Dear Bill

"I have had a hard time keeping employees. About the time I have them trained they leave. And now my best employee is pregnant. How do I get employees to stay and be motivated to do the job I've specified in their job description?"

Free contraceptives?

I'm kidding.

This is a critical ingredient if you want a practice of significance and influence. Having a stable, well-trained and motivated support team is essential. Staff turnover is quite expensive, even though you don't get a bill in the mail. Besides distracting and dispiriting, when new faces come and go too frequently it can erode patient confidence.

This topic, and related issues, came up during a recent one-hour telephone chiropractic consultation. Here are some of my observations and suggestions.

Revealing Use of Language

If you're a regular reader of this chiropractic blog you may have noticed my frequent focus on language and word choice. That's because the words we use are a window into our hearts and how we see ourselves in the world. I noticed three important word choices in the doctor's question above. Did you catch them?

Employees – At first glance this is a term that merely defines the legal relationship between you and someone for whom you hire, pay, and withhold taxes. They are employees. However this term frequently drips with status. Employees being inferior or subordinate. Using this term often connotes a focus on hierarchy, making the relationship arms length. Using a term such as team member, co-worker, support staff, or paraprofessional might be a more respectful terms.

Motivated – This suggests that there is something that one must do to another to urge them into action. Providing a bonus structure or other perks are often used for this purpose. But again this word choice may reveal insights into the relationship. Motivation, like a drug, is outside in. It must be continually supplied to maintain stasis. This is the outdated Industrial Age carrot and stick approach to management. More respectful is the term "inspired." Inspire is inside-out. The key is to add individuals to your team who can live their purpose by contributing to yours.

Job – Finally, referring to the opportunity in your practice as a job (Just Over Broke) is even more revealing. It implies that you're filling a slot, position, or chair; a cog in your practice machine. It makes the relationship largely transactional, trading the daily use of their body in exchange for money. As a result you get a different type of individual applying for your position than if you were to refer to it as an opportunity, career, or a calling. Which first requires that you see it that way.

A Career at the Front Desk

Chiropractors who contributed at the front desk of a practice before going to chiropractic college are often better at recognizing the opportunity being offered.

How long would you last at the front desk if you were merely asked to answer the phone, make data entries, supervise patient flow, clean the office, file insurance claims and the other largely administrative responsibilities?

Probably not very long.

No wonder the best people leave after quickly mastering these superficial requirements.

Chiropractors who are the most successful leaders deploy various strategies to enhance the emotional and psychological investment their team makes in the practice. Again, language shows up here too. Do you refer to it as "our" practice or "my" practice? "Our" patients or "my" patients? Yes, it's your name on the business license and the building lease. However, if you want your team to invest their discretionary energy in your enterprise you'll want to be more inclusive.

Naturally you'll want to conduct regular team meetings.

"But there's nothing to talk about."

Of course there isn't. You're carrying everything on your own shoulders and simply want automatons to do your biding. Yes, you make the final decisions, but you'll want to do it as a benevolent dictator, genuinely seeking feedback rather than issuing orders accompanied by the never-said-but-implied "because I said so."

The other thing you can do to bring significance to the sometimes mundane, but necessary procedures, is to share your clinical successes. At each team meeting share a patient case, complete with pre and post X-rays. Share your enthusiasm for the patient's recovery and how your team helped make it possible. How? By creating a healing environment. By making those recalls. By providing reassurance and encouragement. This is what "we" did. Remember, there's no "i" in team.

Working With Millennials

Besides the issues above there are several other elements that can contribute to high turnover.

Maturity – It's no secret that the current crop of millennials in the workforce is a new breed. This generation is often typified as not being particularly loyal or engaged. The trap is to rely solely on the paycheck to keep them committed. You may find older employees a better fit. Most tend to be far more loyal, consistent, and responsible.

Pay – That said, be prepared to pay enough. It's generally true that you get what you pay for. You're simply not going to get a quality contributor if you're being chintzy with the salary. And forget about using money to motivate. It rarely works. At least for very long. Far more enticing is to offer work that is significant and emotionally meaningful.

Philosophy – You have an additional challenge if your primary focus is personal injury cases. Patients rarely want to be in the practice. Creating a long-term connection isn't impossible, but more difficult. It's easy for patients to become whiplash cases rather than people with hopes and dreams who want to be their best. You'll want to take special care during your team huddles to avoid objectification. These are people, not merely spines, lawsuits, or rehab routines.

