Don't Let Absenteeism Invade Your Practice

Absenteeism is a major problem for employers large and small, according to a report by Circadian Technologies, Inc., a leading international research and consulting firm. The report, “Absenteeism, The Bottom-Line Killer,” indicates that absenteeism, conservatively, costs employers $3,600 per hourly employee per year, and $2,650 per salaried employee per year.

Medical practices are not immune.

Henry Cloud, a clinical psychologist, consultant, and author of the just-released book Boundaries for Leaders (HarperBusiness, 2013), says much of the problem stems from the way any business creates its culture.

“The more that somebody has to have both feet into something as a career path, I think it’s a little easier to have glue that sticks them there,” Cloud says. “I think the big gains in this arena have much more to do with how any business, small or large, creates its culture.”

Trickle down effect

Cloud says that in any company, but especially in a smaller one, such as a medical practice, it’s much easier to fall back on the default position of having a divide or a chasm between the top — the principles or the owners — and the workers.

Such a situation sets up a dynamic where, at best, where the owner or physician is placed in a position of benevolent paternalism, or having to carry the full burden of making sure everyone is happy all the time. Or, on the flip side of the coin, the situation can mean the physician or owner is enforcing a lot of limits and a lot of rules. In the latter kind of dynamic, the result is either unhappy compliance, or passive or active acting out.

“The better dimension,” Cloud says, “is when owners or the principles recognize that their success is really going to be built around creating a culture of an organization that functions where absenteeism, along with other work place problems, is dealt with by the culture of the organization in its norms and its values and its teams.”

He explains that the best businesses are ones that start by building teams where the teams themselves come up with collaborative goals and a common purpose. They have values that they decide upon, and then they decide what behaviors will make the values happen — “what kind of place do we want to look like?” And then they become their own immune system.

“When everybody has a voice in creating those, then you move from ‘okay, what’s our vision, our values and our behaviors,’ to specifically, ‘what are the behaviors that are going to drive that result?’” explains Cloud. “And then you figure out a mutual accountability system. Now employees will work out these problems in their own circles.”

The driving force

Cloud says one of the problems to be worked out could be determining what drives absenteeism. The practice might find that schedules are not created far enough in advance so employees can build in time to take care of life issues. As a result, they phone in sick in order to take a day to run errands.

Results of a CCH Unscheduled Absence Survey support that scenario. The annual survey found that while 34% of people call in sick at work at the last minute due to “personal illness,” two-thirds of them are actually taking time off to deal with personal or family issues.

“It’s important to get a team working on these problems that are closest to what really drives them,” Cloud says. “Doctors are not involved at that level to know why people don’t show up. They just know that they need the nurse, and the nurse isn’t there. And so then they go yell at someone, and it filters down the organization. I think a good team-based approach like this makes sense.”

Teaching accountability

A section of Cloud’s latest book addresses the importance of control. He explains that when principles in a small business give control to staff for figuring out how to solve a problem like absenteeism, it holds them accountable for doing so. The results, he says, are much more positive.

“We know that people act out against negative cultures,” Cloud explains. “That’s a big issue that comes from the top. And when people are under threat and toxicity emotionally from somebody yelling at them and correcting them that way, their brains keep them from thinking really well. And the leader gets much less good performance than they want.

“As opposed to a positive culture that has a good kind of fear,” he continues. “And the good kind of fear is that there are accountability systems where people know that there are policies and norms about showing up. And there are real consequences that they decided upon. So then they’re afraid in the good sense of fear and not the negative sense. And I think a lot of those things are important.”