HR 101


The art of managing people.

By Kim Stamp

As a practice owner, or human resources (HR) manager, it is important to recognize that your most valuable asset is your staff. Oftentimes we spend countless hours strategizing how to grow and manage our practice, while at the same time neglecting the needs of our employees. I have come to believe that managing people is both a creative art form and a key component to any clinic’s success. It’s not enough to have company policies and programs in place. We must recognize that each one of our employees comes to us with a unique personality and a backlog of experiences that will influence the way they work. Taking the time to understand your staff, and individually care for them, will positively impact your practice and contribute to your overall success.

Over the years, I have heard countless disparaging stories from employees about how they were treated at their former places of employment. Within my company alone (five clinics), I can think of at least five good therapists who left their former positions due to HR-related issues. In today’s job market, with more than 30,000 physical therapy jobs that will go unfilled in 2016, it is difficult to understand why a practice owner wouldn’t make the effort to appropriately care for their therapists. Taking good care of our staff will not only help our practices thrive, it will also save us the high cost of employee turnover.

While there are many factors that drive employee turnover, poor communication is at the top of the list. To overcome this, become an expert at communication. An integral part of the process is listening. If an employee feels their concerns are being heard, they will be more likely to work through any issues that arise. In addition, if we as managers purposely get to know our employees we will not only be able to deal with problems effectively, we will also be better equipped to tailor a conversation so that our employee hears what we are saying. For instance, if a person is insecure, they will most likely shut down if we become critical of something they’ve done. But if we first let them know a few of the things they are doing well and then follow up with what we would like them to do differently, they will be more likely to receive what we are saying and make the needed adjustments.

Daniel Pink, in his wonderful book, Drive: The Surprising Truth About What Motivates Us, points out that people want to believe they are contributing to something meaningful. As owners and managers, it’s on us to communicate what our company values and how each individual employee contributes to the overall company mission. Creating strong company values, and a clear mission statement, are necessary to motivate and engage our staff. If an employee has no idea what the company stands for, or how they fit into the big picture, they will have little to no engagement with their job. As staff begins to understand the practice’s mission and begins to see how they contribute to fulfilling that mission, they will become more engaged with their job.

A recent Gallup study found that more than 70 percent of all employees were disengaged at work. Disengaged employees tend to create drama, dominate an HR manager’s time, and subtly communicate their unhappiness to patients. On the flip side of the coin, engaged employees genuinely care about the company they work for and will regularly go the extra mile. Essentially, an engaged employee will contribute to the overall success of your practice while a disengaged worker will be a detriment.

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The next step to effectively managing people is to create a solid performance review process. In our company, we have found it effective to complete a 90-day review on all new employees. This gives a manager the opportunity to correct any problems that have arisen as well as solidify how the new employee fits into the company’s mission. After the 90-day review, taking the time to complete an annual review is a great way to both recognize a valued employee and tweak the performance of an employee who’s falling short.

Having regular employee appreciation celebrations is also important. We all want to feel appreciated, and I have found that our employees respond positively to being provided morning coffee and pastries or a pizza lunch when their clinic has a good month. We also utilize gift cards (which can be considered taxable income) and encouraging notes to let individual employees know that we recognize their hard work. Anything along this line will be meaningful when sincerely presented by an owner or manager. In looking at what motivates employees, Daniel Pink suggests that most people are innately motivated by autonomy. Essentially, his philosophy is that we should hire good people and let them do their job. While it may be tempting to micromanage every aspect of your company, it can often be oppressive and demeaning to your employees.

Finally, when faced with managing a disengaged or negative employee, it’s important to realize the effect that person has on other employees and the patients coming into our clinics. Too often we repetitively train, and retrain, an employee who is falling short rather than letting them go in order to preserve the overall atmosphere within the clinic. As difficult as it is to terminate an employee, we must put the needs of the whole clinic above the negative behavior of one person.

