Human Resources: Saying Goodbye the Right Way

It was nearly 20 years ago, but Nancy Becker remembers the incident well. She was working as a medical practice manager when she received a phone call inquiring about a job opening. She knew the caller. It was a woman she had personally fired for poor performance from another practice. Becker was incredulous that this woman was inquiring about a job from the very person who had let her go three years earlier.

But the caller was insistent, saying she had “turned her life around.” Becker, now a practice management consultant in Westchester, Penn., agreed to interview her, and she says that when the woman walked through the door, “I would not have recognized her. She dressed better, looked great, and had a good attitude.”

The woman told Becker that when she dismissed her three years ago, “it was a personal wake-up call.” She changed her attitude, went back to school, and earned her GED and associate’s degree. She actually thanked Becker for being the catalyst for the positive changes she had made. Becker rehired her, and says the woman was an exemplary employee who stayed with the practice for five years, leaving only when Becker encouraged her to apply for an office manager’s opening at a nearby practice, a job that she landed and in which she enjoyed a long tenure.

Of course, not all termination stories have such happy endings. Indeed, it’s a task that no manager relishes.

An unsavory task

Bob Levoy, author of the recently published book, “222 Secrets of Hiring, Managing, and Retaining Great Employees in Healthcare Practices,” says dismissing employees is “management’s most unpleasant task.” Because of the awkward confrontation that terminating an employee entails, Levoy says that many administrators cannot bring themselves to do it, and so they “put up with” poor performers for prolonged periods of time. Doing so can affect an entire practice, says Levoy.

“Nothing makes employees as discouraged and resentful as having to work alongside people who don’t pull their own weight. Employees who are not performing up to par are expensive in terms of payroll, and even worse, are in danger of alienating or perhaps even endangering patients,” says Levoy. “If one person is permitted to behave inappropriately, eventually other people will feel that they have that ‘privilege.’”

Levoy says there is “no way to make firing someone a pleasant task. You can only minimize the pain and hostility.” Still, when dealing with a poor performer who won’t or can’t improve, dismissal is for the best. Levoy recalls a physician who finally worked up the courage to fire his longtime bookkeeper after attending one of his seminars. “He said it was without doubt the hardest, most painful thing he’d ever done,” the author recalls. “But he also said it was the best thing for his staff, his patients, and himself. It was hard for him to recognize the negative impact that [the bookkeeper] had on the practice until she left.”

Deborah Martin-Norcross, a Princeton, N.J.-based attorney who specializes in employment law, agrees that physicians tend to avoid confrontation more than most other professionals. Avoiding communication with a troublesome or underperforming employee until termination seems the only option is always a bad idea, says Martin-Norcross. You should always give such a staffer a chance to correct poor performance or inappropriate behavior, and that means you have to be clear about your expectations.

“The employee who’s been the recipient of good communication about their performance, their match in the job, or whatever the issue is,” says Martin-Norcross, “at least will believe that they haven’t been run out. And in my experience that lessens the likelihood that they will come after their employers and file a lawsuit or discrimination charges.”

Thomas Weida, medical director of the University Physician Group at Fishburn Road in Hershey, Penn., says that he doesn’t fire employees, “they fire themselves.” He says that when managers work with underperforming employees to help them identify and correct underlying problems, they should recognize that they are dealing with human beings who may have issues outside the workplace that affect their behavior. “But,” says Weida, “at some point they have to work those issues out for themselves.” 

How to get fired

Employees get fired for reasons that most commonly have to do with underperformance, an inability to adapt to a practice’s culture, excessive absenteeism or tardiness, inappropriate behavior with other staff or patients, and - perhaps the most egregious - patient confidentiality breaches.

Only that the last infraction is sometimes serious enough to get an employee fired on the spot. Most of the time employees are dismissed due to ongoing problems that are not corrected. In these cases, managers unanimously agree that continually documenting their communication with the employee is paramount.

