How to Handle a Case Thief
Dr. Smith sits down for lunch and opens her computer to look at the appointment calendar for the day. While she reviews the morning appointments, she is shocked to see that in addition to the 7 clients who had requested her, 7 additional appointments with no specific doctor requested were all being seen by Dr. Jones, the other associate in the practice.
Was Dr. Jones trying to make her look less qualified in comparison by taking all the additional patients? Were the receptionists unintentionally assigning all appointments to just one doctor, or had Dr. Jones been applying some pressure?
Because many associates’ annual compensation depends on their monetary production, assuring fairness in case distribution is essential. Although there is no way to ensure that each doctor will see the exact same number of cases in a given time period, using basic strategies can help level the playing field while creating an environment in which associates can strive for excellence without stepping on each others’ toes.
Unabated, a case thief does more than simply increase his or her take-home pay. He or she can damage morale and create conflict within the practice, too. Clients may sense the tension between team members, and patient care may suffer if one doctor is spread too thin with an overabundance of cases.
It is possible, even expected, that there is a consistent top performer in your practice who does not engage in any shady dealings to achieve high production levels. It is important for any practice, however, to create an environment in which the opportunity for higher production exists for all doctors in a practice.
Policy is the Best Protection
For any practice to thrive with minimal conflict there must be specific policies in place to deal with the various scenarios that arise from the moment an appointment is made until the bill has been paid. These policies should be in writing and clearly communicated to each member of the team, including receptionists, assistants, technicians, and practitioners.
A fundamental characteristic of successful practices is that core principles are shared and that these principles influence the behavior of all team members. Take some time to define the principles that are central to your practice’s culture and based on its mission and values; from these principles, develop standard operating procedures (SOPs) to cover such topics as how to answer the phone, how to schedule an appointment, and what is covered in a wellness exam. Creating SOPs is the first step toward developing a fair and consistent workplace.
Teaching the Team
Once you have taken the time to create written SOPs for your practice, the next step is to share them with every team member. Part of any solution is engaging support of the team, and in order to engage team support, each person must understand his or her roles, responsibilities, and contributions (see Appointment Flowchart). When team members clearly understand their roles, situations such as scheduling appointments for specific doctors can be dealt with in a fair and consistent manner. It will become nearly impossible for an associate to “steal” cases from another if well-defined protocols for scheduling are followed by all team members.
Clearing the Way for Communication
If any associate feels that another is taking advantage of the system, that associate must feel comfortable discussing the matter with the practice manager. This discussion should take place in private, preferably outside office hours so as not to interfere with patient care. The associate should have enough trust in the office manager that his or her concerns will remain confidential and not be shared with other team members. The practice manager can then observe the behavior in question and use the production reports as mentioned to assess the situation and verify whether the reported behavior is in fact case thievery.
Foiling the Thief
If there is a problem with case distribution, the best way to handle it is by developing protocols that will prevent it in the future. Your SOPs can act as locks on the door to keep out a would-be thief. The goal of these policies is to ensure that the opportunity for achievement is the same for every associate, not to completely erase all forms of competition and opportunities for achievement. There has to be a balance between cooperation and competitiveness. A little competitiveness within a practice is healthy, and actually creates space for individual achievement. In a well-run practice that has enlisted these protocols, one can expect to minimize problems associated with caseload distribution, and as a result, maximize associate satisfaction, increase morale, and help assure the best possible experience for your clients and patients.
Is There a Case Thief in the House?
You don’t need to be Sherlock Holmes to determine if you have a case thief in your midst. Just follow these 2 tips.
1. Develop a monthly report of several standard services provided by your clinic, and calculate how many of each service each individual veterinarian is providing. For example, the practice management may choose to analyze heartworm tests, spay/neuter surgeries, microchip insertions, and senior wellness exams that have been billed in a particular month. If there appears to be an associate with a disproportionately high number of these services when compared with the others in the practice, this may be your first clue that there is a case thief at work. In the following example, Dr. Jones seems to have more than an appropriate number of follow-up appointments.
Service Comparison by Veterinarian—February 2012
|Dr. Jones||Dr. Smith|
|Ratio of Medical: Progress Appointments||1.25||2.14|
|Percent of Medical vs Progress Appointments||80%||47%|
|Needs Improvement (70%– 80%)|
|Unsatisfactory (< 70%)||X|
|Hours Available for Appointments||8||8|
|Hours Filled Up with Appointments||8||6|
|Excellent (80% +)||X|
|Unsatisfactory (< 70%)|
2. Frankly discuss the matter with each team member individually while being careful not to cause tension among the staff. Has anyone noticed that one of the doctors is aggressively taking cases for follow-up that started with another doctor? Does one doctor seem to always be busy while another is looking for something to do? Have any of the support staff members been approached to help steer cases toward a certain doctor? Knowing the answers to these questions in addition to examining production data may confirm that a problem exists.