Operational Challenges in Healthcare: Getting the People, Structure and Compliance Right
Running a medical practice is about much more than providing great patient care. Behind every successful clinic is a business that needs the right people, the right operational structure and the right employment frameworks in place.
In the third instalment of From Script to Setup, I sat down with Jim Babalis to discuss some of the operational challenges and opportunities facing medical and healthcare practices, particularly from an employment law perspective.
We covered some of the issues I regularly see practice owners and managers navigating, including:
• Recruitment and finding the right people
• Employment contracts
• Award interpretation and compliance
• Managing difficult employees
• Performance management
• Practitioner and contractor arrangements
• Payroll tax considerations
• Patient relationships and intellectual property
These are all areas that can have a significant impact on the day to day operation of a medical practice.
Getting the Structure Right From the Beginning
One of the biggest messages from our discussion was the importance of establishing clear arrangements from the outset.
Whether someone is joining a practice as an employee, contractor, practitioner or director, simply having a contract in place is not enough.
The actual working arrangement, responsibilities and expectations need to be understood and appropriately structured.
For employees, practices should be considering:
• Appropriate staffing levels
• Clinic operating hours
• Rostering requirements
• Award classifications
• Position descriptions
• Pay and employment conditions
For doctors and other practitioners, there also needs to be clarity around the nature of the relationship and the terms agreed between both parties.
Most importantly, the paperwork should reflect how the relationship actually operates within the practice.
Recruitment Is More Than Filling a Vacancy
Recruitment should never simply be about finding someone who has the qualifications to perform the role.
You also need to ask whether they are the right fit for your practice.
Healthcare businesses should undertake appropriate due diligence when recruiting staff and practitioners.
This may include:
• Conducting reference checks
• Reviewing relevant professional history
• Considering indemnity and professional risk
• Understanding the services the practitioner provides
• Assessing whether those services suit the clinic and patient demographic
• Considering how the person will fit within the existing team and culture
The right person is not simply someone who can perform the role. They need to fit the business, the team and the community you are servicing.
Regional practices can face even greater recruitment challenges. Depending on the circumstances, practices may need to think differently about what they can offer potential candidates, such as flexible working arrangements, relocation assistance, professional development opportunities or other appropriate incentives.
Difficult Employees: Do Not Jump Straight to Termination
Managing staff performance and workplace issues is one of the more challenging responsibilities for any practice owner or manager.
One of the strongest points from my discussion with Jim was simple:
Do not jump the gun. Follow the process and document it.
When issues arise involving poor performance, bullying, harassment or misconduct, practices should not simply make assumptions and immediately move to termination.
Depending on the circumstances, appropriate steps may include:
• Documenting the concerns
• Speaking with the employee
• Investigating the issue
• Giving the employee an opportunity to respond
• Providing appropriate procedural fairness
• Identifying whether further training or support is required
• Seeking professional HR or employment law advice where necessary
It is also important to remember that poor performance does not automatically mean someone is the wrong employee.
Sometimes the real issue is that the employee has not been given adequate training, their induction was insufficient, expectations were unclear or they have not received the support they need.
Before deciding that someone cannot perform their role, practice owners and managers should ask themselves:
Have we actually given this person the training, systems, expectations and support they need to succeed?
Good performance management is not just about documenting what an employee has done wrong. It is also about looking at what the business can do better.
Award Compliance: Your Position Description Needs to Match the Job
Award compliance is another important operational responsibility for medical and healthcare practices.
Two awards commonly relevant within the private healthcare sector are the Health Professionals and Support Services Award and the Nurses Award.
One of the key points we discussed was making sure there is alignment between:
• The employee's position description
• The duties they actually perform
• Their award classification
• Their remuneration and employment conditions
A job title alone does not determine the appropriate classification.
If an employee is regularly performing duties at a higher level than their documented position, there may be potential underpayment or compliance issues.
Employment documentation should therefore not simply be created when somebody starts and then forgotten.
As a person's role changes and develops within the practice, their position description, classification and remuneration arrangements should also be reviewed.
Let's Talk About Payroll Tax
It has certainly been one of the biggest topics of conversation within general practice and healthcare over the last few years.
Payroll tax.
There continues to be a lot of information circulating among practice owners and practitioners, and sometimes that information can be conflicting.
One of the important points from our discussion was that simply calling a practitioner a contractor within an agreement does not necessarily determine the nature of the overall arrangement.
Practices need to consider how the relationship actually operates in the real world.
Things that may need consideration include:
• The service agreement
• How the practitioner operates within the clinic
• The level of independence within the arrangement
• Appointment and administrative processes
• Payment arrangements
• The overall operational structure of the practice
This is an area where practice owners should seek advice specific to their individual circumstances from appropriately qualified legal, accounting and taxation professionals.
Every medical practice operates differently, so simply copying the structure of another clinic is not necessarily the right solution.
Who Owns the Patient Relationship?
Another really interesting topic we discussed was what happens when a practitioner brings an existing patient base into a clinic and later decides to leave.
Who owns that relationship?
This is exactly why these conversations should happen before the practitioner starts.
Service agreements should clearly address matters such as:
• Existing patient relationships
• Intellectual property
• Goodwill
• Patient records
• What happens when the practitioner leaves
• Any content or material created during the relationship
The situation can become more complicated when the patient relationship has developed within the clinic or where the patient has received care from multiple practitioners within the same practice.
Patients, of course, have the right to choose their healthcare provider. However, patient records still need to be managed and transferred through the appropriate processes and in accordance with privacy obligations.
Clear agreements and conversations at the beginning of a working relationship can prevent a great deal of confusion later.
Strong Operations Reduce Risk
One message continued to come through during my conversation with Jim:
Operational management and compliance cannot operate separately.
Everything within a medical practice connects.
• Recruitment affects your culture
• Contracts create expectations
• Position descriptions affect award compliance
• Training affects performance
• Practitioner structures can affect financial and legal risk
• Documentation protects both the business and the employee
• Good systems create consistency across the practice
This is why good practice management is not simply about keeping the appointment book full, managing the roster or making sure the clinic runs on time.
It is about building the systems behind the healthcare.
At Private Practice Medical Consulting, we work alongside medical practice owners, directors and practice managers to strengthen those systems.
Our support includes medical centre start ups and acquisitions, operational reviews, recruitment, team structures, workflow optimisation, practice management, business management and ongoing consulting support.
Because when the business behind the medicine is structured well, clinicians and their teams can spend more time focusing on what matters most:
Their patients.
Watch the Full Discussion
Watch the full From Script to Setup discussion with Stephanie Portoglou and Jim Babalis as we explore the operational and employment challenges that medical and healthcare practices are facing today.
For more information about how Private Practice Medical Consulting can support your medical practice, visit www.privatepmc.com.au.
This article provides general operational information only and does not constitute legal, employment, taxation or financial advice. Practices should obtain professional advice relevant to their individual circumstances.
