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  • Staff risk management

    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 contractors.

    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

    1. 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 Strategies

      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 ethics.
      • 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.
       

       
    2. Staff are key to the smooth and efficient operation of your practice.

      Risks Strategies

      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 organisation chart.
      • 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).
       

       
    3. In a court judgement in Alexander v Heise & Anor [2001] 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.

      Risks Strategies

      These include failure of practice staff to prioritise patients accurately.

      • Instruct practice staff on the proper management of patients who present with symptoms or complaints that may warrant urgent attention.
      • 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 guidelines.
      • CPR training for all staff may be appropriate, depending on your location.
       

       
    4. As an employer you are vicariously liable for the actions of your employees.

      Risks Strategies

      These include performance of patient procedures by employees, employed health practitioners practising without registration or insurance, breach of confidentiality/privacy and unethical behaviour.

      • Ensure that nurses only perform procedures they are trained and competent to perform. Such training should be up to date and ongoing.
      • Ensure nurses are properly supervised when performing medical procedures.
      • 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 Australia.
      • 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 confidentiality.
      • Ensure all staff receive regular training in key policies and procedures. Document attendance at the training and maintain those records.
       

       
    5. 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 legislation.

      Risks Strategies

      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 safety policy.
      • Have processes in place for staff to raise safety issues and report injuries.
      • Assess and minimise safety risks in the practice.
       

       
    6. 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.

      Risks Strategies

      These include employee dissatisfaction, employee disputes and legal action.

      • 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 employee.
      • Use probation periods to assess employee performance and suitability.
      • Keep records of employment details for tracking leave entitlements.
      • Have dispute resolution procedures in place.
      • Seek advice to follow correct procedure for redundancies or terminations.
       

       
    7. 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.