Are some jobs at your medical practice just too urgent or important to assign to specific people? That’s the argument some practice managers and physicians make, e.g:
“Phones need to be answered by the first available person, whatever their job”
“Everyone should keep an eye on the fax machine, and deliver faxes they see piling up”
“Let’s all keep an eye on the reception area, to make sure no one’s waiting too long”
“It’s the entire team’s job to make sure the patient bathrooms are clean and stocked”
When the entire team is engaged on these important, urgent tasks, the theory usually goes, there will always be someone available to do them, right when the need arises. Everyone will have an equal stake in making sure they’ll get done — right?
Have you ever heard the amusing little story about four people named Everybody, Somebody, Anybody and Nobody? It goes like this:
There was an important job to be done and Everybody was sure that Somebody would do it. Anybody could have done it, but Nobody did it. Somebody got angry about that, because it was Everybody’s job. Everybody thought Anybody could do it, but Nobody realized that Everybody wouldn’t do it. It ended up that Everybody blamed Somebody when Nobody did what Anybody could have done.*
There is a lot of organizational insight packed into that little verse.
When something is everybody’s job, it’s effectively nobody’s job. Nobody is actually accountable to do the work, and everybody can rationalize that they thought someone else would do it. When everyone has other work to do that they believe is important, they’ll be more likely to assume someone else will take care of the group responsibility.
We have worked with several practices that have applied this “everyone’s job” idea and been very unhappy with the results. Laurie, they say, why aren’t the staff answering the phones? We tell them over and over that everyone has to answer the phones! Instead, our messages are piling up, patients and other doctors are complaining, and nobody’s getting the help they need when they call. How can we make them see the importance of answering the phone?*
It looks in these situations like the entire staff is screwing up, but usually what’s actually happening is that they’ve been set up to fail. Here are some reasons why, using the specific example of inbound phone calls:
- Expertise: Everyone’s supposed to answer the phone, but staff have differing knowledge of how to triage calls, set appointments, etc. When staff members answer the phone and don’t have the tools to help the caller, the caller gets frustrated, and the staff member gets discouraged. Calls take too long to process, pulling staff away from other tasks they need to accomplish. After a few repetitions of this, staff who are not specifically trained to handle the wide variety of issues that come up on the phone will hope that someone else will answer it;
- Process inefficiency: Related to the expertise problem, sharing a task across an entire team can gum up workflow. For example, if a patient calls in and speaks to a different person every time, s/he may wind up explaining a detailed problem over and over;
- No upside, shared downside: It usually doesn’t take long for the physicians and/or the practice manager to get understandably fed up with phones ringing and not being answered properly, which inevitably leads to escalating admonishments. Even those who tried their best to answer the phone frequently will get dressed down with the group, leaving them to wonder why they should bother trying when their efforts are unrecognized and they’ll all end up ‘in trouble’ anyway;
- Prioritization problems: Expecting everyone to answer phones alongside their other responsibilities means expecting them to decide each time they hear the phone ring whether what they’re working on at that moment is more or less important than the ringing phone. Given that they have no way of knowing what the caller wants, how can they make the right choice? Most people will rationally focus on completing the task in front of them — especially because those tasks are the ones they’ll be individually accountable for completing;
- Resentments and conflicts: When the entire team is always in trouble with the boss for work that’s not getting done, resentments will quickly develop as employees try to figure out who’s not pulling their weight;
- Deteriorating morale: Most people want to do a good job. They want to leave at the end of the day feeling that they have completed the work that was expected of them, and pleased the customer and the boss. But when a job is not done well because it’s not clear who owns it — and, instead, everyone takes the blame — everyone fails.
If a task is so important that everyone should care about it, then it’s too important to leave to whomever is free. A task like that needs to be assigned to a person (or persons) who can be held accountable for getting it done. That, in turn, gives that person a sense that their role matters in the organization, and that they can focus their energies on how to perform it best. It gives that person a chance to shine! Now, that doesn’t mean people can’t pitch in when there are unexpected busy periods — which certainly happens on occasion with tasks like the phones. But everyone will understand when those overflow situations occur — and how best to help support their colleague in getting the job done, without confusion about whose job it actually is.
*author of this delightful and oft-shared little story is unknown