Overcoming crises when several clinicians leave

How to overcome crises–When several clinicians leave

Posted in Overcoming hardships
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Ugh. Overcoming crises is no fun. There are stretches when the business seems to be rolling along, growing, thriving, and then a crisis hits–for example, in a relatively short period of time, several employees may decide to leave. What is going on?

It’s not the same as it used to be

I can think of several times in my thirty-eight years of ownership when this happened. And nearly every practice owner I know has had a similar experience. In some ways this only makes sense. An organization with thirty or forty clinicians goes through many different stages before it gets to that size. And employees join at one point only to have the organization change underneath them.

In my history, here are some of the events that triggered a mass exodus:

  • Changing the structure of our organization and especially when we moved everyone from independent contractors to employees
  • When we changed our financial formula to make the practice more sustainable
  • When we required all staff to attend certain meetings
  • Whenever we promoted some and not others
  • A time when BCBS reduced its fees, which meant working more hours for less pay
  • When we got so large that our organization no longer felt like a family to some
  • Whenever leaders left or leadership roles changed

You can see several things in common about these events. They all involved changes in the way that the organization operated. And may, more importantly, they all changed the way clinicians conceived of themselves. I am reminded of that old book “Who Moved My Cheese?” Change is uncomfortable and there are many responses to it.

Some of these changes are actually a result of success and some a result of outside influences beyond our control. The reality is that no matter what stage an organization is at when you join, it will morph into something else. Inevitably that requires clinicians to change. Sometimes the required change becomes the tipping point for several to resign within a short time frame.

1. Self-examination

The first step when anyone leaves is for the leadership to do a debriefing, a post-mortem. Overcoming crises means looking hard at the possibility that the leaving was avoidable. And furthermore, overcoming crises means listening to the exiting people to learn about their experiences as an employee. We may just learn something that will help us with future employees.

But of course, we can err by being too hard on ourselves too and learn the wrong lessons. So how do we find the right level of responsibility to take?

In short, study your tendencies. It helps if we are hearing themes from multiple sources inside and outside your organization. Furthermore, we need safe places to talk through our hypotheses of what we might have done differently.

And once we have settled on a needed adjustment, there is no harm in confessing the need for the changes to your remaining employees. We are giving a positive message to all when we show that we can change and learn from the past.

2. Doing what it takes to survive

One’s size makes a huge difference in how vulnerable an organization is when people resign. Obviously, there is a huge difference when three people leave a group of ten (30 percent loss of productivity) than a group of thirty (10 percent loss of productivity). In my view, an organization with ten clinicians is at its most vulnerable time. The investments the owner has made to support ten clinicians are significant. And yet the margin for error is quite small.  When smaller than ten, the costs are not as high. When larger than ten, productivity can remain high even when some leave. I have written about this dangerous time here: Most hazardous practice size? Ten people.

3. Learn how to use credit to your advantage

The one benefit of the ten-person practice is that you can now show a track record to a potential lender. With a proven track record, they will generally be willing to loan you money to get you out of tough spots. That track record means a lot to a bank, especially if you can explain why the bad times happened and you outline a plan for digging your way out. They will not make loans for the newer or smaller organization because the owner and business have not yet proven themselves to be a good risk. Banks are inherently conservative and want assurance that they will see a return on their money but they can be part of the method for overcoming crises. That is one of the things they do.

Once you have the size and a track record, the next big challenge is to resist the temptation to borrow too much or too frequently. I have made this error. While borrowing money did allow us to grow faster than we would have without those loans, there were seasons when it was a struggle to repay those loans. We had many many tight months and years.

My advice? Have a well-thought-out plan for repayment. It is far easier to borrow money than it is to repay it.

4. Consider whether downsizing is the right move

I have seen practices elect to downsize rather than borrow. In some of those cases, I think the decision to downsize, was both a money issue and a disillusionment with what it is to manage a practice.

And I have seen practices downsize and then thrive on a smaller scale. But sadly and perhaps more commonly, I have seen practices that never got back to thriving. Once some key people left, the owners never figured out how to attract and keep enough employees for the practice to grow. Downsizing then was not what they wished for but it is what happened anyway.

I think this decision should be driven by the owner’s vision of what they want the practice to be. There is no one right decision for all. Each owner needs to honestly assess what gifts they have and what they truly enjoy. Don’t grow a practice into something you hate.

5. The best answer: Overcoming crises by growing your way out

The most common way for overcoming crises is to grow our way out of them. We may need to find new employees to replace those that left. That means working on your hiring practices so that you get good at staffing your organization with excellent staff.

Once you have corrected the correctable reasons that people left, then it comes down to finding good candidates, interviewing them, hiring them, and training them. I talk about how to hone that process in another post. What one cannot afford to do is to become bitter about those who have left. We have to move on, to focus on the parts we can control from this day forward. That is where growth is, where your joy, where stability is.

The mistakes of the past must stay in the past. Focus on what is good; what you enjoy doing. With that positive spirit, you can overcome any setback.

Upward and onward.

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