In May 2012, MedHQ conducted a customer survey to see what drove their need for human resources support. The survey questioned why facilities contact the human resources department and what their most challenging employee issue was. "The most frequent reason to call HR is employee benefit and payroll questions or issues, and the most challenging employee issue was discipline," says Tom Jacobs, CEO of MedHQ. While answering questions about benefits is often simple, dealing with disciplinary issues is more complex.
The most successful ambulatory surgery centers have a good culture of teamwork; everyone knows their responsibilities and how they impact the ASC's success. Employees feel good about coming to work and surgeons enjoy performing cases there. However, if employees exhibit performance issues or feel the work environment is hostile, there is room for improvement.
"When working with employees, keep self-control in mind," says Mr. Jacobs. "Continually look at the situation around you, and your own situation. Are you communicating properly? Are you setting expectations? Are you listening and holding yourself accountable, and are you willing to take action in tough situations? When a problem does arise, you don't want to dwell on that situation."
More recently, Mr. Jacobs independently surveyed the attendees of the California Ambulatory Surgery Association to identify and rank top disciplinary issues. Results were similar to last year's survey, with the most frequent issue being tardiness and the most concerning problems being attitude issues and employee disputes.
Here, Mr. Jacobs outlines five common disciplinary issues and what ambulatory surgery center administrators can do to solve and prevent them in the future.
1. Performance issues and hostile work environments. Most organizations include high, middle and low performers; culture is often dictated by the high or low performers, depending on which side has the greatest influence on the middle performers.
"If the strong personalities are all high performers, that's great because then the middle tends to follow the strong personality," says Mr. Jacobs. "However, if low performers are the strong personality, something needs to change. We don't necessarily just want to terminate low performers because employee turnover is expensive, but we want to do what we can to rehabilitate them and move them to middle or high performers."
Mr. Jacobs says there are several steps to assess the situation and motivate low-performing employees:
• Clearly set expectations
• Follow through with promises
• Act on problems as soon as they surface
2. Personnel policy compliance. Employees who don't follow personnel policy or protocol put the ASC at risk. Even when employees receive a handbook with policies and procedures, and undergo training before stepping into a new role, they may not follow protocol.
"A supervisor's job is never done; it's a continual process," says Mr. Jacobs. "You have to devote time to being a good manager. For every employee you have, spend a minimum of 15 to 30 minutes per week walking around in their work area talking, observing and asking questions. In addition to all your other roles at the ASC, set aside a few minutes for managing."
Mr. Jacobs suggests asking open-ended questions, such as, "How are you doing?" to engage a meaningful response. "If you start asking questions, people will come to you with their thoughts, input and ideas," he says. "As a supervisor, you're in charge. Gather information from different sources to put you in a good position to understand what goes on at the center."
3. Attitude issues. When a position opens at the ASC, an extensive search for the best job candidates and interview process will hopefully lead the surgery center to hire someone with a positive attitude committed to the ASC's mission of excellence. However, attitudes often change with time and negative behavior impacts the entire culture.
"Attitude issues often surface from job dissatisfaction," says Mr. Jacobs. "Someone might have a bad attitude and then a dispute will occur. Improve job satisfaction by soliciting input from other people to hear their ideas and act on those ideas. In staff meetings, solicit their thoughts and ask if there are issues they want to improve. If you put their ideas on a "To Do" list, employees will feel good about their contributions. They feel like they've made an impact."
4. Tardiness and attendance difficulties. Arriving late to work once in a while isn't cause for alarm, but chronic tardiness and other attendance difficulties is often an indicator of other problems. Mr. Jacobs advises ASC leaders be attentive to early warning signs, but to not come down too hard after the first late arrival, but when it happens multiple times within a few weeks it's time for another approach.
"There are often personal problems, such as health issues or family issues, and there are resources that can help them with that," says Mr. Jacobs. "If someone has an elderly parent that takes a turn for the worst, maybe they need an approved leave of absence. If the employee has financial issues they may need employee assistance program referrals. That can be a good way to address some of the personal problems. Everyone wants privacy and you don't have to be their counselor, but you can give them a place to go for help."
5. Employee interactions and disputes. Poor communication and disputes between employees cause a bad working environment and culture. Some issues can be prevented by approaching employees to settle the dispute instead of letting it fester.
"There are positive ways to go about solving disputes between employees," says Mr. Jacobs. "Get them involved in the center and be realistic about the problems. Don't let them fester. As managers, we sometimes feel like we are not in control and we try to figure out how to take control. The quickest way to control a situation is to ask questions. It's your job to find out about a disagreement or misunderstanding and be the person of authority in that situation."
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