So setting mutual expectations for your practice, we've heard a lot about in the prior presentation setting those expectations and clearly communicating what is expected is a great starting point. I have no disclosures. So when we have unclear expectations, it's one of the top frustrations for employees especially when the organization is going through change and without the clear expectations because it really supports that age-old saying of we fail to plan, we are planning to fail. So what does mutual expectations do? It provides a focus for us, it decreases frustration, and it allows for constructive criticism and benchmarking. That's one of the elements I hadn't really thought of when we sit down with employees as we've talked about sitting down during the interview process, through the orientation period. When our expectations are unclear regarding what our expectations are, it makes the constructive criticism process or the benchmarking piece much more difficult for us. So on the pre-employment side, we set the mutual expectations by the schedule and we talk about are you expecting the APP to work Monday through Friday? On the weekends, what hours of the day, what day off may they have, which locations would they need to go to? Of course, the number of patients per day, the types of patients they're going to be seeing, and of course, pay and benefits. I did put a little asterisk in here in the sense of I just need to remind everyone that the employer always has the right to make changes to fit the needs of the business. And this comes about when there needs to be possibly a change in maybe the days of the week that are worked. So for example, if you've had only, if you've had two APPs in the practice, if each of them have had four 10-hour days, and now one of them is moving out of the area, you may need to go back and have one of the APPs work Monday through Friday. And that is just the fact that we have the right to change the structure of the business or the structure of the hours to fit the business need. And then during employment, you're going to want to set those mutual expectations for productivity and efficiency, and efficiency usually comes about in charting in the sense of how long it takes for someone to complete all of the after-work processes. I once went through an interview process with an APP, and we just did one of the virtual interviews with her, and I said, hey, just tell me, what's the end of your day like? What are you doing toward the time you're wrapping up? It's now 5 o'clock in the afternoon, and tell me what your final hour is. And she goes, oh, it's not an hour. I'm usually charting until 8 or 9 o'clock at night. And we backed up a second and said, but why are you doing that? And she said, I just really can't let go of the storytelling and charting, and our physician realized that that's not the type of individual we wanted to hire. We need somebody who can get to the meat of the story with the patient, but not document an entire novel. And so we realized that wasn't going to be a good fit for us. So again, the quality of care in the sense of, do they know the right diagnosis and treatment plan? And again, as we've mentioned, are their chart notes clear and concise? Do they have great customer service, and are they part of a team, or can they work as part of a team? Whether it's a team with the management staff, their colleagues as APPs and MDs, we're really looking toward making sure that they know that they're going to be a part of a team and are expected to participate as the team member. When we're setting the expectations, we want to make sure that they are what we call smart, that they are specific, they are measurable, achievable, realistic, and timely. So when we had talked before in the orientation process and the list of symptoms that we used, one of the things that we could do is we could tell a new APP, for example, and work with them to say, okay, our expectations are that you would see 14 patients per day by September 30th, let's say it's now January 1st, by September 30th, and to be able to manage all of the GI conditions as we've listed on the symptoms list. And that way, we've measured it, we've set a timeline, and we've set what our expectations are. And you need to communicate that there's no room for confusion. You don't want to do this in a drive-by scenario. So, for example, if you're a lead APP and you're working with coaching new APPs, don't just walk by the consult room and say, hey, by the way, you just need to do more office visits by next week. You need to set aside that time, dedicate to that, you need to prepare in terms of what you're going to communicate, and include any examples if you have them available, and then, of course, put it in writing. Sometimes you may want to tell the individual first what you need to meet about so that they're prepared. I'm sure there's nothing more unnerving for any employee, whether it's an APP or front desk staff member or medical workers, whoever, myself included, is that you don't want to walk into a situation when you know they need to be talked to, but you don't know what the subject matter is. So, you might want to give them a heads up, hey, next week, I'd like to talk to you about the number of patients you're seeing, how you're doing on the diagnosis list, are you progressing well enough, what sort of resources. So, I'll meet with you next Thursday at your break at 10 o'clock, and we'll spend some time just chatting. And that way, you set the stage for them, they know what to expect, they're not going to be nervous ahead of time. You sit down, you have that meeting, it's Thursday at 10 o'clock, and then afterwards, you put in writing what you discussed. Today, we chatted