Disruptive employees aren't commonplace in most healthcare settings. But they aren't so rare that you shouldn't have a plan in place for how to deal with them. Unfortunately, that's a message a lot of medical groups and hospitals aren't getting.
"Many practices do not have formal employee personnel policy and procedure manuals," says John McDaniel of New Orleans-based consultancy Peak Performance Physicians, LLC.
"Even if they have some simple policies and procedures, they usually only relate to things like sick time, vacations, and holidays," McDaniel says. "In a large percentage of cases, they do not spell out a disciplinary process or how an employee grievance process should be conducted. That is what usually gets them in trouble."
Mary J. Witt, vice president of The Camden Group, a consulting firm in El Segundo, CA, says it's more effective to deal with disruptive behavior proactively—before it starts—but that's difficult if your organization doesn't have a code of conduct in place.
"One of the biggest problems I find when I go into practices is there are not measurable performance standards established for the various functions in the practice," Witt says. "Then it becomes difficult to hold staff or physicians accountable because you haven't clearly defined your expectations for good behavior and good performance."
Once you've established a code of conduct, and employees understand your expectations, "it is easier to come back and have discussions with the employee about what is not working," Witt says. "You've set the stage for what the expectations are. You've helped them clearly understand by your definition and performance standards what is expected, so it becomes easier to have that conversation."
Three types of disruptive behavior
Peak Performance Physicians breaks down disruptive behavior into three categories:
- Group 1 is the garden-variety rudeness or yelling at physicians, patients, or fellow staff; a breach of confidentiality; or a failure to follow dress codes, which can usually be resolved with a quick corrective chat identifying the problem, a reminder of practice policies, and documentation that the event occurred.
- Group 2 disruptive behavior would include ongoing problems that have been previously identified and addressed, but not rectified, along with issues like failing to complete assigned tasks.
- Group 3 behaviors are usually severe, and could warrant immediate termination for offenses, such as embezzling or other theft of medications or equipment, or flagrant and consistent abuse or sexual harassment.
Except in the most extreme instances that warrant immediate termination, your physician practice should follow the same guidelines for every situation that requires an intervention, McDaniel says.
"The first step would be a verbal and or written reprimand. Even if it is verbal, notes need to be taken, it needs to be in writing, and both parties should sign it," McDaniel says. "If there is not improvement, the second step would be a probationary period—one more chance—in writing and dated. The third step is termination. It's a formal documented process."
When it comes to addressing disruptive behavior, Witt has three rules: "Document, document, document."
"That means that you have documented all along that you have spoken with the employee, you've told them what the problem was, and you've given them the opportunity to correct it. You have to make sure the documentation is there."
The signed documentation doesn't have to mean that the employee agrees with the corrective action, only that that he or she has been notified about it.
Witt also recommends having employees sign job description and code of conduct forms. "That way, I know they've gotten it and it is their responsibility to read it and understand it," she says.
Address disruptive behavior immediately. "You don't want to ignore those issues and then suddenly take them up six months after they happen," Witt says. "If a problem occurs, you want to immediately address that with the employee. Set for them what the expected behavior is so they clearly understand what is expected of them."
Don't be judgmental. Using precise, measurable standards will take a lot of the emotion out of an employee corrective action because you're being objective and factual, Witt says. She also recommends steering clear of emotionally laden words when confronting a disruptive employee.
"I hear people say they want to tell their employee they have a bad attitude. Well, that doesn't tell the employee anything and that begins to get to an emotional level and can make employees defensive," Witt says. "Instead, you need to think about how that bad attitude translates into behavior. It might mean that if I have a bad attitude, I'm not smiling and greeting patients warmly when they walk through the door, or I'm snarling at coworkers. Focus on the behaviors."
Hear the employee's version of events. Although it's important to document everything in case you find yourself defending a wrongful discharge law suit, McDaniel says it's also important not to run a kangaroo court in your practice. Be fair.
"Employees should be given an opportunity for due process," he says. "Give them the opportunity to be heard. If there is a third person who can corroborate the employee's side, that person should be interviewed."
Witt says you should determine whether the disruptive behavior is an employee's reaction to adverse working conditions that inhibit job performance. "Are there issues in the practice that make it difficult for the employee to be successful? If that is the case, you need to fix those issues before you can hold the employee accountable," she says.
For example, if you expect your employees to efficiently greet and register patients while simultaneously answering 20 phone calls, it's going to be difficult for them to do a good job. "You have to ensure that your processes don't create barriers to good employee performance as well," Witt says.
You also can't assume that your employees have the knowledge or the skill sets needed for the tasks to which they are assigned. "If I am expecting them to work on the computer, and they don't know the particular software program, it's unreasonable for me to expect them to perform well," Witt says.