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What the clinic handbook doesn’t cover


Beyond the official handbook, employees will also come with their own “rules of survival” that they expect the clinic to follow. Unfortunately, the practice will have no idea what the rules-or deviation of the rules-are until they occur.


Take-home message: Beyond the official handbook, employees will also come with their own “rules of survival” that they expect the clinic to follow. Unfortunately, the practice will have no idea what the rules-or deviation of the rules-are until they occur.



Putting It In View By Dianna E. Graves, COMT, BS Ed

My administrator wants the clinic managers to get together soon to discuss the employee handbook. It seems to be that time again.

When a new employee is hired, he or she is sent a welcome letter as well as copy of the handbook to review prior to the first day of orientation. When he or she arrives in the clinic, we go over it page by page, as well as other rules that are not in the book.

For example, one paragraph deals with personnel conflicts. I call these “dustups,” or depending on who is involved, old-fashioned cat fights.

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We discuss what the handbook says, and then we review the employee “rules of survival.” The technicians have a code that we follow for dustups. When two employees cannot see eye to eye, the irritated technician will go to the “offender” and ask if she can speak to her kindly, gently, and professionally.

The two will then go into a room, shut the door, and settle the issue. The “offender” also has rebuttal time and will use the same rules of engagement. I always warn people that if they cannot get the issue straightened out, I will get involved and both parties will feel the wrath equally.

In more than 12 years, I have only had to mediate a dustup once. Since then, these disagreements have been resolved by the technicians themselves to avoid a repeat of the shock and awe. If I feel the problem is still occurring, or still simmering, I will proactively jump back into the fray to keep them honest. This usually stops the issue from re-escalating.

Crazy as it sounds, it does work. Every new employee is told about it and after hearing the rules will smile-until someone approaches him or her.

Next: Employees will bring their own rules


Employees will bring their own rules

Be forewarned that employees will also come with their own “rules” that they expect the clinic to follow. Unfortunately, you have no idea what these rules (or deviation of the rules) are until they occur.

Employee rules are never evident in the probation period. They start to appear once the probation period ends, usually around the end of the first year of employment.

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Here are some of the employee rules of survival I have had to be creative with in my years of managing:

1.             I can’t drive over bridges, so I need to work closer to home.”

When I first heard this, I thought the technician was having fun with me, and I began to laugh. Then I realized she had tears in her eyes and was serious.

She had an issue with bridges due to an auto accident she had once on one of our more notorious bridges that spans a major river. Since that accident, she had done everything she could to avoid driving across them. If I put her in a clinic that was connected to different sides of the cities, she would scope out all the back roads and it would take her 2 hours to get to that clinic.

Because she was an extremely good technician, and the patients adored her, I managed for 4 years to keep her only in clinics that avoided the bridges. She has since left our clinic, has moved north, and is working 6 miles from her house.

Next: ""I didn't think you meant every day-I am not a morning person"


2.             “I coach soccer for the high school every fall. I wasn’t sure if they were going to accept my contract again this year, so I never mentioned it. I need to be out at 3:30 every afternoon from September until October 31. It’s very important to me.”

This was a technician we hired in early summer who became a worker bee in the general clinics. She was very attuned to detail, and her skills were top notch.

Because she was such a hard worker and great with patients, her fellow technicians did not grumble too much in the beginning when she was leaving to attend practice.

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One thing she never discussed-and we didn’t think to ask-was: Practice was one thing, but how many games were you planning on playing and when did you need to leave for those? Her team did great and made it to state finals, then regionals. The season went through November.

At the end of the season, she advised me they had hired her to be a teacher in the district and she would be going back to teaching and coaching her team. She gave a 1-week notice.


3.             “I didn’t think you meant every day-I am not a morning person.”

Jane applied for a position at the hospital for a surgical/general clinic technician. She arrived at the interview very confident of her skills, and very adamant that she was the person I was looking for. Her background for the operating room was very good, and her recommendations regarding her general skills were solid. She made it very clear that she wanted, and needed, a full-time position, and that if I hired her, I would not be sorry for my decision.

I hired her shortly thereafter and she quickly dug into life as a general technician.

After a short period of getting acclimated to the clinic, she was placed in her first rotation in the operating room. The technician rules kicked in on day 3.

There were four cases that day. The physician returned to clinic promptly after his surgeries. Having been in the operating room during the early part of my career, I remembered there was breakdown and clean up to be done, so I waited patiently. Still, no Jane.

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I called the supervisor and asked where Jane was. She stated she had left an hour and half ago.

I checked with everyone, and after 2 hours, called her home. With a sleepy voice she answered, “Hello.”

“Hi, Jane, this is Diane-What are you doing home?”

“Sleeping,” she responded.

Next: "Fire me if you don't like me-please"


“But we are waiting for you in clinic.” It was now 10:45 a.m.

“I did my tour this morning. Are you serious?! Do you think that I am supposed to also come to clinic and work all day after being in the operating room? That was never made clear as part of the deal!”

We discussed this situation the next day. She was firm that she was not a morning person and getting up to go to the operating room and then working the rest of the day was NOT what she meant by full-time position and I should have clarified “full time” better.

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She thought full time meant to do her operating room stint, and then leave when that was done. On non-operating room days, she would then work in the general clinic until her shift was over, or 5 p.m.-whichever came first.

Jane ended up leaving us after 3 weeks to work 3 half-days a week at the hospital taking patients in the emergency room. (Hopefully, the afternoon shift.)


4.   “Fire me if you don’t like it-please.”

Another manager-friend of mine in a busy orthopedic practice had a coder in her office. She was the only full-time coder the group had and therefore had a high view of her worth within the clinic.

She began to flex her muscles more and more: demanding given days off, dictating work hours, and when she would arrive and leave the clinic. Every time the manager spoke with her about this, she would state: “If you don’t like how I am doing my job-fire me. Please, feel free to let me go.”

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Her overall goal was to be fired, collect unemployment, and spend the summer at her lake home. I asked how my friend knew this and she stated the employee told her twice a week of her goal.

Next: Stopping your next hire from blaming exam rooms on her anxiety



When the time comes to revise the clinic handbook, make sure the correct handbook is updated. I have learned through the years that the employee rules need to be covertly brought to the forefront via the “rules of survival” and then mentioned more formally in the employee handbook.

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If you do this, you might be covered for the next person you hire who decides the paint in all the exam rooms causes her to have extreme anxiety, so she will only be able to room patients and return them to the waiting room for $28.00 an hour.



Dianna E. Graves, COMT, BS Ed

E: dgraves@stpauleye.com

Graves is clinical services manager at St. Paul Eye Clinic PA, in Woodbury, MN. Graves is a graduate of the School of Ophthalmic Medical Technology, St. Paul, MN, and has been a member of its teaching faculty since 1983.






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