When it comes to managing the people working at your practice, keep in mind that it’s more of a creative art form than a clever program or a set of guidelines that we try to follow. Sharpen your communication skills and work toward helping your employees to fully engage with your goals and values. Do these things and you are on your way to successfully managing your greatest asset!


Kim Stamp is the regional business manager for South Sound Physical & Hand Therapy in Olympia and Tacoma, and the vice president for the Washington State Physical Therapy Managers Association. She can be reached at

Outsourcing HR


Do you need a professional employer organization (PEO) to handle your human resources needs?

By Kevin Mason

Business owners today are faced with a growing list of challenges to be successful—from recruiting and training the right employees to growing revenues and keeping clients happy and everything in between. Often, the aspects of business that become most challenging involve the ever-expanding rules and regulations around employment. Whether it’s collecting the right information at hire, paying employees and taxes correctly, keeping an up-to-date handbook, maintaining compliance with the Affordable Care Act, handling terminations, or any other employment action—it’s enough to make your head spin and potentially get you into trouble.

When it comes to managing the employment side of your business there are many options to consider for help. There are a growing number of vendors with which to work to outsource various aspects of your human resources (HR) services. Payroll companies are common and will help make sure you pay your taxes timely and accurately. Employee benefit brokers can help you put together a competitive benefits package for your employees. HR consultants can assist in making sure your handbook is up to date and that you have the right policies in place. There are also separate vendors for services like retirement plans, background checks, employee perks and discounts, safety training, unemployment management, flexible spending accounts, and more. It can become a full-time job just managing all these relationships.

An alternative to having so many vendors is working with one partner that can manage all of these things for your business. Professional employer organizations (PEOs) do just this for small and mid-sized businesses. While the PEO industry is not a new one, many businesses are not aware of the value they can bring. So what exactly is a PEO?

A professional employer organization (PEO) helps businesses manage complex employee-related matters such as employee benefits, human resource compliance, workers compensation, payroll tax compliance, and unemployment management. A PEO partners with your business to perform these processes, assume associated responsibilities, and provide expertise in all human resources matters. A PEO provides a suite of integrated services, often a tailored HR solution, to effectively manage your critical human resources responsibilities and employer risks.

Here are seven of the top reasons that businesses will partner with a PEO:

  1. PEO clients are often able to offer a broader array of benefits to their employees than companies that do not use PEOs.
  2. PEOs remove the heavy burden, distractions, and worries of HR management, allowing you to focus on what you do best.
  3. Clients often receive savings on certain employee benefit plans by leveraging the relationship with a PEO.
  4. A PEO helps minimize threats to your business, from compliance to insurance, record keeping, tax filings, immigration issues, and beyond.
  5. The employee turnover rate for PEO clients is 10 percent to 14 percent lower per year than that of comparable companies, according to the National Association of Professional Employer Organizations (NAPEO).1
  6. Using a PEO as a single-source provider lowers internal costs.
  7. Businesses that use PEOs are approximately 50 percent less likely to fail one year to the next when compared to similar companies (NAPEO study).1

A PEO delivers these services by establishing and maintaining an employer relationship with the employees at the client’s worksite and by contractually assuming certain employer rights, responsibilities, and risks. How does a PEO relationship work? PEOs and their clients sign a co-employment agreement in which both the PEO and client company have an employment relationship with the worker. The PEO and client company share and allocate responsibilities and liabilities. The PEO assumes much of the responsibility and liability for the business of employment, such as risk management, human resource management, and payroll and employee tax compliance.

The client company retains responsibility for and manages product development and production, business operations, marketing, sales, and service. The PEO and the client share certain responsibilities for employment law compliance. As a co-employer, the PEO provides a complete human resource and benefit package for worksite employees.

