Vicarious Liability:  Employee Matters Really Matter

You, the physician, are responsible for the actions of your employees. As “captain of the ship,” you have liability for your employees, who are considered extenders of your practice. It is important that you hire the best, train and treat them appropriately, and make changes when necessary.

As physicians’ schedules get painfully squeezed to accommodate more patients and less reimbursement, many physicians are increasing the number of extenders they utilize, including physicians assistants, nurse practitioners, medical assistants, technicians, and administrative staff. All of these people represent you and your practice.  It is important to have the best staff you can find as these people provide the first impression of you to your patients and, therefore, can be a terrific asset or a frightening liability.

•  Hire the best people you can find and pay them appropriately. There are a number of ways to find good employees, but bear in mind that your practice probably has a reputation for how its employees are treated. This can influence the quality of people who apply to work with you. Physicians who treat their employees fairly and compassionately generally enjoy a good reputation in their community and people will want to work for you. In these practices, employee turnover is relatively low, which can be a good sign that they are well-treated. Well-treated employees also treat patients well as that is the value system of the practice. Be mindful of how you treat your employees as that might be how they treat your patients. When interviewing potential employees, observe not just what the people say, but also their nonverbal behaviors. If their job is to work directly with patients, are they warm, friendly, able to make eye contact, and relate to patients? Do you like being with them – and do you think your patients will feel cared for by this person? Check references and perhaps have a team of your employees interview the potential team member as well.

•  Train your staff in the ways you want them to treat your patients. They should have a clear understanding of their job functions as well as clear expectations as to their style of patient and co-worker interactions. Remember, you are the role model, so your behavior is important and should reflect the ways you want your extenders to treat your patients.

•  Have an employee handbook outlining your practice’s rules and expectations, including consequences if specific behaviors are not adhered to. New employees should study the handbook and sign that they accept all the requirements, including the need for strict patient confidentiality, for example. You can check with the MGMA (Medical Group Managers Association) for sample employee handbooks.

•  Keep a paper trail of employees’ misdeeds and consequences. Progressive discipline is usually the appropriate course, but there are some behaviors that warrant immediate employment termination. Showing up to work intoxicated or under the influence of drugs should be grounds for such termination. This documentation will help you if you decide to terminate such an employee and help if an employee files a wrongful termination suit.

•  Schedule regular staff meetings to improve office communication and to discuss other issues. Providing on-going training and interaction will aid the staff in knowing how you want the practice run and to answer the myriad of questions which arise during the course of their busy work days. You can also use these meetings to provide specific skill-building training as well. Be sure to document all training you provide for your staff.

Your employees represent you in a number of public relations and legal situations. Be sure to hire the best, pay them well, train them often, recognize their good behaviors and modify inappropriate ones. Your staff can be one of your greatest assets – or scariest liabilities. Treat them well. Your patients will thank you.

IND offers three risk management programs per year, two in Las Vegas and one in Reno.  In addition, tailored programs are also held for nurses, administrators, and medical office staff.  Information regarding these programs can be found here:  http://www.ind-insurance.com/risk-management.  Please contact Idora Silver, IND Director of Risk Management, at (775) 829-0606 if you have any specific risk management questions or would like to consult with her on customizing a program specific to your needs.