Shaping Healthy Office Relationships

By Benjamin Davidow

Maintaining positive interpersonal relationships in a chiropractic office is the cornerstone of being able to provide patients with quality care. A chiropractor’s office is an environment that must be nurtured to reflect the qualities of its services. For example, the first impression a patient often has of a practice is over the phone. If a staff member makes a bad impression, it could have a negative impact on the business. We often forget that the business environment is the external product of its internal practices and, to a patient, is often indicative of how well a visit will go. In order to further enhance patients’ trust and confidence in the services they are seeking, a professional office must cultivate amicable relationships among all staff members. A chiropractic office cannot create sustainable relationships with patients without first nurturing a diligent team of employees, so to build a successful practice, a chiropractor must find the right person for the right job. 


Effective Hiring 

The hiring process lays the foundation for the way a practice will function. Therefore, it is important to seek individuals who not only possess the general knowledge of a clinical assistant’s skills, but also have the ability to execute those skills in addition to working well with others. Kim Gambino, D.C., alongside her husband, has run two prosperous practices, one in West Virginia and the other in San Diego, for many years. Gambino’s hiring process is methodical and systematic, arranged to handle and prevent problems before they occur. The first step is designed to weed out careless applicants by requiring applicants to reply to job listings and online classified ads with a resume sent in PDF format. Any resume received that is not in PDF format will be immediately discarded because the applicant must demonstrate the ability to follow simple directions. The second part of the process requires that applicants go to Gambino’s website and respond via a forum on the site, in an effort to show competency in online skills. Once this has been completed, the applicant must watch a video on YouTube that illuminates some important details of Gambino’s practice. Gambino then requires that the applicant write a one-paragraph response to the video. If the paragraph is satisfactory, the applicant is scheduled to come in for an interview. 


The interview is guided by one inquiry: Gambino supplies the topic, “Money is the root of all evil,” and then asks, “How do you feel about that?” “You want to make sure they have a good relationship with money,” explains Gambino, due to its unavoidable role in the running of a successful practice. An applicant may agree or disagree; however, Gambino is less interested in a person’s subjective philosophy than she is in his or her awareness of the necessity of money in terms of growing and handling a successful practice. 


Gambino’s hiring process does not stop at the interview. As the final and most important step, Gambino requires that each applicant under consideration take an extensive personality test, Gallup StrengthsFinder (strengths.gallup.com), which focuses on revealing strengths and abilities. She then uses the results to place each future employee in the position that is best suited to his or her personality. That way, each staff member is innately specialized to handle specific operations in the office, rather than simply filling a menial position. A personality test facilitates cohesion in the workplace, which eliminates many day-to-day frustrations and keeps productivity high. 


Over the years, Gambino has observed that using personality tests betters office relations. “When we hire, we like to hire people who will find purpose in their job,” she says. “When you hire like this, everyone gets along. If you’ve ever been asked about doing something you don’t like, but you do it for a job because you need it, after two or three months you aren’t as excited about going to work and that affects your relationships.” Thus, Gambino believes providing an employee with purpose “feeds their soul.”


Finding Effective CAs

Finding the right chiropractic assistants (CAs) can often make or break a practice. Les Wise, D.C., ran a successful practice in Spartanburg, S.C., for 35 years that continues to thrive under his son. Wise has been an educator at Sherman College of Chiropractic for 39 years, teaching ethics and practice management for students preparing to open their own practices. Wise notes that CAs can generally be divided into two categories: clerical and clinical. 


The clerical CA has seven main functions: answering phones, making appointments, taking payments, filing insurance forms, handling bank deposits, facilitating correspondence and managing databases. Wise believes that these skills are largely generic, so “professionals may look to traditional places like secretarial programs at tech schools and community colleges.” However, “local classified ads will produce a flood of applicants for the doctor (or outsourced agency) to screen for levels of computer skills and communication expertise.” 


The clinical CA is responsible for such duties as taking vital signs, assisting patients with history forms, assisting the doctor with documentation, performing adjunctive therapies and, in some states, the CA may take X-rays but not interpret the results. The list of duties for a clinical CA does not stop there and may include a variety of other responsibilities specific to the practice. 

The Building Blocks of Successful Practices

A chiropractic office should run on relationships that communicate its strengths. Patients often observe interactions among staff members, so those who exhibit kindness toward one another as a daily practice are appreciated. The staff’s positive output can also enhance patients’ connections to the chiropractic care they receive. The same can be said of negative interactions. “Personal animosity between staff members is visible, audible and sometimes palpable to patients,” says Wise. “A grouchy, unmotivated front desk CA can really squash a practice, [whereas] a likeable and motivated CA can help it flourish.” 


Each CA is a part of the larger chiropractic organism that thrives best by focusing on a team mentality. “A team mentality is important to the smooth functioning of the office,” Wise points out, and establishes the atmosphere of treatment. Every patient who walks through the door is essentially tuning into an episode of the practice. The patient expects to see a well-oiled professional machine that operates with honesty and integrity. However, if a patient observes despondent workers who, instead of checking files are checking Facebook, flirting conspicuously or rudely toting other patients through the office, he or she may feel distrustful of the practice as a whole. To guarantee that the patient feels assured by a chiropractor’s team, Wise believes that it is the responsibility of the doctor to see that everything works well. 


In his practice, Wise defined clear staff expectations, in addition to utilizing effective strategies that maintain and develop thoughtful staff. Training, handbooks and weekly team meetings are just a few of the ways to improve staff interaction and function and can also help set clear expectations for the work environment. With his students, Wise stresses the importance of creating a job description document for every employee, along with an employee handbook that explains office policies, compensation issues, days off and sick leave. This can prevent “a messy business,” he says. 


Handling Conflict

Even in the most well run practices, conflict between staff members can occur. Wise suggests using a periodic staff meeting to iron out issues among employees, with the DC as moderator and final authority. Though conflicts may not be pleasant when they happen, they can drive the office to become more tenacious and dynamic by creating an opportunity for staff to work together to generate improved relationships. 


Gambino prefers the direct approach when it comes to employee conflict, though she claims that altercations usually don’t happen because of the way she utilizes the strengths tests. Often, Gambino says that avoiding a conflict “can be [accomplished by] in changing the direction of a conversation.” In an effort to prevent conflict, Gambino requires her employees to practice daily tracking on index cards of the moments that make them feel good. “By keeping the index cards and realizing what makes you happy, you want to do that more,” she says. Therefore each employee is cognizant of the behaviors that produce positive life interactions. If employees are actively working to increase their level of happiness, they tend to seek compassionate relations, have fewer conflicts and develop a stronger sense of emotional control when they are faced with a conflict. 


It is important to realize that problems are often opportunities for solutions. An office run by staff members who respect one another will naturally yield a professional and productive environment. Using constructive hiring practices and fostering good relationships among staff members can help ensure the longevity of a sound practice and will ultimately help to put the patient’s quality of care first.