Practice leaders make difficult decisions every day.

Using what we’ve learned from helping practices navigate thousands of employee-relations decisions, we developed a process that makes finding a solution easier! The CLIMBTM Model for Leadership Decisions guides practice leaders through the process of finding solutions that fit their practice culture, complies with applicable employment regulations, proactively addresses potential risks, and creates balance and buy-in from their team.

Common Questions from Practice Leaders

My hygienist is going on maternity leave – what do I do? Our front desk admin has been coming in late for several weeks – how should I handle this? My assistant is unhappy with their pay – what can I do? A team member claims they are being harassed by another employee – what do I do? I want to take a vacation – what should I tell my staff? My team isn’t grateful for anything I do for them – how do I make them appreciate me? My office manager wants to paid a salary – can I do that?

The list goes on. Questions like these are common among practices – others are more unique and difficult to answer. Regardless of the situation, The CLIMBTM Model provides a simple, 5-step process for finding a solution.

The CLIMB Model for Leadership Decisions (trademark of Clinical HR LLC)

Step 1: Culture Alignment

Every aspect of your practice is driven by culture, and culture starts at the top. The decisions you make as a leader will be reflected in the culture you create. Every practice likes to say they have a positive practice culture, but too often the choices made by leaders do not manifest in a way that supports this statement.

Regardless of what type of culture you’re creating in your practice, aligning your decisions to your culture should always be the first step of the process. Coincidently, if your practice culture isn’t top-of-mind when making leadership decisions, that in itself aligns with your culture – albeit, maybe not the kind of alignment you hope to have.

There isn’t one right way to be a practice leader. Successful businesses have been built on many types of company cultures incorporating many leadership styles. The question you want to ask yourself when considering possible solutions to a leadership problem is: Should I do it? This is before getting into any question of legality, risk management, etc. “Should I do it” is the essence of whether a decision fits your practice culture.

An Example of Typical Decisions

You’ve been short staffed lately and are unsure whether you can support this extended leave. If your practice has a positive, supportive, employee-centric culture, then the answer to “Should I do it” is undoubtedly yes!

However, if you are a smaller organization – a start-up, for example – and budget is more of a concern, then perhaps you’re typically more inclined to only do what is legally required of you. At this point, you move on to the second step.

Step 2: Legal Analysis1

Once you’ve decided “this solution fits my practice culture,” the next step is to ensure your choice doesn’t conflict with local, state, or federal regulations. If you are unfamiliar with the guidelines for your particular situation, this is the point where you should seek outside counsel from an employer-side employment attorney licensed in your state or an HR Consultant familiar with your state laws.

In the example above, we look at two reactions to a request for medical leave. If this is a smaller practice – under 50 employees – then the Family Medical Leave Act (FMLA) does not apply. However, depending on the employee headcount and the reason the employee is taking leave, the Americans with Disabilities Act could factor in. Regardless, these laws are a floor, not a ceiling. What that means is, you can always do more than is required.

Back to Our Example

In the case of the practice who chooses to automatically grant the leave, there is little to do on the Legal Analysis side. On the flip side, the practice leader who wants to know whether they’re required to provide leave should do their research and consult with an advisor before denying the leave.

If you get to this step and find your solution has a regulatory conflict, don’t panic! Determine what possible paths are available to you, then return to Culture Alignment and choose a viable solution that aligns with your practice culture.

The question you are asking yourself here is: Can I do it? The most common scenarios we see where practice leaders fail to consider the regulatory implications of what they can and cannot do are related to paying their people, bonus systems, leave and break laws, and paid time off. There are many other state and federal employment laws impacting practices of all sizes. This step should always be considered when making leadership decisions.

Step 3: Issues & Outcomes of Your Decisions

When you’re confident your decision fits your practice culture and is compliant with applicable regulations, the next step is identifying any potential issues or outcomes. While straightforward in nature, it’s often more difficult than you’d think. It’s helpful to include a mentor, advisor, or another member of your leadership team in this step if the decision is one of significance.

In the example of an employee taking an extended medical leave – regardless of whether you’re granting the leave or have decided you’re unable to accommodate the employee – there could be numerous outcomes each with potential issues. Problems that extend the medical leave, additional work for scheduled employees covering leave, the need to hire a temporary employee to assist, financial implications, etc. While this isn’t a step that should dictate one way or another the decision you ultimately make, it’s an important part of any decision making process for practice leaders.

Step 4: Manage Risk

After you’ve identified the potential outcomes and problems that may occur, the next course of action is taking steps to mitigate any risk. This could come in the form of documentation, policy reviews, conversations with key employees, liability waivers, reviewing insurance coverage, and more.

Depending on the situation and potential decisions made, this is another step where it’s helpful to have a knowledgeable advisor or mentor on your side. You don’t know what you don’t know. While there’s no guarantees in life and in HR, there are certainly things you can do to cover your bases and protect your practice.

Step 5: Balance & Buy-in

We’ve arrived at the final step in The CLIMBTM Model. You have the perfect solution! From your perspective, it totally fits your practice culture, does not conflict with any regulations you or your advisor could find, you’ve identified the potential issues and have a plan for managing the risk. Time to set the wheels in motion!

Except, no one on your team seems to be happy about it. From what you can tell, your team feels this decision benefits you more than it does them. They don’t feel like you considered their needs during the decision-making process and are resisting any steps you’re taking to implement your solution.

Maybe that’s true. Hopefully, if your culture is one built on a positive, employee-centric mindset, you truly did work through how your decision would impact your team and this really is the best solution for both sides. Then what’s the problem?

Getting Your Team On Board

Positive reactions come from balanced solutions. Your team is more likely to support your decision and support its implementation if they understand the balance between the benefit to the practice and the benefit to the team. The best way to demonstrate this balance and earn their buy-in is through transparency and communication. If possible, make your team part of the process in finding a solution.

Using our previous example, you know you have a team member who needs to take an extended medical leave. You’ve established that you’ll either need to hire a temp or delegate additional duties to some of the other team members. Instead of making a snap-decision outright, hold a meeting with the key team members who would be impacted by the employee taking an extended leave. No need to go into details of why the employee is out (and really, if it’s a medical leave, you shouldn’t), but you can certainly involve them in the decision-making process. You may be surprised to find out they are absolutely willing to take on extra duties for a few weeks and rotate lunch breaks so you have coverage, eliminating the additional cost needed to find and hire a temp. Balanced needs, team buy-in, and positive culture for the win!

The CLIMBTM Model for Leadership Decisions works for more than just determining whether an employee can take an extended medical leave. Attendance issues, training investment, performance problems, employee advancement, strategic planning, new software implementation, bonus structures, and so much more can all be decided using these five steps to create a solution that fits the unique needs of your practice.

Want to learn more about how to implement The CLIMBTM Model in your practice?

1 We are not attorneys and nothing in this article or on this site should be considered formal legal advice. Please seek counsel from an attorney licensed in your state if you have a legal issue.