How to keep a toxic employee from poisoning your practice

• Employees who poison the workplace atmosphere affect your income by driving away patients and staff members, as well as contributing to decreased productivity among workers who stay.

• The only course of action once you have confirmed that an employee is a problem in this way is to fire him or her.

No matter how long you have been in practice, chances are you have encountered a toxic employee who poisoned the atmosphere of your workplace. If you don't take action fast, such an employee can threaten your relationships with your patients and your staff, affecting your income in many ways:

Staff defections. When one employee treats another one poorly, says Keith Borglum, a consultant with Professional Management and Marketing in Santa Rosa, California, "often, the other staff members are reticent to say anything, so they quit."

And it happens more than you might think. Twelve percent of workers have left jobs because of poor treatment. (See "How one uncivil act can affect employees.") When that happens, an employer will spend an amount equivalent to one to five times an employee's annual salary to recruit and train the departed employee, depending on his or her position. Those statistics come courtesy of research conducted by Christine Pearson, PhD, professor of global leadership at the Thunderbird School of Global Management, and Christine Porath, PhD, associate professor at the Georgetown University McDonough School of Business, authors of The Cost of Bad Behavior: How Incivility Is Damaging Your Business and What You Can Do About It.

Decreased productivity. More than 95% of Americans say they've experienced rudeness at work, according to Pearson and Porath. Among workers who decide to remain in their positions despite their bad experiences, a toxic employee frequently becomes the focus of the workplace, causing a time-wasting distraction. And teamwork among staff members may become a thing of the past.

"The productivity of the toxic individual can slow, because nobody wants to be around [him or her]," says Borglum, a Medical Economics editorial consultant. "One bad player on a football team can cause the whole team to lose."

Also, office morale will take a hit if your dependable, hardworking employees think you condone poor behavior. They may see you as an ineffective manager who does not know the difference between workers you should value and those you should fire.

Lost patients. If a patient has a run-in with a problem employee-or even witnesses one staff member treating another one poorly-he or she may be compelled to seek medical care elsewhere and to spread the word about the negative experience in your practice. (See "Patient retention: Attitude is everything.")

Given these threats to your livelihood, only one solution works when it comes to a confirmed problem worker, experts advise, and although it may seem extreme, you can't afford to put it off: Fire the employee. But first you must properly identify toxic activity, and you'll also want to handle the situation fairly for all involved.

HEED THE WARNING SIGNS

A toxic employee is not necessarily an ineptly skilled one. He or she may even be making positive contributions to the practice, but the person's net effect on the practice is negative.

"Sometimes your toxic employee is doing a really good job; she is just a jerk," Borglum says.

What are the warning signs?

Watch for unethical, inappropriate, or unprofessional conduct. Toxic employees often exhibit passive-aggressive behavior, spread gossip about their co-workers, and are rude to patients and colleagues.

"They stimulate a sense of discord in the workplace," Borglum says.

They also may be uncooperative, exhibit a flagrant disregard for office rules, and seldom take responsibility for their actions. "It's everybody and everything else that's wrong, not themselves," Borglum says.

Many have negative attitudes. "Almost never do you have a toxic employee who is a happy-go-lucky, positive person in the rest of [his or her] life," he adds.

Because you are a busy physician, your staff members may recognize the telltale indicators before you do, so take their complaints about a co-worker seriously, and try to be aware of staff dynamics.

Remind your employees that you can't fix a problem you don't know about, says Kenneth Bowden, CHBC, president of Berkshire Professional Management in Pittsfield, Massachusetts. "Tell them they can come to you with any issues whenever they need to."

TAKE ACTION RIGHT AWAY

When you realize your staff members or patients have a problem with an employee, take action immediately. Don't wait.

Call the problem employee into your office for a private meeting. Ask questions to determine whether the behavior is permanent or temporary. Your employee's actions may be a symptom of something else, such as marital troubles or a personal financial crisis.

"You have to have an accurate diagnosis before you start treating," Borglum says. "Once you're clear in your diagnosis, it's usually best to work out the issue in a straightforward manner."

Clearly state the problem and explain that you are going to document his or her behavior in writing. Emphasize that any slip-ups will be noted in his or her personnel file. This point is important, Borglum says, because physicians rarely can change a toxic employee.

"It's different from a work-oriented problem," he explains. "Toxic employees tend to have deeper problems."

Tell the employee how you expect him or her to behave from that point forward. Offer specific examples. Tell him or her what he or she did wrong, and clearly explain exactly what you expect instead.

Provide a detailed improvement plan, which will make it easier for you to terminate the employment of your toxic worker if he or she continues to exhibit bad behavior. For example, you may choose to offer 30 days or three chances to change. Explain that any subsequent violations will result in termination so he or she knows the consequences of not following the agreed-on plan.

Regularly meet with the employee to make sure the plan is being followed. Above all, make sure you both stick to the agreement (the employee needs to alter actions, and you need to acknowledge performance improvements and inappropriate behavior).

Stress that if the behavior occurs again, you will fire the employee (see "6 keys to firing a poisonous person" for tips on how to do so). Stick to the terms of the plan. For example, if the employee slips up after the third try, do not give him or her one more chance. Or, if you give 30 days to show improvement but the bad behavior continues, fire him or her on day 30.

"If they do it again, bring them back into your office and tell them you have in writing what they just did and what they did before," says Bowden, a Medical Economics editorial consultant. Let the employee know that documentation exists.

