You are sitting at your desk at the end of a very busy day. After getting halfway through the pile of Post-it notes stuck all over your computer screen, your employee of 11 months knocks on the door and says, "I have a question, if you have a minute..." Sure, no problem! She proceeds to ask you if she can use her vacation benefit one month early, since her one-year mark is just around the corner. You look at her with wide eyes, purse your lips together, and say, "Umm, let me get back to you on that..." because, in all honesty, you don't know and never really thought about it.
Questions like this one can be avoided with the implementation of a thorough and comprehensive employment manual. Important decisions, such as this, can have an impact on your practice financially and clinically. They can also affect your relationships with staff members.
For the first three years of private practice, my employment manual consisted of four pages. Yes, four pages that more or less welcomed the employee to the practice, stated my practice philosophy, listed vacation days, covered a brief review of employee benefits, and stated when I would do reviews. I figured that pretty much covered it. Because the status quo was never challenged, I didn't think twice about making changes. Moreover, because I was focused on so many other things, it never occurred to me that my current manual was severely inadequate.
The turning point came when I was contemplating firing my first employee. I realized, with some vexation, that my four-page employment manual could not even be referred to or relied upon to offer me any kind of backup or protection with regard to the employee/employer rights. Had the issues that eventually eroded the welcomed presence of this employee been addressed and reviewed at the very beginning of her employment with a comprehensive employment manual, then everyone would have been better off. There would not have been any questions, expectations would have been spelled out, and my decision would have been based on things that were written down - not just implied.
I resolved, therefore, to write an all-inclusive employment manual that would set guidelines to protect me as a small-business owner and establish a reference and guide to initiate amiable working relationships with my employees.
I was dazed when I first began the process. There were so many resources available! The more I read about it, the more confused I became. It seemed like there were rules for rules on what I should and should not include in a manual. I finally concluded that the only thing I could do was compile all the information I found and put together an employment manual that to this day serves me well.
My first question was, what exactly should be in an employment manual? The short answer is that it must set forth expectations, rules, and guidelines to employees and, moreover, lay out the legal obligations you have to your employees as their employer. But when you get down to the nitty-gritty, there is much more to it than that. Considerations include exploring state laws and requirements as well as incorporating mandatory and nonmandatory information in the manual. This is just the tip of the iceberg, so let's break it down.
The manual should, first of all, be easy to read and organized in such a way that the information can be accessed without difficulty. A cover page with your logo, name, and other pertinent information is recommended. Secondly, a table of contents is also very helpful for at-a-glance topic searches. The pages should be numbered, and there should be a place for the employee to put his or her initials so you can verify that the employee has read through the information on every single page. In addition, in the footer, I recommend that you put the date and number of the latest manual version so you can keep track of any additions/deletions to the contents.
The body of the manual is what sets the parameters for all things work-related. I have broken it down into these sections.
I like the introduction because it allows you to welcome a new staff member into your employment and is an opportunity for you to give a brief history of yourself and your practice. A mission statement is always a plus and can be announced here as well.
2. Employee definition and status
Is your employee part-time, full-time, or temporary? Clarifying this sets the stage for benefits, overtime pay, etc. If you do a probationary period when you hire, then you can discuss specifics here.
3. Employment policies
This is what I like to call the "housekeeping" section of the manual. It should include, but is not limited to: Equal Employment Opportunity and Americans with Disabilities Act information, employee background check, personnel records and administration, change of personal data, safety, building security, health-related issues, employees requiring medical attention, weather and emergency-related closings, and parking.
Also included in this section is an employee's anniversary date. Some employers go by calendar year; some go by the first date of hire. Whichever you use, be specific and clear as this is the date on which reviews, benefits, pay raises, etc., are based.
4. Standards of conduct
Rules and standards of conduct are where you need to be clear, specific, and detail-oriented. It should be stated, right out of the gate, that these expectations are to be followed and that variance of execution and not following protocol will warrant appropriate assessment and discipline.
Lack of attendance and punctuality are undoubtedly some of the most prevalent problems many employers have. Be clear with your employees on when they need to be at work. Your hours of operation, morning huddle, and scheduling will dictate your requirements.
It is difficult to do your job when your staff members do not show up. Absenteeism, whether scheduled or not, can make or break your day. How? Production, scheduling, and ability to treat patients are just a few of the things that are impacted. In the event that a staff member needs to take any time off, it is recommended that the request be done in writing. If an employee is sick or something unexpected arises rendering them incapable of coming into work, then who is notified and how?
