One challenge in managing a remote medical team is recruiting experienced, specialized clinicians that can answer questions from other clinicians in the same field. If you are going to employ medical professionals to support an experienced medical team remotely, it is probably best to hire from within your company, treating the move as a promotion rather than finding outsiders who have not been trained. In-clinic medical staff and sales staff alike need a remote medical team available to them almost immediately when there are questions or concerns about patient candidacy, safety, and protocols. Having this teamwork from home as a collaborative “call center” improves clinic flow and safety tremendously.
As a part of our series about the five things you need to successfully manage a remote team, I had the pleasure of interviewing Emily Perbellini.
Emily Perbellini is a Board Certified Family Nurse Practitioner specializing in aesthetic dermatology. She began her career as an RN in 2004 specializing in women’s health, and transitioned into aesthetic dermatology in 2008. Emily has gained extensive bedside experience as well as managed teams of clinicians both in person and remotely. She has maintained multiple RN and NP licenses in order to practice in multiple states. Emily has held many titles in her career including Director of Operations, Vice President of Clinical Operations, Regional Director of Standardization, and National Director of Telehealth. She is a specialist not only in aesthetic dermatology treatments, but also in hiring, training, providing continuing education, as well as optimizing clinician retention. For the last four years she has exclusively managed remote medical teams for LaserAway, the nation’s leader in aesthetic dermatology, to perform remote medical assessments and medical clearances on a national scale.
Thank you so much for doing this with us! Before we dig in, our readers would love to get to know you a bit better. What is your “backstory”?
I was born and raised in a small town outside of Houston, Texas. At the age of three, I discovered I could play the piano — somehow I simply understood the math behind the instrument. I played in junior symphonies and also excelled in percussion. In school, my interests weighed heavily in math and science. These interests paired well with a degree in nursing.
In 2000, I attended nursing school at University of Texas Medical Branch and then practiced as a women’s health RN in Houston for about 2 years before moving to Los Angeles in 2006. I continued practicing women’s health and composed several music therapy albums to help patients endure labor pains.
In 2008 I began working for Kirby Dermatology in Beverly Hills and quickly fell in love with aesthetic medicine. In 2009, after having performed thousands of treatments, I was promoted to Vice President of Operations. I then achieved my Nurse Practitioner degree in 2014 from Azusa Pacific University. Upon graduation, I was given the Spiritual Care award. I realized that the artistry, technicalities and teamwork that were required in playing the piano and instruments were applicable in understanding math, science, and ultimately in being a Registered Nurse and Nurse Practitioner.
In 2015 I joined the best aesthetic dermatology company in the world: LaserAway. Here I serve as the National Director of Telehealth and oversee 45 clinicians in all states where LaserAway exists. Having obtained 6 Nurse Practitioner licenses nationwide, I have hired, taught, and managed very large groups of medical professionals both in person and remotely in the field of aesthetic dermatology.
Music has helped me in treating patients holistically, artistically, and medically. The same principles in music and nursing can be applied to managing a team as well. Taking into account clinicians skill level, needs for training, availability, interest in the field, it is imperative to develop a “plan of care” for their career, keep them interested, and make sure they are maintaining a healthy work/life balance and working together as a team. Ultimately this approach increases retention rates, which means happy clinicians and happy employers.
Can you share the most interesting story that happened to you since you started your career?
I accepted a job in 2008 for Kirby Dermatology. My family was so excited about the new opportunity. I began receiving phone calls from family members whom I had not heard from in years. I was perplexed as to why…they could not believe I was working with “Dr. Will from Big Brother!” I had no idea who he was or that he had a level of fame outside of being a physician in Beverly Hills. Oftentimes I would find TMZ or paparazzi outside of the clinic when reporting to work. This was definitely a funny welcome into the Beverly Hills scene.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Managing multiple teams in multiple states can get confusing — mostly because of the different time zones! I once scheduled myself for a shift from 8 am until 8 pm for what I thought was PST but ended up being 8 am EST until 8 pm PST. I did not realize the mistake until it was too late to look for additional coverage for New York. This was a very long and tiresome shift from 5:00 am PST until 8 pm PST!
What advice would you give to other business leaders to help their employees to thrive and avoid burnout?
Nurture employees as if they will retire with your company. Help them develop goals for their career path and do not forget yearly reviews. Provide continuing education and growth opportunities. Help them develop a work schedule that supports maintenance of a healthy work/life balance. Check in with the employees often and always let them know they are appreciated — a little goes a long way! Most importantly, work on “ground level” with them as much as possible so you are a part of the team and can navigate through any obstacles that may present. As leaders we should never feel “above” any managed role.
