Managing staff can be a challenge, and one for
which most medical practitioners are not trained. However,
minimising risk with staff is as much about communication and good
relationships as with systems and good management.
In general, the employment of employees in the private sector is
regulated by federal government legislation and industrial
instruments. There are a number of federal government agencies
which provide information to small business operators about the
rights and obligations of employers.
Many staff are engaged as contractors, rather than employees.
For example, the medical practitioners in your practice may be
engaged as contractors. You should make yourself aware of the
differences in your obligations towards employees and
Human resources risks fall into a variety of areas. Better
practice involves adopting all of the strategies listed. A practice
manager with knowledge and experience in these areas, and given
opportunities to remain up to date with changing requirements, will
be able to assist you with many of these tasks.
Improving your practice
- Practice staff are the patient's first contact with your
practice, and their dealings with the patient can have a dramatic
impact on patient satisfaction.
Risks include poor public relations, poor practice experience
for patients, rudeness or unhelpful staff.
- Set a good example in your own conduct with patients.
- Have in place a practice code of conduct and/or code of
- Create good staff conditions - facilities, work breaks,
flexibility, opportunities for training and development and
understanding with time off work etc.
- Recruit staff with suitable temperament and attitude.
- Provide staff with customer service training.
- Staff are key to the smooth and efficient operation of your
Risks include incorrect or inefficient performance of practice
procedures, loss of intellectual capital when staff leave,
workplace bullying or staff disharmony, theft and fraud,
unauthorised internet activity and privacy breaches.
- Have a staff induction program and conduct ongoing training
about your organisation's key policies and procedures. Ensure that
training records are kept of attendance at training.
- Have job descriptions, clear position responsibilities and an
- Ensure there is a policy and procedures manual that is indexed,
signed as read and understood by all staff, has amendments dated
and is made known to staff. The policy and procedures manual should
be reviewed and amended as required.
- Ensure that the manual includes a confidential complaint
procedure and outlines the consequences of failing to adhere to
acceptable standards of staff conduct.
- Ensure that staff performance and conduct issues are dealt with
in a timely and consistent way.
- Hold regular staff meetings.
- Have performance appraisals.
- Avoid key person dependency by multi-skilling staff.
- Have clear systems for checking finances (e.g. control of petty
cash, external bookkeeper).
- Implement IT auditing processes (e.g. to detect unauthorised
internet access and to mitigate fraud).
- In a court judgement in Alexander v Heise & Anor 
NSWCA 422, practice staff were found to have a duty of care to
patients. This case involved the receptionist deciding that an
appointment was not urgent, and the patient died from an aneurysm
before the appointment. In court the receptionist was found,
however, not to have breached her duty of care on this occasion, as
she based her assessment on the information given to her. This
raises several risk management issues.
These include failure of practice staff to prioritise patients
- Instruct practice staff on the proper management of patients
who present with symptoms or complaints that may warrant urgent
- Have guidelines in place so that if a staff member is unsure of
the urgency of a condition, he or she consults the doctor.
- Documented triage policy. A laminated triage flow sheet visible
near the telephone may assist staff in following triaging
- CPR training for all staff may be appropriate, depending on
- As an employer you are vicariously liable for the actions of
These include performance of patient procedures by employees,
employed health practitioners practising without registration or
insurance, breach of confidentiality/privacy and unethical
- Ensure that nurses only perform procedures they are trained and
competent to perform. Such training should be up to date and
- Ensure nurses are properly supervised when performing medical
- Have indemnity insurance policies for staff where applicable
(seek advice from your Avant portfolio service officer).
- Develop a routine pre-employment checklist, including such
things as evidence of current registration and right to work in
- Confidentiality agreement signed by staff.
- Ensure performance appraisals, job descriptions and documented
lines of authority.
- Ensure that employment contracts include reference to
dismissible offences such as breach of patient
- Ensure all staff receive regular training in key policies and
procedures. Document attendance at the training and maintain those
- Workplace safety is the responsibility of many parties,
including the employer and anyone carrying on a business. Your
practice must comply with workplace health and safety
These include staff injury, staff off work on workers'
compensation and management of return to work, increased workers'
compensation premiums and prosecution.
- Know the workplace health and safety legislation that applies
in your state.
- Have workers' compensation insurance.
- Know the requirements for reporting incidents and claims to
your workers' compensation insurer and the authority responsible
for workplace health and safety.
- Provide and explain to staff your practice workplace health and
- Have processes in place for staff to raise safety issues and
- Assess and minimise safety risks in the practice.
- You must comply with industrial relations laws regarding
recruitment, offers and contracts of employment, probation periods,
conditions for permanent and casual employees, awards, pay slips,
superannuation, PAYG tax, leave entitlements, dispute resolution
procedures, termination and record keeping.
These include employee dissatisfaction, employee disputes and
- Be familiar with legislative requirements, including award
rates and pay slip information requirements (see Industrial relations links).
- Attend industrial relations training courses.
- Adopt effective recruitment procedures to try to eliminate the
stress and business disruption of dealing with an unsuitable
- Use probation periods to assess employee performance and
- Keep records of employment details for tracking leave
- Have dispute resolution procedures in place.
- Seek advice to follow correct procedure for redundancies or
- In some states, staff in contact with children must undergo a
'working with children' check. This involves applying to the
relevant government agency to register for the program, and staff
signing a declaration. See industrial relations links
for further information.