Let’s look at this through the lens of Excellent ENT — a fictitious practice displaying a very real scenario. Over the past six months, the two hearing care providers’ conversion rates have dropped dramatically, and sales are down. They are both tenured professionals who have proven records of success with the practice. To remedy this situation, the practice decides to invest in a training to sharpen their skills and help pull them out of their rut.
Spoiler alert: The providers attend a training, and though they are open-minded and engaged, their results do not improve. In fact, in the three months following, they drop even further.
Through this article, we will investigate why this might have happened and how you can avoid this common pitfall.
Understanding Human Performance
To increase team performance, it’s important to understand the factors that influence how people work. Only then can you identify specific problems and appropriate solutions. Let’s explore the six factors of human performance, including examples of potential challenges within each.
Structure and Process: Often people overlook the operational elements that impact one’s workflow and ability to be effective. There are several process-oriented elements that could have an impact on individual or team performance. Some examples being:
- Walk-in appointments interrupting flow — often practices try to be accommodating by accepting walk-in or work-in appointments. What they overlook is that by double-booking one patient, you are not only impacting the provider’s schedule but also causing all other patients to wait, which can become increasingly frustrating.
- Wait times causing frustration — speaking of waiting, studies have shown that patients are only willing to wait a maximum of 20 minutes before becoming frustrated, yet the average wait time in otolaryngology is 24 minutes. When a patient is frustrated from the get-go, it is going to be more difficult to achieve their desired results.
- Insufficient time allotted for appointments — schedule for what you actually do, not what you want to do. If an appointment type takes 30 minutes, give it 30 minutes. If you schedule based on goals and not actuals, you will always be running behind, your patients won’t be getting the best care from you, and your wait times will skyrocket.
Resources: When the resources are missing, insufficient, or too difficult to use, it will inevitably impact the person using the resources. Here are some examples of how this can create performance problems for your team:
- Old equipment — if a person is constantly battling old, faulty, or unreliable equipment, it takes valuable time away from their focus and can cause them to be inefficient or ineffective in their role. The up-front investment will pay in dividends on the back end.
- Disorganized work environment — when a workspace is unorganized, every task takes more time and mental energy to complete. Ensure the right resources are available, and clear the rest of the clutter.
- Missing equipment — if there is only one sound booth but two hearing care providers scheduling hearing tests in tandem, there will be a constant battle over usage. Ensure that your practice has the right amount of equipment to meet the demands.
Information Exchange: This is all about communication and how information flows through a practice. There are several ways information flows in a medical practice, and different audiences have different usages and demands for the information. Ensuring everyone has what they need when they need it is critical to success and often an unseen breaking point. A few examples:
- Missing or incomplete patient forms — ensuring everyone who interacts with the patient has the information they need in front of them will eliminate unnecessary repetition and avoid assumptions being made.
- Lack of communication between positions — when multiple people interact with patients, it is critical to ensure they are all sharing information. Studies have shown that poor communication during patient handoffs in a hospital setting are the third most common cause of death, preceded only by cancer and heart disease.
- Practice changes not being communicated — medicine is ever-changing, and there are variables that dictate change that are outside of your control. When a process or procedure-based change needs to occur, how is it being communicated? Is everyone aware? And more importantly, does everyone understand the application?
Knowledge and Skill: This is where training comes in, when there is a gap in someone’s understanding (knowledge) or ability to apply what they know (skill). As noted in our example with Excellent ENT, this is often where people look for a solution when there is a performance problem. Some examples that fall into this category are:
- Someone doesn’t know what do to — either they haven’t been shown, they don’t understand, or they forgot. This happens frequently and is often a silent alarm, because many people are hesitant to admit when they don’t know how to do something.
- Lack of opportunity to practice skills — if a person is taught something and never has a chance to practice it, they are likely to forget. It is especially important to keep skills current and sharp in medical professions. Providing a safe place to practice is critical.
- Task assignment is beyond a person’s abilities — we all have a limit to what we can accomplish, and that is perfectly okay. Ensuring that the tasks assigned to your team are within their abilities is critical in setting people up for success.
Motivation: In the adage of skill versus will, motivation is the will. If your people aren’t motivated to do the work, it will be very difficult to change behavior. Motivation can be influenced, though it is the most difficult factor on which to move the needle and is often outside of your control as motivation lives within each individual. Lack of motivation is easy to spot because it often arises out of a negative attitude or signs of withdrawal, examples being:
- Conflicting values — if you are asking someone to do something that they do not believe in, it will be difficult for them to be motivated. Do your hearing care providers want to sell hearing aids or would they rather be doing diagnostics?
- The wrong person is in the wrong position — this happens very often when people are put in roles out of necessity rather than fit. If you have an unhappy, unmotivated employee, one of the first things to do is ensure they are in the right role. If they aren’t, chances are they won’t perform.
- Lack of appreciation — people want to feel appreciated and hear that they are doing a good job. For some people, appreciation is tied to compensation; for others, a simple “thank you” will do the job. Learn what makes your employees tick, and show appreciation on a consistent basis.