Ok, let’s jump to the core of our interview. Some companies have many years of experience with managing a remote team. Others have just started this, due to the COVID-19 pandemic. Can you tell us how many years of experience you have managing remote teams?
I have experience working with remote teams for 10 years and have been managing multiple remote medical teams exclusively and full time for almost 4 years. My team has grown from approximately 8 to 45 employees during this time.
Managing a team remotely can be very different than managing a team that is in front of you. Can you articulate for our readers what the five main challenges are regarding managing a remote team? Can you give a story or example for each?
Managing a remote medical team specifically presents a unique set of challenges. At LaserAway, I have created two different remote groups: the Remote Medical Assessment Team, and the Good Faith Examination Team. These two teams all follow the same medical protocols but have a different focus and require different levels of credentialing. Here are the five main challenges I have faced managing remote medical teams:
- One challenge in managing a remote medical team is recruiting experienced, specialized clinicians that can answer questions from other clinicians in the same field. If you are going to employ medical professionals to support an experienced medical team remotely, it is probably best to hire from within your company, treating the move as a promotion rather than finding outsiders who have not been trained. In-clinic medical staff and sales staff alike need a remote medical team available to them almost immediately when there are questions or concerns about patient candidacy, safety, and protocols. Having this teamwork from home as a collaborative “call center” improves clinic flow and safety tremendously.
- Another challenge is to remain up to date with varying state regulations, follow credentialing requirements, and as a supervisor maintain licensure in each state. Depending on the role of the remote medical provider, he or she will need to be licensed and credentialed in his or her remote state. For example, certain states require “Good Faith Exams” to be completed by a Nurse Practitioner, Physician Assistant, or Physician prior to a patient being treated by an RN without a physician on site. These Good Faith Examiners must be licensed in the state in which the Good Faith Exam is required. They can work remotely and complete these medical clearances via telehealth transmission. As a supervisor, creating incentive for clinicians to obtain multiple licenses in order to cover more than one state can drastically reduce cost for the company.
- A third challenge is creating a way to quantify performance that you and your team can monitor so you can have constructive and collaborative conversations on how the team is doing. When your remote team can view and evaluate his or her performance, it gives them a sense of autonomy and self-motivation. Simply discussing these quantifiable data monthly can prevent problems from developing and helps maintain the strength of every team member. For example, LaserAway can perform up to 450 good faith examinations in one day. Each midlevel can view how many exams they have done during their shift, which creates a sense of healthy competition and therefore optimizes job performance in a collaborative, fun way. If a clinician is falling behind on the number of GFEs completed in a day, discussions on improving numbers should be positive and motivating rather than negative and attacking.
- A very important challenge I’ve faced is maintaining standardization between medical assessments and exam performance. Thankfully, LaserAway abides by strict medical protocols written by Dermatologists with extensive experience in the field. This serves as an excellent means by which to standardize; however, there is a level of subjectivity in developing a plan of care for a patient. Having an electronic medical record that allows you to review medical assessments and plans of care set forth by your remote medical team is imperative in maintaining standardization. Approaching any discrepancies in assessments should be done in a collaborative way instead of a condescending way.
- The fifth and final challenge is creating a sense of camaraderie and collaboration between remote clinicians nationwide. It is important that no remote clinician ever feels alone without support during his or her shift. Chains of supervision within the group are also important so that you do not overwhelm yourself as a supervisor. Creating daily group texts between working clinicians is an excellent way to keep everyone discussing and collaborating.
Based on your experience, what can one do to address or redress each of those challenges?
1. Recognizing and employing experienced remote medical team members is such an important part of creating a strong team. Fostering growth always increases clinician retention, and working from home as a remote medical team member is such an incentive for experienced clinicians with tenure.
2. It is imperative that you take your time in understanding each state’s medical rules and regulations when it comes to remote medical teams. You would be surprised how easy it is to contact the medical board and speak to an expert on exactly what practices keep you in compliance with telehealth and telemedicine. We also have an incredible team of attorneys at LaserAway that assist in keeping our team up to date and in compliance.
3. Having an efficient and up to date electronic medical record system makes quantifying clinician performance so much easier. We are fortunate at LaserAway to have a brilliant team of computer programmers that keep our system up to date and performing to optimize efficiency and data analysis.
