • When meeting with staff members, give your full attention and do not rush. You are investing in your staff.
  • Protect staff from abuse from providers, patients, vendors, injuries and overwork at every turn.
  • Get to know employees and the people around them, e.g. family and children. Remember to ask about what you know is important to your staff members but ask for permission before asking a personal question.
  • Respect personal space and working territory. Keep the staff restroom and break room clean and well-attired.
  • Treat staff equally and courteously. Stay person-centered not task-centered.
  • Listen when staff speaks. Do not discount what they say or how they feel, and never speak down to them or correct them in front of others.
  • Know staff’s assigned schedule. Invite the return of staff after a maternity or paternity leave with encouragement and flexible schedules.
  • Jump in to help with any task when needed in a crisis or when short-staffed. (This is different than solving others’problems or taking over because no one else knows how or does it well enough.)
  • Allow and expect staff to solve problems, allow them to improve processes, and allow them to suggest solutions.
  • Recognize staff achievement—both individually and collectively—through verbal recognition and tangible rewards that are visible to everyone associated with the center. Make staff look good in front of others, e.g. other staff, their families and patients.

  • “Surprise” staff by providing lunch on busy days, with spot bonuses, or unexpected recognition activities.

Conclusion

An engaged and happy front-line staff is essential to a well-run and sustainable urgent care operation. Urgent care leaders who dismiss, overlook, or neglect their front-line staff will experience dissatisfied patients, negative word of mouth, increased operating costs, instability in operations, and increased risk. In extreme cases, subcultures may develop that completely undermine management’s ability to control the operation. The best remedy in “wining the hearts and minds” of the front-line staff is to create affinity—that is, through communication, to become “real” to them by realizing shared values, demonstrating humility, and emphasizing their importance to the operation.

Alan A. Ayers, MBA, MAcc is Vice President of Strategic Initiatives at Practice Velocity, LLC and is Practice Management Editor at The Journal of Urgent Care Medicine.

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