Health and Wellness: If employees’ basic needs of health and wellness aren’t being met, they likely will not be performing. We need to ensure our employees have their basic necessities met so they can thrive in their roles. In medical practices, this can often be associated with burnout.
- Lack of work/life balance — if employees are constantly worrying about getting out on time to pick up their kids from school or catch a soccer game, they are not going to be focused on the task in front of them. If it is impossible to take time off for personal appointments, frustration can grow and performance can decline.
- Burnout — there is no sugar coating the fact that working in health care can be stressful and can take a toll on employees. Be aware of signs of burnout, and give people the time and space to rejuvenate. Ensure employees are taking PTO so they have time to rest and relax.
- Poor mental or physical health — it is hard to be effective when we aren’t feeling good. Are your employees given health insurance? Are they encouraged to stay home when sick? This very basic need can quickly wear a person down if it isn’t addressed proactively.
Identifying The Root Cause
Now that you understand the six factors that impact performance, let’s think back to our initial example of Excellent ENT. Do we have any idea which of these factors are impacting them? At this point we are just guessing. Let’s add another layer of information to this story. We now know that in the six months leading up to the training, the practice hired a new physician, doubling the patient load, and to compensate for the increase in work, cut all hearing-related appointments’ time in half.
We know a little bit more, but the answer still isn’t totally clear. To identify the best solution, the next step is pinpointing the root cause or causes. This is what is referred to as a root-cause analysis. Below are the steps for this process.
- Step 1: Pinpoint the problem. In this case, declining conversion. Why is that a problem? Less revenue, fewer patients being treated.
- Step 2: Identify the relevant data for review. In this example, key performance indicators, including conversion, average selling price, number of patients, appointment times, types of patients being seen, change in contracts, and the like.
- Step 3: Identify causal factors. In this example, perhaps structure and process. The new scheduling approach has certainly changed things. Most of the other human-performance factors don’t seem to apply; however, information exchange — miscommunication about the time needed for appointments, for example — may be an issue.
- Step 4: Identify root causes — more information to come below.
- Step 5: Recommend and implement solutions.
3 Tactics for Getting to the Root Cause
- Brainstorming: A great approach when various perspectives are involved. Brainstorming allows for free-flowing ideas and creativity that can positively challenge others’ thinking. It’s effective for diverse teams or groups that are inclined to collaborate.
- Five Whys: This is an approach taken from the analyze phase of Six Sigma. Simply start with the problem, or the symptom of the problem, and ask, “Why is this happening”? Once you have the answer to the initial question, repeat it four more times. What you are left with at the end is often the root cause of the symptom.
- Surveying: Consider this approach when tackling a practice-wide issue with myriad possible causes. If you’re experiencing high turnover, an employee-engagement survey can offer insight from those affected. It can also prove useful if employees are intimidated by leadership and unlikely to speak freely otherwise.
Selecting The Right Solution
With the underlying problem and root causes now identified, you can explore various options for addressing the issue. With the Excellent ENT example, the root cause is likely information exchange. Changes in structure or process created the problem, but what created the changes in structure and process? Likely, it was a lack of information exchange around expectations and what is reasonable in a given time slot. Below are some ideas for common solutions around the examples we shared in the beginning.
Structure and Process:
- Leave specific time blocks for work-in patients
- Conduct a scheduling audit to determine where there is opportunity for change
- Schedule based on time needed per appointment per provider to reduce wait time
- Invest in necessary up-to-date equipment
- Create systems for organization and provide administrative time to stay organized
- Audit current equipment and needs to ensure the practice owns the right resources
- Determine who is responsible for getting what information from patients
- Implement a monthly all-staff meeting to discuss efficiency and communication
- Create a policy for rolling out changes; consider a weekly email newsletter for all staff updates
Knowledge and Skill:
- Provide ongoing training to ensure everyone is up to date on knowledge and expectations
- Rotate staff to give opportunities to practice skills in various roles
- Audit the organization chart to ensure everyone is in a role they can be successful in
- Audit job descriptions and place people in roles that meet their values and skills
- Consider parting ways with employees who are not a good fit for the practice — don’t hold on to someone for fear of being without
- Implement forums for appreciation such as shout-outs, thank-you notes, an all-star board, and financial compensation tied to your annual review process
Health and Wellness:
- Improving timeliness with appointments will allow for employees to adhere to their schedule
- Provide PTO and encourage employees to use it
- Provide medical insurance and consider other perks such as gym memberships or personal days
With the example we’ve been tracking of Excellent ENT, much of their strife could have been avoided by slowing down to consider why the providers’ conversion was declining and taking the time to communicate. As you can see, human-performance improvement is multifaceted and can be a daunting challenge. This is why Audigy has you covered. From operations and finance to human resources and professional development, we are experts in finding the root cause and saving you time and headache by helping to apply the right solution.
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