4. Standardizing medical assessments and exams can be addressed by tight medical protocols, experience, and continuing education. Continuing education is by far the most important intervention in maintaining standardization. Holding biweekly or monthly zoom calls addressing challenging cases and subjects is a great way to maintain standardization nationwide.
5. Two platforms that have served as excellent resources for remote collaboration are Slack and Zoom. Slack has been an excellent daily communication tool. It can also provide insight for supervisors to recognize training gaps based on questions asked. Zoom has served as a great way to meet for conference calls, trainings, and parties alike. Getting to know each other through these platforms is so important in keeping the team tight and happy.
In my experience, one of the trickiest parts of managing a remote team is giving honest feedback, in a way that doesn’t come across as too harsh. If someone is in front of you much of the nuance can be picked up in facial expressions and body language. But not when someone is remote. Can you give a few suggestions about how to best give constructive criticism to a remote employee?
Call me old fashioned, but I am a huge fan of picking up the phone to address situations that require constructive feedback. This allows for a direct, polite conversation where tone can be articulated and understood without question. Always begin phone calls with a compliment on something the clinician is doing very well. Give examples of this behavior and how it is helping the team. Thank them. Then you can segue into areas needing improvement. It is imperative to be able to quantify your feedback through number of patients seen in a day, patient reviews, etc. Ask the clinician what his or her plan is for improvement and then develop a plan together. End the conversation by letting them know how much they are appreciated and how grateful you are for their hard work. Compliment them often when you see the improved behavior being implemented.
Can you specifically address how to give constructive feedback over email? How do you prevent the email from sounding too critical or harsh?
If an email must be sent to give constructive criticism and for documentation purposes perhaps, I always begin with positive feedback and appreciation for the clinician’s hard work. I make sure the tone is set in the beginning that the email is not an attack on his or her character, but rather a discussion on how they can continue to improve. Addressing the issue should include examples of quantifiable data that the employee themselves can track to make sure he or she is improving. A date should be set to redress the issue and evaluate improvement. Finally, it is important to conclude the email by expressing appreciation and thanking the employee for their hard work.
Can you share any suggestions for teams who are used to working together on location but are forced to work remotely due to the pandemic. Are there potential obstacles one should avoid with a team that is just getting used to working remotely?
Make sure you are maintaining close contact with those who are working from home suddenly. There is a fine line between maintaining close contact and micromanagement however. This is why it is so important to be able to quantify work performance.
Keeping a weekly Zoom meeting is a great way to maintain company culture and unity. In a remote medical setting, it is also important to make sure clinicians have a professional background that presents well to patients when utilizing telehealth. Standardizing telehealth backgrounds and dress codes is an excellent way to keep everyone looking and feeling their best. These backgrounds can be assessed during weekly Zoom calls.
What do you suggest can be done to create a healthy and empowering work culture with a team that is remote and not physically together?
One of the best ways to create a healthy and empowering work culture with a remote team is sending frequent (but not too frequent) appreciation texts both individually and in groups. Some examples of empowering texts:
- A text to an individual may say, “I see you Jane. Way to go on your 100 good faith exams today. You are such a valuable member of this team!! Please never hesitate to reach out if you are ever overwhelmed or need help!”
- A group text might look like this: “Whoa…virtual assessment team conquering 250 remote medical assessments today with only 12 patients that were not candidates???? Incredible!!! This is a dream team and I’m lucky to be a part of it!!”
Another way to create a healthy and empowering work culture is making sure you are paying a fair and competitive salary as well as rewarding those who are going above and beyond! Yes, budget is extremely important, but it is much less expensive to maintain a strong team than it is when you have frequent clinician turnover.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Approaching leadership with a sense of nurture, growth and love always has a far better outcome than approaching leadership in an authoritative, fear-based way. I’ve worked for companies that have managed by the latter approach, and the outcome was not good. LaserAway is family-owned and family-run, and even though we have 62 clinics nationwide, we still feel very close because we know we are cared for and appreciated. That type of management from the top has a contagious, trickle down effect and I am blessed to be a part of it.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“To answer before listening — that is folly and shame.” — Proverbs 18:13 (NIV). When it comes to my professional career, I’ve learned to take the time to listen to each employee’s requests, suggestions, concerns, complaints etc. The simple act of listening goes such a long way. Validating feelings and working towards solutions is such a positive approach and you will create a beautiful work environment for your team.
Thank you for these great insights!