Ops Management

Promoting Employee Knowledge, Not Tenure

If you think your teacher is tough, wait until you get a boss. He doesn't have tenure.
— Bill Gates

Over the years, I have had many conversations with owners and managers in the DME and complex rehab business about the issue of employee retention and their corresponding salaries. From most of those conversations and coupled with my own experiences, I have arrived at the conclusion that employees in today's workforce expect a pay raise every year, regardless of their performance.

That magical anniversary of their hire date approaches, and the employee expects an instant increase in their salary. On occasion, I too have had that feeling of dread wash over me like a cold ocean wave in anticipation of letting that employee know that they really haven't earned a raise based on their performance.

In doing so, I am aware of the difficulty a small business experiences when an employee leaves to make that extra $1 per hour somewhere else. New employees mean lots of training, and we all know that means time — lots of time — a commodity none of us have in abundance. A peer recently took a class where he learned that the average re-training of an employee costs $3,000.

A few years ago I was in just that situation, and it dawned on my consciousness that maybe I had been going about this in all of the wrong ways. My employee had not done a great job in the past year, and I felt that this employee did not merit a raise. I had done the usual manager things such as verbal reprimands and once even an action plan, but I knew that the culture I had created made this employee expect a raise. That's just what was expected.

A Performance-Based Raise

This experience got me to thinking about what many smart business managers had figured out a long time ago. Raises and increases in pay should be performance based.

Throughout this period, I began to take a look at competencies. What specific skills should a particular employee possess for a particular job?

The process seemed to be a bit more complicated as I tried to devise a system for assistive technology professionals (ATPs). Much of their work (excluding revenue) is subjective, particularly for an old-school, years-removed RTS like me.

What we created was a Job Level system for all positions in the company. Loosely defined, each employee — such as admin, tech or ATP — would fall into a Level based on their specific competencies. For example, an intake coordinator with no previous experience would be Admin Level 1. This position would have a set salary. Raises occur when the admin tests for Level 2, which consists of several exams created by our leadership team.

A Level 2 admin would have to pass a test on reimbursement, Brightree systems, and areas that would prove they now had a greater skills set than they did at Level 1.

When a review occurs, we have measurables that help us understand that this employee is now more valuable to us because they can perform at a higher level.

Now I realize that this might not be rocket science here, and I should have done this 15 years ago. For we now know that changing the efficiencies and performance metrics of our company will create a better environment.

Defining Skills Set Levels for Today's ATP

In examining the ATP system, we realized that we faced several distinct challenges in implementation:

  • If levels are affected by salary, what should we do with a Level 3 (Advanced) ATP who is currently receiving a Level 4 (Expert) salary?
  • What defines the differences between the Levels?
  • What is the overall goal of the system?
  • What should we test the ATP on?
  • Who writes the tests?
  • What will this do to morale?

We chose to test the ATP with a written exam that covered several key areas:

  • Products Exam
  • Reimbursement Exam
  • Clinical Exam
  • Medical Terminology Exam
  • Situational Ethics Exam

As in most businesses, the ATP also must maintain the revenue goals for each level and maintain a respectable, pre-determined GPM per quarter.

Jessica Savitch, a broadcaster, once said, “No matter how many goals you have achieved, you must set your sights on a higher one.” Every employee wants to know how they measure up. We are doing our employees no special favors when we are ambiguous or unclear about expectations specifi c to their competencies. An employee cannot be praised for conquering a new skill if we as managers never knew of their accomplishment. If we don't care...why should they?

With respect to complex rehab, it is my job as a manager to ensure that each patient who encounters Active American Mobility receives the best, most thorough assessment that we can provide. By defining ATP competencies based on knowledge and performance, we can ensure that our clients are getting the best treatment possible, on all levels. Can your ATP verbally break down the entire process required for a patient to receive a power wheelchair through Medicare? Can he or she do a custom mold properly? Do they maintain a GPM that you can live with?

Then there is the whole issue of ethics. While RESNA does a great job of illuminating the code of ethics for ATPs, there are situations that are not black and white that put your company's reputation and possibly its existence at great risk. That is why we have created an ethics component to our level system. We want our ATPs to be thinking of ethics at every eval and in every scenario.

In our organization we have a lead ATP. This is a person who already fits into our Level 4 (Expert) category and is the most knowledgeable about products, clinical, reimbursement/funding, and is a high producer with good GPMs. They do ATP work every day. Who better to serve as a conduit between ATPs in the field and our management team? This is one arm in which we can measure competencies.

We will have our full system employed in August and look forward to more effective employee reviews.

This article originally appeared in the August 2011 issue of Mobility Management.

Rolling Dynamics, Rolling Resistance &  Optimizing Wheeled Prosthetics