Do you think a PEO is worth considering for your business? If so, here are a few steps to help find out which PEO might be the right fit for you. Most PEOs are similar to each other, but differences in service model, benefits offered, billing method, and accreditations might be very important. Here’s what you can do:

  1. Investigate the PEO’s accreditations. Have their business practices been independently accredited by the Employer Services Assurance Corporation (ESAC, Are they a current member of NAPEO, the national trade association of the PEO industry? Do they have proven financial strength, security, and comply with the industry’s performance practices?
  2. Explore the employee benefits offering of each PEO, paying special attention to the doctor’s network for the areas where your employees live. Also, make sure to compare the details of the plans with your current plans to make sure you know what you are getting into. There are almost always differences with copays, deductibles, prescriptions, etc. Hopefully more of the differences are in your favor.
  3. Check within your network and ask for client and professional references. Do you know anyone who has had success and would recommend partnering with a PEO?
  4. Research the locally headquartered PEOs. Oftentimes a locally headquartered PEO will have better options for employee benefits. Ensure that they can handle multistate employees, if needed. To find a service provider near you, search NAPEO’s online member directory.
  5. Explore your options and most importantly, give yourself time to evaluate. A minimum of 90 days prior to your renewal is recommended.

A growing number of business owners are looking for help managing the employment side of their business. Each year the rules and regulations seem to change, and the costs for employee benefits and other services continue to rise. Solutions to these issues can take a number of forms. Could a professional employer organization be the right solution for your business?


1. National Association of Professional Employer Organizations, Accessed May 2016.

Kevin Mason is the business development manager for GenesisHR Solutions in Burlington, Massachusetts. He can be reached at

*The author has a vested interest in this article’s subject matter.

How to Drive the Journey of Change


Creating an evidence-based model of intentional change that is effective, practical, and adaptable to your people and organization.

By Robert S. Wainner, PT, PhD, ACC, FAAOMPT, Daphne Scott, PT, DSc, FAAOMPT, MAPP, and Laurence N. Benz, PT, DPT, OCS, MBA, MAPP

It has been said that change is inevitable. Whether you like change or not, I think most would agree with Eric Hoffer who said, “In times of change, learners inherit the earth; while the learned find themselves beautifully equipped to deal with a world that no longer exists.” Which do you prefer, to learn or be among the “learned”?

There are a lot of theories, models, and approaches to the complex topic of change. The desire to simply default to a consistent behavior rather than adjust is likely one of the reasons most people find change difficult. Where are you supposed to start? Another likely reason is that practical frameworks for effecting intentional change are few and seldom taught.

This article will present an evidence-based model and heuristic process for intentional change that is effective, practical, and adaptable to your people and organization. In addition, we hope to expose you to the best change resources we have been able to curate. By doing so, our hope is that you will become a connoisseur of change who embraces the process.

Einstein once said that “Everything should be as simple as it can be but not simpler.” So instead of delving into theory, we will present our heuristic process for change and review the theories, concepts, and techniques on which it’s based. Finally, we will share our own change journey over the last 18 months.

Our three-part heuristic process for driving change is getting the following three “W’s” right:

  1. The “Where”: Where are you now and where do you want to go? You need a compass and map.
  2. The “Why”: What is driving your powerful “Why”? You need to feel it coming from the inside.
  3. The “What”: What do you want to change and at what level? You have to be specific.

Successful change is the combination of really knowing where you want to go, having the internal motivation to get there, and being specific about where and how to leverage yourself and the environment for maximum impact. Resolving these three questions will ensure that you make the right change journey and help you drive it as smoothly as possible.

Now that we have described our heuristic process or rule of thumb for change, we will break down each part in more detail.

Your Compass and Map: Coaching 101
Change at its core really is a journey, and you need a compass and a map. Whether it’s an individual, a 1,000 plus organization, or something in between, it’s all about getting from point A to point B, which is your ultimate destination. It’s simple Coaching 101, but simple does not mean easy. What makes it hard is the lack of awareness most have in the following three areas:

  1. Knowing where you are: We all have blind spots, and you have to be willing to see those for what they are.
  2. Knowing where you want to go: Without a clear, compelling vision and powerful “Why,” your direction will be unclear and internal motivation will be lacking.
  3. Knowing how to bridge the gap: This is about having the right strategy and mechanics. When you have awareness and clarity in the first two areas, the “how to get there” often becomes self-evident.1

Your powerful “Why”: it has to come from the inside
Internal motivation equates to our “drive,” or why we do the things we do. Dan Pink has done a great job of curating Deci’s research2 and boiling down internal motivation to the basic elements listed here. People don’t necessarily have to have all three of these in place at the same time to be internally motivated, but they do need a sufficient measure of any one element to stoke the fires within.