about the fact that we would like to increase the number of patients that you're seeing, or include this diagnosis code, we realized that we haven't spent time with you in mentoring in that, so we're going to go ahead and get that arranged, and we both mutually agreed that by this time in three weeks, you should be able to see this next GI condition. And you do want to meet regularly, and you want to focus on the wins. You want to make sure that you hold them accountable, because expectations only work if you're held accountable to them. And you want to schedule those regular check-ins. We do our MD and APP check-ins once a month, again, when the APP is just getting started for about 30 minutes. Right now, our managing partner is still trying to meet roughly once a month with each of our APPs, even though a number of them are quite seasoned. It's not so much for the check-in of how they're doing clinically, in the sense of their quality of care with the patients. As I mentioned before, we are incredibly blessed to have a great group of APPs who are fabulous with patients, and they have a deep knowledge of GI. It's more just a check-in to see how they are doing, especially during the COVID crisis. We unfortunately had to furlough them for a number of months. And when we brought them back this past month, it was important for our managing partner to sit down with them and just check in with them to see how they're doing, to reassure them that we are hopefully back on the right track and will not have to hit another furlough situation. And you also, when you want to emphasize those wins and give praise accordingly, no one wants to sit down with their lead managing partner, for example, and always hear the negatives. You want to balance that with the positives as well. But what if there's no mutual agreement regarding the expectations? So I think it's really easy for me to sit here and say to you, here's what you do. You decide what your mutual expectations should be. Like it's this many, again, patients per day, these many diagnosis codes that you could see. And then say it has to be measurable, it has to be realistic, it has to be done with a timeframe in mind. I think all of us intuitively know that. I think the challenge comes in is when you don't agree with the expectations that are being put forth. And what sort of tool do you need to go through that conversation? One of the best books I've found is called Crucial Conversations. And as the author defines, it's a discussion between two or more people where the stakes are high, opinions vary, and when emotions rung strong. I've actually used some of the teaching in this in my personal life as well. It's sometimes struggling with your spouse, for example, when you don't agree. This book walks you through how to have those crucial conversations. And they use the acronym of STATE. So state your facts, tell your story, ask for the other's path and viewpoint. You can talk tentatively, and then you encourage the testing. So for example, if one of our newer APPs, again, we've had to furlough them for the past two months, and now we're back on track. We are going through our continuing onboarding and training session. And let's say that we had missed the fact that we didn't, we had had their old templates in place, meaning that we had expected them to see, say, 16 patients a day now. And if the APP realized that they're not ready to see that number of patients per day, they may have approached this from this crucial conversation. Hey, Barbara, I realize that my template right now has me slated to do 16 patients starting next month. I want to tell my story that I'm not ready to do that yet. I missed two months of my mentoring due to the COVID crisis. I'd like to come back and ask for, this is the ask path, I'd like to ask to have a few of those appointment times blocked for the next two to three weeks until one of the MDs has some time with me to go over the next list of diagnosis codes. Would you be okay with that, that talking tentatively and encouraging the testing? I'd like to see if that's okay with you. My reply, yes, it is. Thank you for bringing it to my attention. I hadn't thought about that component. So encourage the testing of, and I'd like to go back and follow up with you in three weeks to touch base with you, for me to tell you how I'm doing, and then we can move forward. So that didn't put either one of us at odds in the sense that she wasn't arguing with it. She was going through that process of stating her facts, telling me why it was important to do this. And she told it from both the, I'm feeling uncomfortable coming back from COVID, not only because I haven't had the adequate training, but we had put so many more workflows in place because of COVID that we have realized we need to add another block within the schedule to help keep everyone running on time and to make it a lot less stressful. And then she asked for the viewpoint to see how I saw the situation and she talked tentatively and we encouraged the testing going forward. So it brought us together in the sense of what our mutual conversation and mutual expectations are going to be. So from the practice pearls from this is the mutual expectations can increase the clarity and the satisfaction and also can increase the engagement of the employee with you. And there, it allows for that basis of benchmarking and the constructive criticism. Constructive criticism becomes much more difficult if you have a very unclear expectations to begin with. But as I mentioned, it may require some strong communication skills in order to reach that consensus and understanding. Thank you.

mutual expectations

practice

communication

Crucial Conversations

employee engagement