Tips on how to set limits on staff conduct
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
For those of us blessed(?) with children, setting limits on acceptable behavior is nothing new. We have been doing it since the little darlings were born. The good thing about that parental training is that it has prepared us for dealing with the unique experiences we find daily in the operating room and all the little darlings therein.
Confession is good for the soul, so I’m going to own up to a few personal peccadilloes. First, I used to make fun of my past bosses. I would point and laugh and make cracks about their management style and the way they would "spy" on us in the back of the department. I was, to say the least, a real jerk.
Second, I used to push the limits of the envelope of acceptable behavior because, well . . . I could. Third, and this is the embarrassing part, I would be passive-aggressive with the other staff members. I would take the most obedient of the staff and plant seeds of doubt regarding the action of our boss. In my wilder years, I was a royal pain in the butt.
Recognize that many facilities have behavior problems hiding in the shadows. You definitely are not alone! It is widespread, growing, and frankly causing many department heads, administrators, and managers to scratch their heads and wonder why ignoring the problem is not making it go away.
Deal with behavior issues swiftly and decisively, but do so from a position of strength and not with a knee-jerk reaction to one spontaneous incident.
It’s sad to say, but as we conduct our audits of facilities, I am discovering many people like me in the workplace. So let me share just of bit of what we are finding, how we are dealing with it, and how it might help your particular situation.
You need to ask yourself three questions:
1. What is a behavioral problem? I would define this as any conduct by a person or group of people who disturbs the line of business of the facility. This conduct can be delay of cases, uncooperative responses to verbal or written requests, or failure to follow the guidelines. It can be from a staff member, a surgeon, or anesthesia staff member. It can be passive in the way a person disrupts a staff meeting with snickers and innuendoes about seemingly everything, constantly arrives late, takes excessive sick time, and delays cases by stalling, or it can be aggressive with open confrontations in the hallways.
2. What is my tolerance? The military has a saying, "Do you want to die on that hill?" Translation: Is the incident all that important that you want to make a stand and risk failure? This is a bigger issue than most people know. There have been many situations in which I have observed behavior that falls outside of the norm that I just pretend I don’t see. Not because I don’t want to deal with it, but because it is behavior taken out of context and not worth the confrontation that will occur if I push it. A good example might be an otherwise compliant staff member slamming a door and uttering a swear word after getting off the phone with an ex-spouse. It’s best to just look the other way as long as it is a rare outburst and not an ongoing event.
Another example is your lead surgeon being late repeatedly, or anesthesia coming in late repeatedly. These are issues that are worth the fight.
3. How far am I willing to go to control it? In other words, what are your limits? In some situations, doing your job well can cause you to lose it. Consider the last two examples. Are you going to give up your job just to make sure that your busiest surgeon comes in on time? My advice is: No!
Like it or not, there are exceptions to everything in life. But what about the loss of face to the other surgeons or staff if you ignore this behavior? You could look like someone who refuses to stand up to an intimidating situation. So? Who cares what they might think? As a manager, your job is to make your facility run smoothly.
The loss of several hundred cases because you upset your lead surgeon is not making the facility run smoothly. Your challenge is to go back to the first question and turn the situation around so that it does not disrupt the department. One suggestion is to not let staff think you have been stymied by this situation. At your next staff meeting confront the issue with your staff. Roll your eyes and say, "Dr. Brown obviously is not going to comply with the clock, so we are going to open his room 15 minutes later than the scheduled time to stay on par with him."
A good manager will take a difficult situation and find a fix. Staff and cases increasingly are difficult to find; and in a perfect world, you want to keep both. If a situation comes up that you cannot tolerate, be smart and obtain the support of your board, medical director, or boss to address it. In a world of finger pointing, make sure you get the backing of your boss before you make a stand. Your goal is to make it work — whatever it takes!
(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.)
For those of us blessed(?) with children, setting limits on acceptable behavior is nothing new. We have been doing it since the little darlings were born.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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