Invite another person to the meeting. "Having two people in the meeting can validate that nothing inappropriate happened in that room," Borglum says. If that's not possible, leave the door open a crack.

The only way to deal with a confirmed problem person? "Get rid of a toxic employee as quickly as you can," Borglum advises. "Toxic people don't change."

He adds, "No firing should ever come as a surprise." However, employment termination may come as a shock to someone who is in denial about his or her behavior. If the employee gets defensive and protests with a list of workplace accomplishments, acknowledge his or her abilities and explain, once again, that the problem was with his or her behavior. Do not argue or listen to excuses. Tell the employee that you agreed on a plan, you made your decision, and you are sticking with it.

"Docs aren't good at firing people," Bowden says. "They are people persons and very soft-hearted."

After the termination has occurred, inform your staff members that a co-worker was let go. Do not go into detail; the less said, the better. They probably know what led to the firing anyway.

"There are two kinds of employees," Bowden says. "Those with 20 years of experience, and those with 1-year of experience 20 times. You've got to get rid of those 1-year experience folks."

Patient retention: Attitude is everything

Your staff members' attitudes play a central role in how patients perceive your practice-and whether they decide to continue receiving care there, according to new research from the PricewaterhouseCoopers (PwC) Health Research Institute (HRI).

When interacting with a physician's office, patients are almost twice as likely as customers in the airline, hotel, and banking industries to say that staff friendliness and attitude dictate whether their experience was positive or negative, according to findings in the "Customer experience in healthcare: The moment of truth" report. Additionally, one-third of patients say they would be willing to change healthcare providers if another one offered a more "ideal experience."

So what can you do? Create mechanisms to collect patient feedback so you can proactively monitor and manage patient experiences, advises the HRI.

"The voice of the customer may be the best kept secret in healthcare, but that's changing as consumers exert greater control over how their healthcare dollars are spent and exercise power to vote with their feet and wallets," says Kelly Barnes, U.S. health industries leader, PwC.

The report draws on findings from PwC's Customer Experience Radar, a nationwide survey of about 6,000 consumers across nearly a dozen industries. HRI compared the experiences and attitudes of consumers in the banking, hotel, airline, and retail sectors with those of patients in the healthcare industry.

Although patient expectations in healthcare track closely with consumer expectations in other industries in many respects, healthcare consumers differ in several areas:

• Staff attitude was cited as the main contributor to positive experiences by 70% of consumers in the provider sector, compared with 38% of retail shoppers and 33% of bank, hospital, and airline customers.

• Personal experience was found to be the top reason that patients choose a doctor or hospital, and it's more than two and a half times more important than it is to consumers in other industries. Price was the top driver of purchasing decisions for consumers in every industry but healthcare provider.

"Lessons from other industries have slowly made their way into the health industry, but most healthcare companies-whether payer or provider-still have a ways to go before they can match the transparency, convenience, and overall quality of experience individual consumers often demand in other sectors," says Paul D'Alessandro, health industries advisory principal and U.S. customer impact leader, PwC.

6 KEYS TO FIRING A POISONOUS PERSON

The adverse effect the toxic employee has on your practice probably outweighs the risk of a lawsuit, but to protect your practice and yourself, be sure to take these steps related to employee behavior and the termination process.

1. Establish and follow disciplinary and termination policies

"You make it so much easier for yourself if you create a process that you follow and are consistent with," says Barbara Rittinger Rigo, JD, a shareholder of Littler Mendelson in Philadelphia, Pennsylvania. "If you just terminate people on a whim with no reason and no explanation, they are going to think it's for an illegal reason."

2. Create an employee handbook

An up-to-date, state-compliant handbook should address the types of behavior problems that can be cause for discipline or termination in your practice. Give a copy to all employees you hire, and ask them to sign an acknowledgement that they received and read it. By signing this document, employees verify that they know the policies exist.

"Nine times out of 10, people don't look at it unless they have to, and maybe not at all," Rigo says. "But at least they have signed something that said that they looked at it at the time they were hired."

3. Know your rights

Don't waste time worrying about a lawsuit for wrongful termination. In most states, employment is "at will," which means you, as the employer, have the right to fire an employee at any time, for any reason or no reason at all, as long as the termination is not related to race, gender, disability, age, or another discriminatory reason.

The exception is employees who are under contract. You must follow the terms of the contract, particularly if it states you can terminate employment for cause only.

4. Create a paper trail

Documentation, such as performance reviews and disciplinary action reports previously shared with the employee, is important, because it provides proof that the employee knew you were unhappy with his or her actions and was aware of the discipline you planned to take if the unwelcome behavior continued.

5. Be brief

If you decide to terminate a worker's employment, keep the meeting brief.

"A termination meeting shouldn't be a negotiation," Rigo says. You reached your decision because the employee violated your agreed-on policies, and that's all you need to explain in your meeting with the employee.

6. Show some respect

Immediately after you terminate a worker's employment, help him or her gather personal belongings to take home and, if necessary, grant the person permission to come back after-hours-when you are there-to get what's left.

Don't allow the employee to linger; you don't want him or her to walk off with patient information or badmouth your practice to anyone who will listen.

"There's nothing that employees find more humiliating than being escorted off the premises," Rigo says. If that's your preference, however, then make sure that you're respectful and discreet when doing it.