  1. Autonomy: The desire to direct your life within an interdependent context.
  2. Mastery: The urge to make progress and get better at something that matters.
  3. Purpose: The urge to do what you do in the service of something larger than yourself.3

Be specific: Know what you really want to change
To be specific with organizational change, you have to know what you are dealing with and at what level. The 2 x 3 framework below is a helpful tool to determine whether you are primarily dealing with an issue of motivation or ability, and where to focus your efforts. Getting that combination right keeps your change efforts from falling flat and at the same time allows for maximum impact.4

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Once you have identified your three “W’s” for change, you still have to get going and make the journey. And given the angst associated with change, you want the journey to be as smooth as possible.

In their book Switch, Chip and Dan Heath describe an approach that makes it easy to understand how to best get started. By using “Switch” concepts listed here, you can ensure you have the right mix of well-thought-out detail, measured emotion, and an environment that makes driving change efforts as frictionless as possible.

  1. Knowing: This refers to the cognitive element of the change you want to make, the large and small details, if you would (the “Rider,” in Switch language).
  2. Feeling: This is the affective or emotional element and gives you the power or “juice” to get where you want to go. Just because someone knows what to do does not mean they will do it.
  3. Environment: This is the context and milieu in which change occurs. Sometimes success is contingent on something seemingly as trivial as things being one click away instead of two, or as simple as seeding a tip jar.5

And now the big question: Do they really work?

There is more than ample evidence that each of the models described are effective for empowering change. And if our experience over the last 18 months is any indication, it seems to be effective when embodied in a simple heuristic process as well.


We started with a compass and a map. We knew we had three different companies in the rehab sector comprised of over 40 clinics and distinct business units with 400 people across 3 states. We also knew we had a vision for uniting those under a common ownership structure and brand that would bring economies of scale as well as focused attention and execution. By first solidifying where we were and where we wanted to go, we were able to get a clear vision of what we wanted to change, get agreement, and then take the next steps to bridge the gap.

Our purpose or powerful “Why” was and is to “Give more than it takes so that our people, our customers, and our enterprises continually flourish.” This is the “juice” that gave us, and continues to give us, our drive and passion.

We are still early in our journey and so far we have intentionally focused on three distinct areas of change. Early on our primary focus was to inculcate a “think small/stay local” mindset and ability among our individual team leaders. The next stage has been unifying our entire organization around the concepts of conscious positive leadership principles and inculcating those into our culture. A third effort was to adopt a “connect and collaborate” model of growth and management rather than a “command and control” approach, which is the typical model in modern business management. As the next area of change comes into focus, we will target our efforts accordingly while keeping the fly-wheel spinning on the others.

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Finally, while it’s a work in progress, we keep things moving forward by intentionally pulling the right levers at the right time. This includes making sure we are up to date in our skills and knowledge, that we foster our social and emotional intelligence, and that we strive to keep the extraneous, the distracting, and the encumbering at bay so we can operate as efficiently as possible.

One thing is certain: Change is coming soon to a location near you. The real question is whether you are going to settle and drift along on cruise control or set a course for a destination and move change forward consciously. If it’s the former, realize that with today’s fast pace you’re going to eventually get left behind. If the latter, you have a heuristic that can serve as a GPS of sorts to help you get to where you really want to go. It’s up to you to decide where you want to go and how you want to roll.


1. Hicks R. Coaching as a Leadership Style: The Art and Science of Coaching Conversations for Healthcare Professionals. New York: Routledge; 2014.

