Over time, doctors develop their own unique style of practicing medicine. The same is true of medical groups. They develop a style that involves creating a work culture and passing information about it on to staff members. A medical practice's approach to issues such as sick leave and overtime pay are defined and revised over time until they become ingrained in the office's culture.


What to Include?

Your employee handbook or policy manual should be customized to fit your practice. The Small Business Administration lists these issues as among those that should be included:

  • Statement of the company's goals and philosophy
  • Working hours and pay periods
  • Procedures/policies for absences
  • Performance evaluation procedures
  • Safety and accident rules
  • Use of company property, and
  • Vacation and holiday policies.

Some manuals also include issues such as pay rates for certain jobs, probation periods and grounds for termination. Here are some other items that are generally covered.

Disclaimer: State that the manual is not to be construed as a contract between the employee and the practice. Spell out that the practice may -- at any time, with or without cause -- terminate the employment. Part of the disclaimer should be a statement that the practice can change the manual as it deems necessary without notice.

Non-discrimination: Make it clear that you maintain a strict policy of non-discrimination with employees and job applicants. State that all aspects of employment are governed on the basis of merit, competence and qualification and are not influenced by race, religion, creed, color, age, gender, national origin, ancestry, disability, marital status, citizenship or military status.

Sexual harassment: Define what constitutes sexual harassment. Spell out that it covers sexual advances and the creation of an intimidating, hostile or offensive work environment.

HIPAA compliance: Medical practice manuals typically have a statement regarding confidentiality. Your employees are exposed to sensitive, confidential patient information. Your practice must protect this information under federal and state laws, including the Health Insurance Portability and Accountability Act. Prohibit the unauthorized disclosure of confidential information by employees and state that such information cannot be discussed outside the office.

Technology: State that employees are to use office computers and software programs for practice business. Spell out that staff members are not allowed to make copies of computer materials without written permission from the office manager or managing physician.

If you provide online access to employees, your manual should contain an Internet usage policy. Inform staff members that online activities are restricted to practice business and they should have no expectation of privacy. Just as the practice has the right to monitor employees' phone calls and voice mail messages, make it clear that it also has the right to monitor employees' Internet use and email messages.

Job requirements: Employee manuals are an excellent opportunity to clarify duties and obligations. For example, since the appearance of your staff reflects on your reputation, many practices include a dress code and the consequences of violations.

Frequently, such policies and guidelines are passed down verbally to newcomers by the more veteran members of the staff. But for many reasons, a better approach is a written policy manual. It can help reduce training time and eliminate inconsistencies and misunderstandings that often result when the only communication of rules is verbal.

Manuals Help Eliminate Uncertainty

Don't underestimate the importance and the power of a clearly written policy manual. It allows a practice to outline what managers expect from employees and what staff members can expect in the way of pay, benefits, work schedules and more. Clear communication helps manage expectations on both sides of the employee/employer relationship. Committing policies to paper adds a sense of security that should result in more satisfied employees and less turnover.

Beyond retaining satisfied employees, a well-prepared manual can also serve to protect your practice in the event of an employee-related lawsuit. Often, lawsuits occur because of a lack of guidelines governing issues such as pay discrimination and sick leave. In fact, unclear policies are sometimes the key that allows employees to prevail in cases against their employers.

Policies that have been put in a written policy manual or employee handbook are much more likely to be recognized as the official performance standard of your practice, should a lawsuit arise.

Important: Attach an employee acknowledgment to the manual. It should state that the employee has received and reviewed the material, understands it and was given the opportunity to ask questions. This acknowledgment should further state that the employee recognizes that the manual is not an employment contract and all policies may be changed, altered or modified at the discretion of the practice, without notice to the employee. The employee should sign and date the acknowledgment. The signatures are hard evidence that the staffers were aware of policies ranging from tardiness to 401(k) plan contributions.

Although written policy manuals can protect your practice, they can also be used against you in court. Judges have construed employee handbooks and policy manuals as the equivalent of employment contracts because they outline an employer's expectations for particular jobs. Poorly written manuals, which use words that imply cut-and-dried rules for all situations, have been found to create a contractual relationship between employer and employee.

A Few Guidelines

When drafting work rules and policies, you can avoid misinterpretation by using more flexible terms, such as generally, typically and may. The simple inclusion of such words implies there could be exceptions at the discretion of the business owner or administrator.

A practice's best option is to have an employment lawyer review the policy manual before it's issued to ensure it lists valid, legally defensible rules in compliance with the myriad of relevant laws, such as the Fair Labor Standards Act, which governs pay procedures, and the Family and Medical Leave Act, which provides time off for employees in certain situations.

Before you begin drafting or revising policies to be included in the manual, consult with an attorney to ensure they comply with federal and state employment laws. You may want to look for samples of other practices' manuals for ideas on how to put yours together. Make sure to cover all important topics (see right-hand box).

Allow for Change

Policy manuals should not be viewed as though they were carved in stone. Review yours periodically. As laws and industry standards change, the needs and goals of a medical office also change. Your practice may decide that a policy no longer works because of altered circumstances or advances in technology. For example, some medical practices have adopted a "no cell phone" policy to cut down on disruptions among staff.

In the end, it is the actions of the medical group's owners and managers -- not the written policies -- that generally serve as the guide for its staff. Assuming those actions are consistent with what is written, your practice's leaders can bring to life the goals and aspirations embodied in the manual's printed words.

Keep in mind: Your manual's success depends on the consistent application of the information in it. Setting clear employment policies and communicating them to your employees can help your practice avoid misunderstanding, inefficiencies and employment liability claims.