Staff Management During the Covid-19 Crisis You Need to Do the Right Thing While Simultaneously Keeping Your Practice Afloat

THE CONSULTANT IS IN / The Pandemic Update

Staff Management During the Covid-19 Crisis You need to do the right thing while simultaneously keeping your practice afloat.

By Lynn Homisak, PRT

To Our Readers: There are no nent” guidelines in place that serve tors can be left shorthanded and foolish questions. Chances are that as instruction for now. These may other aspects of business activities, if you have a question or concern in actually end up becoming the new typically conducted by administra- your practice, others are experienc- norm moving forward. tive staff, remain at a standstill. ing a similar situation. We’re here to The challenging question be- 35 help. PM [doctor and staff] readers Staff Shortages comes, “do I hold on to staff until are encouraged to submit questions According to a March 17, 2020 such a time that the pandemic safety to [email protected] which will be poll conducted by the Medical Group directives are lifted and office activ- printed and answered in this column Management Association (MGMA), ities can resume?” Or, “do I let staff anonymously. medical practice leaders were asked go, handle things without them for if they have experienced staff short- the time being, and re-hire new or Re: Giving Some Thought ages amid the spread of coronavirus/ existing staff as needed?” to Staffing Amidst COVID-19 COVID-19. Out of 1,220 responses, There is no one-solution-fits-all

Dear Lynn, I’m in the process of re-opening my practice to patients after closure One known document regarding a COVID-19 protocol due to coronavirus/COVID-19 and model, designed by the American Academy of Family struggling with how to lay a new foundation down for staff in particu- Physicians (AAFP), offers a preparation checklist. lar with their schedules, pay, infection prevention/compliance, and expanded job descriptions. I want to do the right the majority (60%) responded “no” answer to these questions; therefore, thing for them, while also doing what while 40% indicated “yes.”1 each office must analyze their own is necessary to keep my practice afloat Shortages are occurring for var- set of circumstances and decide how financially. Is there a protocol model I ious reasons. Some are due to staff to move forward. You can imagine can follow that addresses some of my falling sick themselves, while oth- that these circumstances vary. In a concerns? ers are forced to stay home to care recent PM News poll (672 responses), for their home-from-school children. 29.02% said they hired all staff back, One known document regarding There are those who stay away in 14.29% rehired some staff, 6.85% a COVID-19 protocol model, designed an effort to minimize any potential said no, they have not (hired staff by the American Academy of Family exposure to the virus, and some back), 42.56% said they never fur- Physicians (AAFP), offers a prepara- choose to stay out of work and col- loughed staff, and 7.29% were unaf- tion checklist: lect unemployment benefits that in fected, indicating they practice with- https://www.aafp.org/dam/ some cases are an actual pay in- out staff. AAFP/documents/patient_care/pub- crease. It’s true that in light of a cur- If you wish to keep your cur- lic_health/COVID-19%20Office%20 rently reduced onsite patient sched- rent staff on board, but can’t offer Prep%20Checklist.pdf ule, mandated and personal choice, full-time hours, you might propose In it, some staffing recommen- a full staff may not be needed full temporary part-time work, sharing dations are presented. You are wise time. However, in circumstances an alternating schedule (every other to put some new “temporary/perma- where patients must be seen, doc- Continued on page 36 www.podiatrym.com SEPTEMBER 2020 | PODIATRY MANAGEMENT The Consultant Is In

Staff Management (from page 35)

day, morning/afternoon). Front and back office (normally responsible for direct patient interaction) staff could be temporarily re-assigned to tackle some neglected administrative or non-clinic duties, many of which can be done at home. Staff who have children at home may require a temporary leave of absence, with the option to be rehired when things get back to “normal”. These are some possibilities you could actually present to staff for their consideration as some may favor one option over another. Of course, a more permanent route is to simply downsize—permanently dismiss employees who cannot be shifted elsewhere. For some offices, this ignites the avoided responsibility of evaluating staffing needs. For others, it’s an unwelcome setback accompanied by an equally unwelcome financial impact. Whether the decision is to rehire or hire anew, a sensible action plan moving forward should include cross-training and flexible work schedules. Both will • Update procedure and assist with policy manuals allow for greater consistency and employee coverage if (for more on employee manual updates, see below), some team members do not return to work. • Update and redefine individual job descriptions, In time and with measured safety, patient visits will • Support their participation in various approved 36 be up, busy schedules will return, and we’ll be back to self-training guides and resources, • Maintain contact with patients to reschedule ap- pointments, update health issues Whether the decision is to rehire or • Reach out to patients (via email, social media, website management/updates) to inform them of office hire anew, a sensible action plan moving closure, emergent care availabilities, tele-health visits, re-openings, and inform them on precautions the practice forward should include cross-training has taken to ensure patient safety, and flexible work schedules. • Compile a FAQ for your website or Facebook page to help visitors navigate through some common questions and conceivable re-opening measures