“It’s not just a case of saying, ‘You’re out of here,’” says Rick Jamison, the national director of Practice Solutions Consulting in Saskatoon, Saskatchewan, in Canada. “Employees should not be denied the opportunity to improve and be given the tools they need to do so.” Such tools may include training or personal mentoring, which can be effective for an employee determined to improve or may serve as a wake-up call for others who know they’ve been slacking.

All disciplinary actions should be documented, regardless of whether the employee ultimately improves. “You can never have too much documentation,” says Merrilee Severino, a practice management consultant in Seminole, Fla. Whenever Severino meets with an employee to address performance or behavioral issues, she says she “documents every single move.”

Attorney Martin-Norcross agrees. When doctors or managers tell her they don’t have time to write up performance memos, she tells them that such documentation needn’t be complex. “It could be notes on a calendar,” Martin-Norcross says. “For example, ‘I spoke to Mary today about her coming in late.’ … You just need some contemporaneous documentation of such events in case you need to justify future actions.”

The verbal warning

Before you get to termination, experts generally agree that you should go through the steps of what Levoy has labeled, “progressive discipline,” a process of explaining deficiencies, providing an opportunity to improve, and clearly communicating the consequences of continued underperformance to an employee.

Rule No. 1, says Levoy, is to “tell the employee what the problem is.” Most managers call this first step a “verbal warning.”

“Employees are often in the dark about performance-related issues,” says Levoy. “They don’t know that their attitude or certain things they are doing or aren’t doing are problematic. Nobody ever mentioned it.”

Severino says that when she first talks to an employee about performance or attitude problems, she solicits their point of view regarding the situation. Miscommunication can lead to an employee’s misunderstanding regarding your expectations of him. So Severino says she tries to make her expectations “abundantly clear,” and then she sets a timeline for compliance and schedules a follow-up meeting. “That’s a wake-up point for some people,” she says.

Paula Comm, the administrator of a seven-doctor psychiatric practice near Chicago, says that she takes written notes of her “verbal” warnings, and then asks the employee with which she has spoken to indicate his understanding of the conversation by signing the note. Comm includes language that spells out the subsequent steps she will take if an employee does not improve, which is usually a written warning and ultimately termination if the employee continues to fail to meet explicit expectations.

“I’m very big on documentation so there are no big surprises during reviews,” says Comm. “I think that’s where a lot of managers make mistakes. They assume that their employees understand what is expected of them without spelling it out.”

Jamison says that verbal warnings should be used as opportunities to invite employees’ opinions on their own performance or to elicit their side of the story should the warning be in response to a specific event. “Ninety percent of employees do want to do better,” he says. “They don’t want to have surprises.”

That’s why many human resources departments are deciding that annual performance reviews are inadequate when dealing with an underperformer. “Reprimanding an employee for an event that happened six or nine months ago … just doesn’t cut it any more,” adds Jamison. “Bringing to their attention these events as they happen is the way to go.”

But what if a verbal warning isn’t sufficient?

Write it down

In most cases, the next step is a “written warning.” Like a verbal warning, written warnings should take the form of one-on-one conversations in which the employee is made aware of the situation and is again given specific goals, measurements, and timelines. “With a written warning, I usually will attach something like a copy of the practice’s policies and procedures that were not adhered to,” says Becker. “In cases in which an employee has jeopardized someone’s privacy, I will go over HIPAA regs with them and also include that in their file.”

A written warning doesn’t always imply that an employee will ultimately be terminated. For some, job expectations and rules need to be spelled out again in writing. Comm cites as an example a receptionist she was very concerned about who seemed to be overwhelmed and unable to grasp the office’s policies and procedures even after several interventional meetings. But once Comm dismissed an employee with whom the receptionist worked, her performance improved.