Finding a Unicorn

One of the largest challenges facing chiropractors is finding a candidate for the front desk who is personable and has the right-brain people skills that make patients feel welcome. But who also has the left-brain precision with numbers, organization, and can seemingly do three things at once.

Individuals with equal left- and right-brain powers are as rare as unicorns. If you currently work beside one, congratulations! You may not see another in your lifetime.

Most practitioners must decide on candidates who offer one dominance over the other. As you know, there are pros and cons to either one. Problem is, most chiropractors don't know which one they have until after they're hired.

Besides some simple pre-hire testing, which I'll recommend below, one way to ameliorate this problem is when adding a second individual to your team. Make sure your next addition represents a strength in the opposing hemisphere.

New Hire Orientation

In most practices it's not uncommon to be replacing team members every three years or so. Spouses get transferred. Aging parents need children to be closer. Life happens.

Besides having everything written down in an up to date procedural manual, you'll want a resolved onboarding process. With the demands of keeping the practice going, you don't want to lose momentum trying to find helpful videos, insightful recordings, or scrambling for training materials.

Many practices train their newest members with our 48-page booklet What Every Chiropractic Assistant Should Know and our one-hour audio seminar Chiropractic For Assistants. The key is to have your staff training materials in place before you need them.

If you currently have someone on your team who can finish your sentences and anticipate your every want, it's easy to become complacent. As if this will last forever. It won't. These are the practices hardest hit when the impossible and the unlikely converge to create the need for someone new.

Often neglected is the chiropractic portion of the training curriculum. Your support team does not absorb chiropractic principles simply by working within proximity of your adjusting tables! Without this training it makes it difficult to be an advocate for chiropractic, recognize opportunities to ask for referrals, or be mindful of patient comments that hint at disenchantment or an imminent flight risk.

Pre-hire Testing

It's understandable if you're scarred by your experiences hiring team members. Many chiropractors are. This resignation often produces new hires who have little more than a pulse and the willingness to exchange their time for money. They're merely waiting for a better offer to come along while they're creating the first and last impression of your practice.

Once you accept the possibility that you offer a meaningful career opportunity, set your sights higher. Instead, many chiropractors sugar coat their employment offers in the hopes of merely getting someone with a pulse. They tend to use a beige want ad such as this:

"Front Desk Receptionist for busy Chiropractic Office (PM hours): We need an organized, friendly, people person to help us help others—will train. Phone number etc."

Yikes! If I ran the zoo I'd try the opposite approach.

I'm reminded of the purported want ad published a century ago by the British explorer Ernest Shackleton who was recruiting men for his trek to the South Pole. No sugar coating here:

"Men wanted for hazardous journey. Low wages, bitter cold, long hours of complete darkness. Safe return doubtful. Honour and recognition in event of success."

Shackleton was flooded with applicants.

If you're not willing to phrase your employment opportunity with the downside and the upside, at least include the emotional rewards that can come from their contribution. If you've tried the safe approach, you might be ready to be more forthcoming. Perhaps something like this:

Multitasker Wanted for demanding chiropractic front desk adventure, modest wages, competing demands, occasional miracles and frequent patients who rave about their experience. Can you help us help more people?

And be sure to test the final candidates. Adding a personality assessment can be a great gut check. There are two I'd recommend.

The Myers Briggs personality test measures one's psychological preferences—how someone sees the world and makes decisions. You and your final candidates can take it for free.

The other essential test is the classic DISC profile. This personality test measures your relationship with Dominance, Influence, Steadiness, and Conscientiousness. You and your finalists can take the test online for free as well.

Between your intuition, the test results, and some basic assessments to uncover arithmetic and spelling skills, you're sure to make better hiring decisions.

There are few business decisions you'll make that can more dramatically pave the way for a smooth and fulfilling practice—or make it a living hell, than your hiring decisions. Having a well-trained pit crew is important if you want to take names and make a serious ruckus.

Get this wrong and new patients are lost on the phone. Or key opportunities are missed while you're out of earshot helping patients.

Or drag your feet when you should replace under performing team members and you'll pay a hidden tax and create a needless drag on the aerodynamics of your practice. Remember, hire slow—fire fast.

Thanks for the question!

Ask Bill your question.

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