Most practice owners or managers do not have training in management. Some do not have very much experience on leading and managing a staff. Few therapists get an MBA, and when they do they usually work in hospitals or other large institutions. So how does one learn about hiring, managing, and firing—all areas where we had little or no training?
In my case, I read lots of business books. In fact, the bookshelf in my office contains nearly as many business books as it does therapy books. My favorite business books gave me the road map I needed. I have listed my favorites on the Resources page here.
Hiring requires that you become a manager
As my solo practice began to grow, I faced a dilemma with the referrals that my caseload could not take care of. My options were to either refer excess clients to others outside my practice or I could hire staff to handle the overload. I chose to hire and then learn how to manage. I have explored the dilemma of this choice in the post “The dilemma of success: Do it myself or delegate.” And I have explored some issues regarding managing in the post “The training we never had—Part 2: Managing.”
In this post, I explore both the hiring and firing process.
The hiring process
When hiring clinical staff, we look for indications of the clinician’s self-awareness, that ability to put into words one’s thoughts, feelings, motives, and desires. This ability seems foundational to what therapists do. Furthermore, self-awareness seems hard to teach and is probably pretty deeply-rooted in who each of us is and in how we process life. We want to see it right upfront or it may never show up in a candidate.
We ask a candidate to talk about a therapeutic success and a hard thing that happened in therapy or with a supervisor. The responses are wide-ranging. What we are looking for is less about what actually happened and more about how the candidate dealt with the hardship. We are looking for what he or she derived from the experience, the lessons learned. And we are looking for candidates who use their self-awareness to guide their clinical decisions.
In truth the anxiety of the interview process makes it difficult to tease out a candidate’s level of self-awareness. And yet clearly some do much better at overcoming their situational anxiety and are able to share more of who they really are. No doubt we have made errors in turning down candidates whose ability to share their insights was compromised by their anxiety. We just haven’t found a better way to conduct the interviews.
Our interview process
We use two interviews in our hiring process—in the first we have two leaders interview a candidate. The second is the same except with two different leaders. After each interview, the managers compare notes and pass on their insights to the others on our leadership team. After both interviews are complete we compare notes about the candidate in a leadership meeting. We usually have consensus. Of course I did not always have the benefit of a team of interviewers. Yet even when I was the only interviewer, what I was looking for was the same—that self-awareness and insight into oneself.
Sometimes we do not agree with each other. If one of our managers does not have a good feeling about a candidate, we have learned we should not ignore that feedback. Why? Because we have noticed a pattern. In those cases where we later had regrets, there were warning signs. We made a decision to hire because we failed to take those warning signs seriously enough and instead talked ourselves into hiring out of eagerness to fill a slot or a desire to not disappoint a candidate. It is never a good idea hire out of feeling sorry for someone or because we are desperate to fill a staff position. It is better to leave a slot open than hire the wrong person.
The firing process
No matter how well we do our hiring process, there will be times when we hire someone not suited for the job. The match is just not a good fit. Sometimes we need to face the truth that modifications to either the expectations or the performance are just not possible. There needs to be a parting of ways. To allow someone to remain in a position that is not a good fit jeopardizes both the employee and our business system. An ill-fitting job can contribute to the unhealthy of the employee, the business, or both. And part of the job of an owner or manager is to correct any hiring errors.
In my view, firing someone should never be done lightly or quickly. And yet we need a direct approach that does not back off from addressing the problematic issues. Fortunately, there are times when facing the issues will lead to corrections that work for everyone. Simply pointing out the need for a different approach will bring about the changes we wanted to see. And sadly, there are times when everyone’s best efforts are not successful in bringing about the required changes.
Hoping for change
When issues are identified that require change, the manager should write out what the issues are and what the expectations are for change. As part of the first meeting, we also discuss when the next review will occur, in which there will be a frank discussion about how the progress is going. Our goal in the first meeting is to clarify the issues and expectations while laying out a time frame to accomplish the desired changes. It is nice if the employee agrees that issues, expectations, and time-frames are reasonable, but that is not always possible. Depending upon the degree of defensiveness, this may tip the scales towards termination.
In those cases where a parting of ways ends up being necessary, we evaluate the success of our process in this way. We want to be sure there are no surprises when we finally get to the last meeting. Both the manager and the employee should be fully aware of issues that are driving the discussions, and there should have been more than one discussion about any disappointing results. Again, by the termination meeting there should be no surprises. We have even had termination meetings where there were hugs all around, a surreal but affirming end to a difficult process. But of course, whether there are hugs or not, it is always sad when there is a parting.
For more on some of the types of difficult employees we have dealt with, check out “Addition by subtraction: Types of difficult employees.”