“She couldn’t handle [working with] that employee,” says Comm. “So part of her lack of performance was due to the fact that she was doing her job and this other person’s job as well. Once that dynamic changed, and she was able to build confidence and have someone actually help her so she wasn’t so overwhelmed, she did a 180 turnaround.” Today, a year and half later, Comm says she is “flourishing.”

Weida emphasizes the importance of a consistent approach if employees reach this stage. While some managers will give a second written warning before termination and others will not, what matters most is that you do everything within your power to ensure the employee in question understands the problem, your expectations for improvement, and the timeline she has until the next step is taken.

And such a step should be spelled out, says Levoy. “Employees need to understand the consequences of inaction,” he says. “Generic, open-ended warnings such as, ‘further action will be taken’ are subject to wide, if not misleading, interpretation.” Clarity and documentation of all actions taken previous to a termination are paramount.

Best practices

Managers who determine that an employee must be terminated should have already informed the practice’s physicians - or head physician - of the decision. At this point, the practice’s physicians should also be aware of the severity of the soon-to-be-dismissed employee’s actions. While practice managers should be careful about not bothering physicians regarding minor staff infractions, “any time a practice manager sees the real potential of an employee being dismissed … is the right time to inform the physician of the events that have transpired,” says Jamison.

Martin-Norcross tells managers to keep in mind that they are handling a situation in which a specific individual does not fit into a specific job, avoiding the all-too-common “adversarial mindset” that can increase the likelihood that the terminated employee will sue.

The decision to terminate should be clear and decisive, says Martin-Norcross. “A lot of the time,” she says, “managers will sit with the employee and hem and haw and dance around what the decision is, even if the decision has been made.” Doing so just prolongs the inevitable, she says. If you’ve used the progressive discipline prescribed by most consultants and managers, the employee should see the writing on the wall.

The bottom line is that when an employee is to be dismissed, it should come as no surprise to either the practice’s physicians, upper management, or the employee herself.

To guard against potential lawsuits, Martin-Norcross recommends that practices already have a termination policy spelled out in the employee handbook from which managers should never deviate. She also recommends asking the erstwhile employee to sign a separation agreement in which the employee agrees to leave the practice and in return is granted some considerations, such as the extension of benefits for a prescribed time period. Such agreements are legally binding and can protect physician employers from subsequent claims brought by the dismissed employee.

Separation agreements need not be unduly complicated, says Martin-Norcross, but to ensure that they meet federal and individual state requirements, she recommends consulting an attorney well-versed in employment law to help draw them up.

Levoy has come up with a list of guidelines that emphasize the importance of firing an employee face-to-face (many managers and consultants also recommend that another person be in the room to serve as a witness), making the reason for termination clear and decisive, and not dwelling on the employee’s shortcomings. Simply state that the employee has not demonstrated improvement since the last review, says Levoy, and, if appropriate, express regret that you do not have a job opening more suited to that employee’s specific skill set. “Don’t apologize, don’t defend, justify, or argue,” Levoy advises. “Don’t sympathize or use platitudes like, ‘I know how you feel,’ or ‘You’ll be just fine.’”

Dealing with underperforming employees is a balancing act. You certainly shouldn’t be cavalier about dismissals, as this sends a bad message to the rest of the staff, creates more work and expense for you (both in covering for and replacing any fired employees), and may deprive you of the services of a staffer who might improve and flourish. Yet consultants and managers agree that retaining a stubbornly unsatisfactory employee benefits no one.

“What it does is tell everyone else that it’s OK to break the rules or make repeated mistakes or have a lousy attitude or whatever it is,” says Levoy. “Or it may be interpreted by others employees as favoritism. Either way, it builds resentment. When circumstances warrant termination, just do it.”

Barbara A. Gabriel holds an MA in English literature and is the associate editor of Physicians Practice. She has served as editor and writer for numerous healthcare publications over the past 10 years. Barbara can be reached at bgabriel@physicianspractice.com.

This article originally appeared in the January 2008 issue of Physicians Practice.