the usual problems like “not enough staff”. At that time, It is important to realize that having staff work from the need to re-assess an appropriate number of staff will home should be accompanied by restructured policies be good news, right? and guidelines, action plans, relevant written job descriptions, realistic expectations and outcomes, and deadlines. Remote Staffing/Job Descriptions Re-Imagined Additionally, develop methods to oversee their daily work Prior to COVID-19 sending our normal routines into a and measure their overall productivity; meet regularly state of paralysis, the cry “there isn’t enough time!” was with them via phone or virtually to discuss their progress, often heard in response to managing some overlooked request daily email action reports, etc. These are all bene- (though essential) administrative obligations. Tele-health ficial to remote employee success. visits have proven helpful in some instances to maintain None of their efforts will be in vain. According to a the doctor-patient connection; however, tele-work for most 2018 survey of 31,000 employees by FlexJobs, over 65% of staff who assist with hands-on patient care is not as practi- workers find that working from home actually increases their cal. What better time to get your house in order by tempo- productivity.2 They attribute this to few distractions, less rarily reassigning some non-clinical duties to capable staff? co-worker interruptions, no commuting stress—and I would • Contact maintenance/cleaning company to discon- also add, less anxiety in the throes of micro-management. tinue service for the time being, to suspend orthotic and In the end, these task accomplishments will help to create a specimen routine pick-ups, and other contracted routine more organized practice. services, • Set up alternate means of deliveries, Pay for Exempt/Non-Exempt Employees • Prepping surgical packs, Medical offices commonly employ hourly workers who • Neglected paperwork, are non-exempt under the Fair Labor Standards Act. Some • Inventory management, erroneously assume that by paying their staff a salary, they • Follow up on past due A/Rs and insurance appeals, do not have to pay overtime. For your own protection, learn • Conduct a general patient recall, the rules surrounding exempt/non-exempt employees to • Organize an orthotic recall to launch post-quarantine, Continued on page 38