2. Deci EL, Koestner R, Ryan RM. Extrinsic rewards and intrinsic motivation in education: Reconsidered once again. Review of Educational Research. 2001;71(1): 1-27.

3. Pink DH. Drive: The Surprising Truth About What Motivates Us. New York: Riverhead Books; 2011.

4. Patterson K, Al. JGE. Influencer: The Power to Change Anything. McGraw-Hill Education; 2008.

5. Heath C, Heath D. Switch: How to Change Things When Change Is Hard. Random House of Canada; 2010.

Robert S. Wainner, PT, PhD, ACC, FAAOMPT, is the executive/professional coach of Confluent Health. He can be reached at

Daphne Scott, PT, DSc, FAAOMPT, MAPP, is the chief cultural officer of Confluent Health and the CEO of DS Leadership Life Consulting. She can be reached at

Laurence N. Benz, PT, DPT, OCS, MBA, MAPP is the CEO of Confluent Health in Louisville, Kentucky. He can be reached at

*The author has a vested interest in this article’s subject matter.

Developing Mini-Marketers During Onboarding

By Michelle Collie, PT, DPT, MS, OCS

Whether for a physical therapist or administrative staff member, the onboarding or orientation process is an important time for any new employee in any practice. Employees acquire the knowledge, skills, and behaviors to complete their job duties while discovering the culture of the practice. So often there is a need to have a new employee seeing patients or answering phones, functioning in their new role as soon as possible. But this eagerness to fulfill daily responsibilities may be at the expense of taking the time to develop an employee into an advocate and spokesperson for your practice, someone who could play a valuable role in marketing and promoting your practice.

Marketing2020,1 a comprehensive marketing leadership study, found successful companies incorporated marketing throughout their firms. Marketing was integrated through engagement with employees on the brand’s purpose, as well as providing new staff with targeted marketing language.

The onboarding period in a physical therapy practice provides an opportunity to teach, provide the language and tools, time and expectations such that every new employee can actually be a driver of new patients and business opportunities. Essentially, every employee is a “mini-marketer.” Designing the specifics of the marketing and messages to be delivered during the onboarding process are practice specific but will obviously align with the vision, purpose, and current processes of marketing.

Consumers are turning to the web more and more to make choices about their health care. In addition to ensuring the clinical profiles are up to date on your company website, provide new employees with your logo and a written description of the practice to use, ensuring a consistent message is delivered online. Provide training on creating professional profiles for social media platforms such as LinkedIn and the American Physical Therapy Association’s (APTA) platform. Find a physical therapist (PT) and set the expectation that it is one’s professional responsibility to keep one’s profiles up to date.

During the onboarding, provide education on the social media platforms your practice is active on. Educate staff on the behaviors you support, such as “liking” or “sharing” content that has been posted. Consider how one Twitter or Facebook post can organically be shared to an unlimited number of people, further spreading awareness of your brand. The education on social media is just the beginning. Ongoing education to further develop mini-marketers may include subjects such as blogging or posting to promote patient engagement.

Many practices provide referral reward programs. By including education on this during the onboarding, new employees will truly understand and value their role in driving new patients and new business. Highlighting staff that have referred patients during meetings or in staff newsletters will encourage this ongoing practice.

Onboarding is a time when employees can be provided the education to fully understand the purpose of the practice. By reviewing the practice’s vision, purpose, core values, and goals, a new employee will gain a deeper understanding of the practice, resulting in a more consistent message being delivered to patients, as well as the community. Educate staff to ensure they can talk and deliver a message that aligns with your practice. Consider discussions and role playing to confirm new employees know how to answer questions such as: What is physical therapy? Is a referral needed? How much will it cost?

Finally, assess the effectiveness of the inclusion of these marketing elements into your onboarding program. Employee surveys and feedback, as well as measuring where new patients are coming from, can demonstrate the value of this time spent during onboarding, both from a human resources (HR) and engagement perspective as well as a marketing and new business viewpoint. Creating mini-marketers during onboarding is a win-win and demonstrates the value of HR and marketing integration.


