Improving Human Resources and Productivity in Orthopaedic and Spine Practices

4 steps to improve HR and productivity in daily practice

Spine practices have to plan for the everyday stress of caring for patients while at the same time improving productivity and profitability. Given the wide variety of staff involved in one practice, the lines of communication easily can be crossed, potentially harming practice efficiency. However, when the staff is trained and everyone has a clear understanding of their own job responsibilities, the practice starts to operate like a well-oiled machine.
Medical staff together in reception areaWell-written job descriptions that define roles and responsibilities is essential to optimizing workflow. Photo Source: are four steps to help busy practices improve human resources (HR) and productivity in daily practice.


There is power in defining roles. Well-written job descriptions that define roles and responsibilities as well as the hierarchy of whom each employee reports to is essential to optimizing workflow.

The U.S. military is an example of an organization where there is a clear chain of command and understanding of job descriptions. While employees in spine practices typically report to a human resource or office manager, a physician who oversteps the manager or takes away his/her power may create confusion among the staff.

Other training tools include an employee handbook, which should be a set of guidelines that are specific to your practice and are clear enough for all employees to follow. The handbook should be edited annually to ensure that it reflects any changes at your practice.


Quick and regularly scheduled meetings are the best way to communicate with employees. In addition, an agenda should be issued every morning with a list of daily responsibilities for each employee. For a given project, identify what needs to be done, who is responsible for each task, and the timeline. Furthermore, setting both weekly and monthly goals for each employee lays the groundwork for efficient communication.

Importantly, emails and texts are not effective ways to communicate with staff about what is or is not working in a practice. Reprimanding or responding to reprimands by emails and texts is passive-aggressive.

Good communication also includes annual or biannual reviews, which are typically done by HR or practice managers. Managers can use these reviews to gauge employees’ performance as it related to the employer’s expectations and determines where there are gaps.

In some cases, it may be more appropriate for a physician to be in charge of evaluations for staff with clinical roles, such as a nurse practitioner, nurse, or medical scribe. In fact, those team members may resist reporting to a manager when they spent far more time with a given physician. In such cases, it may be best for an HR manager to oversee the employee review in tangent with the physician.


Office efficiency begins at the front desk, where staff should be trained how to schedule a patient check-in, visit, check-out, and follow-up. Furthermore, dedicated cross-training of administrative positions should be considered to account for staff illness, vacation, and turnover to ensure that office flow remains consistent.

Vacation time should be requested at least a month in advance using request forms that need to be signed off on by management. Having a list of temps on hand may help fill unavoidable gaps in care.


By far, the most impactful factor in workforce and team productivity is hiring and retaining employees with exceptional capabilities and self-motivation. The second-most important productivity factor is hire great managers/leaders, who play critical roles in defining the direction, purpose, priorities, goals, and roles of the workforce.

Managers looking to further their skills and keep updated on compliance issues can consult the following organizations:

  • American Academy of Orthopedic Executives (AAOE)
  • Neurosurgery Executives’ Resource Value & Education Society (NERVES)
  • Medical Group Management Association (MGMA)

Other strategies to promote productivity include delineating team and individual goals, establishing performance metrics for continuous improvement, and effectively rewarding staff, including using productivity bonuses.

Productivity bonuses vary widely by practice and there is no standard. While productivity is relatively simple to measure when it comes to providers, who are direct revenue producers, it is challenging to calculate productivity for non-revenue producing employees.

These bonuses may be calculated using profit sharing based on the overall growth of the company. For example, a company may look at the group’s net profit and designate a small portion of that towards a profit-sharing pool to be distributed to the staff.

Another approach is to look at revenue before and after an employee was hired. If there is a definite surplus in collections since that employee joined the staff, the bonus may be based on a percentage of that increase.


Creating a spine practice that runs efficiently does not happen overnight. This is a process that will continuously evolve, and you must expect and accept change.

Even though every member of the staff might be responsible for different aspects of the practice, they all have to work together with the ultimate goal of offering quality patient care. For example, if the billing department is not working at its optimal level, this will affect patient satisfaction, revenue, and physician morale. The chain reactions one mistake can make in a spine practice prove that HR and productivity are important.

Nicola Hawkinson, DNP, RN, RNFA, is CEO and Founder of SpineSearch, a full service recruitment, education, and consulting company dedicated to orthopedic spine surgeons, neurosurgeons and pain management physicians. SpineSearch is based in New York City and services hospitals, ambulatory centers, and practices nationwide.

Updated on: 09/26/19
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