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Staff Management (from page 36) the perfect time to step in and provide come to 2020. Whether or not you your staff with the training required have an employee manual in your avoid any unpleasant legal and financial and desired? Now, as we enter this new practice, it is strongly recommended ramifications from a disgruntled em- COVID-19 dimension of health care, in that you obtain legal advice and guid- ployee, resentful that s/he is no longer addition to teaching (not telling) them ance from an employment lawyer and employed and who was later found to the various “how-to’s” of their job de- work together to update it. As noted have been (un)intentionally wage-com- scription, they must also be taught new above, some of the policies that need promised. It is important that exempt protocol standards in patient care, in- revisiting or updating surely relate to and non-exempt designations are prop- fection prevention and safety measures. leaves of absence, PTO, layoffs, flex erly assigned to each employee. Not just For existing staff, these will be very hours, and wages, among others. now, but ALWAYS! different from past routines and they A shift in the employee landscape An online article written by Na- must learn to adapt. So, new to the job has created a whole new spectrum of thaniel M. Glasser, a Member of the Firm in the Labor and Employment practice, in the Washington, DC, office of Epstein Becker Green: Whether or not you have an employee manual While exempt employees must in your practice, it is strongly recommended that you be paid their regular salaries, anytime they work any portion of a workweek, obtain legal advice and guidance from an employment non-exempt employees need be paid lawyer and work together to update it. only for the time they work and for times deemed compensable under such employers’ policies and procedures. 38 Non-exempt employees who are out or not, everyone needs to be directly lawsuits, namely bias, discrimination, sick or to care for a relative may be involved in the communication and retaliation, wage and hour violations. entitled to use paid sick time or other planning of all changes. Seeking legal professional advice can paid time off (PTO), such as vacation, While certain OSHA-mandated help you develop policies and proto- personal days, etc. Note that additional infection prevention controls are al- cols surrounding a practice crisis that paid sick leave may be required under ready being followed, a more rigorous would prevent such litigations from legislation that has been passed by the effort will be required throughout the occurring. Furthermore, they will pro- House of Representatives and is await- remainder of COVID-19 and beyond. vide you with necessary knowledge ing action in the Senate. Among them are how to respond to “at and insight into regulations contained There are also a variety of means risk” patients on the phone by craft- in The Families First Coronavirus Re- employers may compensate non-exempt ing scripts and triaging guidelines for sponse Act (Families First Act) as well employees who cannot work and do not various scenarios to help them deliv- as The Coronavirus Aid, Relief, and have available paid time off, including er proper information, staff and pa- Economic Security Act (CARES Act). (i) providing discretionary paid admin- tient screening requirements in person As with any new policy changes istrative leave, (ii) allowing coworkers (e.g., taking temperatures and/or blood and/or additions, they should be ver- to share or donate PTO with others, and oxygen levels), defining and main- bally communicated to and discussed (iii) advancing future PTO. Addition- taining social distance requirements with employees. Their individual ally, for those non-exempt employees in reception areas, new shielding de- signatures should be obtained on a who have some work duties that can be vices such as plexiglass barriers and written copy of the policy changes done remotely, employers may extend face shields, routine disinfection of fre- as verification of their understanding telework options to those staff mem- quently touched surfaces (e.g., touch and agreement to comply. bers, provided they have a way to track screens, keyboards, bathrooms, tab- and record remote work time. lets, pens used by patients, treatment Expand Methods of Communication Given the rapid pace of develop- chairs and rooms, etc.), more frequent Communication is key. That’s al- ments in connection with COVID19, and thorough hand washing and san- ways been true in the past, especially health care employers should re- itizing, proper disposing of hazardous during present circumstances, and as main mindful of additional action waste, PPE and sharps and the proper we look to the future. Explaining to staff by federal, state, and local govern- fit/wearing of masks and gloves. the conditions upon which they can ments impacting these matters.3 return to work is imperative—for their Employee Manual Revisions/Crisis safety, their families and the patients Infection Prevention and PPE Plans they will come into contact with. If they Compliance Training It is almost certain no one had are symptom-free, they can come to As with neglected time-consuming a policy or contingency plan put in work. If not, they must first be tested. tasks, one can no longer dismiss the place to deal with the current glob- If patient hours are limited, staff necessity to properly train staff to be al pandemic/epidemic crisis or other must understand that “no money top-notch employees. With a limited situations requiring mandatory office in, no money out” means a poten- patient schedule, when if not now is shutdown prior to COVID-19. Wel- Continued on page 40

SEPTEMBER 2020 | PODIATRY MANAGEMENT www.podiatrym.com The Consultant Is In

Staff Management (from page 38) for them, and worried about the se- References curity of their job. They miss their 1 https://www.mgma.com/data/ tial in reduced or flex hours (and work and their patients. They miss data-stories/handling-staff-shortag- wages) or alternate salary opportu- a normal paycheck. Will they even es-in-your-medical-practice 2 nities until the practice returns to get their next paycheck? Staff want http://www.techrepublic.com/ar- “healthy”. to know “What will treating patients ticle/why-65-of-workers-would-be-more- productive-working-from-home-then-the- office/ 3 https://www.natlawreview.com/ We were all caught off-guard going into this crisis. article/health-care-employers-how-to-pre- pare-impact-covid-19-your-workforce Don’t get caught unprepared coming out. Ms. Lynn Homisak, President of SOS Take time to educate all staff re- look like?” “To what extent will we Healthcare Manage- garding the changes made to the of- be involved?” Good coaching and ment Solutions, carries fice manual. It has always been ad- training will help them understand a Certificate inH uman vantageous to have discussion and their role and feel protected. Get to Resource Studies from Q&A immediately following, so that know them better. Hold staff meet- Cornell University all their concerns are addressed. ings where, in addition to “shop School of Industry and Develop your management talk”, you can reassure and encour- Labor Relations. She is the 2010 recipient of skillset to provide much appreciat- age everyone, speak in the affirma- Podiatry Management’s Lifetime Achievement ed encouragement, leadership, and tive, be honest, maintain positivity, Award and was inducted into the PM Hall of motivation for your staff. Believe and offer your support. 40 Fame. She is also an Editorial Advisor for Podi- it or not, they are just as devastat- We were all caught off-guard atry Management Magazine and is recognized ed by all the changes taking place, going into this crisis. Don’t get nationwide as a speaker, writer, and expert in don’t know what the future holds caught unprepared coming out. PM staff and human resource management.

SEPTEMBER 2020 | PODIATRY MANAGEMENT www.podiatrym.com