It is also recommended that you include a nondisclosure statement in this section of the manual. Why? You need to protect your business and you need to protect your patients (this also goes hand in hand with HIPAA).
What is your dress code? Are your employees expected to come to work in street clothes and then change into their scrubs? Do you provide a laundry service for lab coats and scrubs? How do you want your front desk employees to dress? Are multiple earrings and nose rings OK? These questions may seem simple or mundane, but these topics arise. What's more, patients will judge your practice based on appearance and image. What kind of image do you want your staff to portray?
Who do you want your staff to go to in the event they have a complaint or would like to file some kind of grievance - you or your office manager? Getting such things in writing is advised, especially if there is friction between staff members.
How do you handle employment termination and resignation? What constitutes voluntary vs. involuntary resignations? Would you like a two-week notice if a staff member is leaving? Headaches and turmoil can be avoided if this section of your manual is meticulously written.
Additional topics include: lunch periods, harassment policies, violence in the workplace, ethical standards, use of equipment, phone, housekeeping, Internet and mail, smoking policy, alcohol and substance abuse, gestures of appreciation, exit interview, and return of company property.
5. Compensation policies
This section will comprise details regarding base compensation, performance bonuses, timekeeping procedures, overtime pay, payroll/paydays, performance/salary reviews, and wage advances.
It is recommended that you be specific about how an employee's compensation is determined - skill, experience, etc. Discuss when reviews are given. I recommend at least yearly. What do you want your assistants and hygienists to do when there is a cancellation or blocks of unfilled time are in the schedule? Do you want them to clock out or work at a reduced rate? Do you offer bonuses or give incentive plans based on production and collection?
Inadequate or unclear compensation policies can do the following: 1) Affect the percentage of your staff salary overhead (typically it runs at 25%) and 2) It can cause undue duress on the employee/employer relationship, especially where the pocketbook is concerned.
6. Group health and related benefits
Providing benefits to your employees is an integral part of their life and well-being. It has an impact on how attractive you are as a potential employer. When conversing among dental colleagues, insurance agents, accountants, and practice management gurus, the consensus is this: being able to offer benefits is wonderful but often difficult due to the financial, legal, and tax implications for you, the small-business owner. These decisions cannot be taken lightly, and it is recommended that you do your research.
The law requires some benefits, and others are offered to employees as part of a comprehensive compensation package. While the specifics may vary from state to state, the following benefits are required: Social Security taxes, unemployment insurance, workers' compensation, and disability insurances.
Nonmandatory, optional benefits include: vacation/holiday pay, sick leave, bereavement pay, and retirement packages (IRA, 401(k), etc.). Others to consider are continuing education reimbursement, vision/dental, and health insurance.
With the implementation of the Affordable Care Act (ACA), there is much confusion as to how this law applies to small-business owners. The following websites are useful in answering questions that you may have:
• www.healthcare.gov/ Get Answers Section
It is also recommended that you discuss and review in your manual: maternity leave, jury duty, military/reserve or National Guard leave of absence, family/medical leave of absence, and uniformed services employment and reemployment.
7. Employee communications
This section is helpful because it acknowledges the fact that communication in the dental office is important. Guidelines to manage disparagement and disagreements between staff members will eliminate a lot of headache and turmoil. Staff meeting parameters can also be reviewed as well as where/who employees can go to in order to make suggestions about improving the practice and services offered to the patients. Offer a brief closing statement to recap the highlights and your overall vision for the practice.
Document, document, document! Having your employee initial every page of your manual and then signing it at the end will ensure that your policies, rules, and expectations are read and understood. It will also serve to protect you in the event someone needs to be dismissed or discipline needs to be given. Give your employee a copy of everything and then keep a copy in his or her file.
When I began the process of creating an employment manual, my inquiry to dental colleagues and associations brought forth the realization that I was not alone! Several did not have manuals, and others, like me, just had a few pages. Since the implementation of my handbook, I have found that the workings of my office have indeed run more smoothly. Everybody is on the same page and knows what to expect from me and vice versa. Most importantly, as a small-business owner, it has allowed me more time and freedom to do what I do best - be a dentist and serve my patients to the best of my ability.
Stacey L. Simmons, DDS, is in private practice in Hamilton, Mont. She is a guest lecturer at the University of Montana and is a contributing author for DentistryIQ, Surgical-Restorative Resource, and Dental Economics. She can be reached at firstname.lastname@example.org.
Also by Dr. Simmons:
The fight for the white: Bringing whitening back into the office
For additional articles by Dr. Simmons, search for "Simmons" in the search field above.