1. Arons, MdeS, van den Driest, F, Weed, K. The ultimate marketing machine. Harvard Business Review. July/Aug 2014. Accessed June 2016.


Michelle Collie, PT, DPT, MS, OCS, is the chair of the PPS PR and Marketing Committee and chief executive officer of Performance Physical Therapy in Rhode Island. She can be reached at

The Value of Time


Let technology help you save this most precious commodity.

By Eric Cardin, PT, MS

Time. Time is money. Time seems infinite yet it is a finite resource. You’ve already given up some by the end of this sentence. Every moment is sacred yet we waste it every day. Technology offers the promise of efficiency and organization, but too often we find ourselves awash in options and lacking solutions.

Much like exercise, you have to find what works for you to be successful. Sometimes finding your “system” is a series of failures, and only trial and error can result in the perfect (or near-perfect) method for staying on top of things. But what are the “things”? Treating patients is straightforward: We define our schedule, the patients (hopefully) keep to it, and all is well. Keeping track of the rest of it—the emails, the voicemails, texts, invoices, payments, regulations—slowly chips away at our time. While we oftentimes worry that the erosion of our time is detrimental to our bottom line, the real effect is much more costly. Lack of organization and efficiency takes away from our time.

Dwight Eisenhower, Supreme Allied Commander, president, and avid golfer was legendary for his efficiency. Whether Ike was born to it or developed it after years in the military, he was known for getting things done. After all, you can’t lead the largest secret military invasion in history without having your ducks in a row. One trick he developed was the “Eisenhower Box.” A simple but powerful tool for organizing and prioritizing tasks by dividing them into four categories across two simple principles. Is it urgent? Is it important? If it’s urgent, should you do it now or have someone else do it very soon? If it is not important or not urgent, do you really need to be doing it?

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So much of what bogs us down is training ourselves to understand what needs our attention. Urgency and importance can be quite subjective, but over time, patterns develop and tasks drive themselves into the appropriate box. Turning a legal pad into a Eisenhower Box can sharpen focus and reduce the overwhelmed feeling that can torpedo efficiency. Several free and paid apps exist to use your smartphone to harness the power of the Eisenhower Box. Some offer calendar integration to allow the user to swipe a “plan it” task right to the calendar, and many offer “task timer” to put yourself on the clock to “do it now.” Setting up your email application with folders for the four boxes can be a powerful tool for taming your inbox. Most email apps have effective tools for learning your preferences and over time can help filter your email to the appropriate folder and further enhance your efficiency in managing email.

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Sometimes we can get lost in too many projects going on at once. Scraps of paper, notebooks, iPhone Notes, and a wall of Post-its leaves you with a mess and not much else. Several online tools/apps have emerged that use cloud technology and smartphones to help with collaboration and organization. Over the past three years apps such as Trello, Asana, Teamwork, Boomerang, Slack, Basecamp, Wrike, and many others have emerged to streamline the ability for individuals and teams to collaborate and efficiently complete tasks. The number of apps is evidence that no one has it exactly figured out (so don’t feel bad about being so disorganized), but it is also proof that finding the right tool or method is an individual thing. Moving our task lists to and prioritizing them in the cloud and accessing them via that one thing you carry around with you all the time, always look at, and (hopefully) never lose, is a great use of technology (although not as satisfying as the video game Candy Crush).

The key to success is similar to physical therapy. Basic ingredients or steps are required, but diligence and consistency are key. If it isn’t working, you probably haven’t found your method, so keep trying. Some of us are prone to procrastination and disorganization and secretly thrive on the pressing deadline or the backlog of work that needs to be done. Who are we kidding? No one likes that and it’s no way to live, so mark a date on your calendar to get started on your path to efficiency and organization. What you get back in time saved will far outweigh time spent.

Eric Cardin, PT, MS, is the executive director of South County Physical Therapy, Inc., in Auburn, Massachusetts. He can be reached at

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