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I hear lots of students say they want a “wellness” practice.  I’m never sure what that means.  Does it mean you want to treat people who are well?  You certainly can do that, but you won’t get any insurance or Medicare money for this, so these people must be “cash” patients.

Does it mean you want to promote wellness among patients and staff?  If so, I applaud you.  If you want to encourage “wellness thinking” among staff, how will you do that?  There are lots of opportunities in your practice to help people think “wellness” instead of “sickness” or “dis-ease.”  Remember, we move toward what we think about .

For example, change your time off policy to have “wellness days” instead of “sick days.”  In a prior job, I heard it called “taking a mental health day.”  The principle is that you don’t need to be sick to take a day off; sometimes you just need to stay at home, or go do some errands that have been piling up, or spend time with your family.  And sometimes people really are sick and need to be at home to “get well.”  A benefit of instituting Wellness Days is that employees can just call in and say they’re taking a wellness day; they don’t need to lie and say they’re sick.  And you don’t need to differentiate between sick days or personal days; they’re all wellness days.

Of course, you must limit the number of Wellness Days you provide; you should have no more than you would have provided for staff sick days and personal days combined.  It makes the time off calculations easier.  More important, it sends a message to your staff that you care about their wellness.

To continue this discussion, what other kinds of things could you do in your office to encourage wellness among staff?  How about encouraging patient wellness?  What would a Wellness Day for patients look like?

1.  Don’t get involved in patient billing or collections.  That is the job of the billing person (what?! You don’t have a billing person?  Get one, now!).  You don’t see medical doctors or dentists talking to their patients about “why didn’t you pay your bill last month?” or “Medicare won’t pay, so you have to.”  Discussing financial issues with patients damage the doctor-patient relationship, which should focus on health care.  If you talk about financial issues with a patient, it sends a mixed message:  “I want to provide you with excellent care, but I’m really more interested in making sure I get paid.”

2.  Don’t discuss appointments, missed appointments, late  appointments, walk-ins with patients.  Let your front desk person do it.  Figure out your policies, communicate them to the front desk person, then stay out of the way.  If you get involved in discussions about “I am too busy to see you now, but come back at the end of the day,” you destroy the credibility of the front desk person (no one will pay any attention to him/her because they know you’ll break the rules).  And don’t contradict the front desk person in front of a patient:  “It’s ok, Jennifer. I’ll see Mrs. Smith, just this once.”  Bad idea.

3.  Finally, don’t get involved in patient/employee, employee/employee disagreements.  In these cases, you will always lose.  Let people work things out on their own.  If the communication breaks down completely:

a.  In the case of a patient vs. an employee, you must support the employee.  If you don’t, you won’t have any employees left.  Set policies, stick to them (see #2 above), and support your employees as they deal with these policies.  If the policy is bad, change it, but don’t do it in front of a patient.

b.  In the case of employee/employee, you will never win trying to arbitrate.  If they feel you’re taking sides, both will resent you.  If they aren’t speaking to one another, tell them you’ll fire them both unless they agree to get along.  You’d be surprised how fast they can “make up.”

In all three of these situations, the presence of a policy/procedure before there is need for one (i.e., before the crisis happens) is vital.  Sit down before you start your practice and set out a policy manual, an employee benefits/office rules manual, and procedures for dealing with patient.  I have an ebook clled “The Practice Manual” on my website  that you can download, along with a template to fill in.

How would you handle these types of situations?