The termination process will go smoothly if your practice establishes its expectations, in writing, from the start.

During a recent presentation, we asked the audience, “How many of you continue to employ at least one person who you should have already released from your practice?” Almost everyone in the audience raised a hand.

We don’t believe that ophthalmic practices have low standards (in fact, it’s often quite the opposite). But, these underperforming or corrosive staff members manage to stay employed with the same practice, often for many years beyond reason, to the chagrin of their efficient and well-mannered coworkers.

Below, you will find tools to help determine when an employee has finally crossed the line and tips on how to proceed with that employee’s termination.

UP-TO-DATE POSITION DESCRIPTIONS

Every job in the practice needs a written position description that specifies detailed job duties and expected performance. Unfortunately, these documents, terribly outdated, are often filed away in a binder. As with all practice management tools, documents that collect dust on a shelf for years result in missed opportunities for practice improvements.

Position descriptions are best utilized when reviewed and revised annually by that position’s immediate supervisor. When kept updated, position descriptions are always ready for interviews with potential new hires and make for a good reference document when evaluating current employee performance.

ANNUAL PERFORMANCE REVIEWS

Feedback to employees about their performance supports individual professional growth and organizational alignment. Annual performance reviews should include:

1. Reference to all guidance and recognition provided to the employee throughout the year.
2. Specifically stated opportunities for improvement.
3. A minimum of three measurable goals for the upcoming year. For example, it’s clearer to the employee and easier for the manager to determine future success if the goal is to “improve patient work-up efficiency by three more patients each day,” and not “work up more patients daily.”

Schedule the annual performance review to coincide with each employee’s hire date. Practices that perform reviews at the same time for all employees find that it encourages salary-increase comparisons and organizational anxiety, because it’s on everyone’s mind at the same time. If your current policy calls for a consolidated review time, phase this out over a one-year period.

PRACTICE STANDARDS

Whether you are a solo practitioner who performs performance evaluations yourself or the managing partner of a large group working with a management team, consider dedicating at least one day each year to review your organization’s goals. Also, use this time to subsequently revise the preferred cultural and performance standards.

This exercise can help long-term by guiding the hiring and firing practices that ultimately lead to your desired practice team.

MANAGEMENT TEAM DEVELOPMENT, SUPPORT

When managing partners and shareholders publicly support administrators’ and managers’ joint decisions, these leaders are generally willing to make hard decisions about staff terminations.

Managers often delay taking action when the physician leadership team is not consistently cohesive in their support of managers and their handling of difficult employee problems. They learn fast that overturned disciplinary action has a negative impact on their leadership effectiveness, so they feel tentative about action. This leads to frustration among both the management team and the staff, who perceive that management does not hold all employees to the same standards.

Management teams align best among themselves and with the organization if they can count on being able to apply standardized, expected behavior throughout the practice. This alignment strengthens the practice’s core.

CONSISTENT EXPECTATIONS

Most employees want to perform their jobs well. To accomplish this goal, they need management to provide clear and consistently applied performance expectations and goals.

For example, if your attendance policy contains several disciplinary steps leading up to and including termination, you must follow it with no deviation. If you make an exception for the “best tech” because you feel sympathy for her personal issues and that she will be hard to replace, you dilute the strength of your own policies and managers. Although it can temporarily hurt to terminate an otherwise valuable employee whose tendency is to break the rules, you will see the rest of your employees stand up straighter, follow the rules, get you over the short-staffing gap and, most of all, appreciate that you do not show favoritism.

AVOIDING CONFRONTATION

Ophthalmologists possess personalities that avoid conflict and confrontation, so this passage of the buck often rolls downhill to the management team.

It’s common to see managers apply poor human resource management choices to workers who do not meet minimal standards, so they can avoid confronting the situation. This is especially difficult with a long-term, loyal employee who just doesn’t have the skills to satisfy the practice’s current needs. In cases like this, sometimes the owner’s ethical compass values loyalty more than finances.

Consider finding a new role for the obsolete worker. As a secondary gain, you send the affirming message to all hard-working staff that the organization recognizes loyalty.

OUTSIDE COUNSEL AND SUPPORT

Even the smallest practices need a labor attorney on speed dial. Although you can poll your peers or read HR law articles to look for solutions to your circumstances, keep in mind that labor laws differ by state — and missteps cost you more than the price of professional advice.

Reduce legal costs with preparation. Have the following information handy when calling a labor attorney:

1. The history of the issue.
2. Steps you took (or failed to take) in following applicable policy.
3. Actions you want to take.
4. Any precedent within your practice that could be applicable.

THANKS FOR THE MEMORIES

Firing a staff member can be an emotional step that impacts doctors and management staffers alike. Your courage to fire when necessary may be inhibited by your or a loved one’s employment history and your feelings about that situation. But, misapplied empathy only delays the inevitable for the worker and practice alike.

To alleviate feelings that may hold you back from the right HR move, be sure you have:

1. Communicated performance standards and potential outcomes if they are not met.
2. Conducted performance appraisals with concrete feedback and goals.
3. Provided additional education and training for improvement opportunities.

If the employee has another lapse in performance, you will rest easy knowing that your practice provided her with every opportunity to succeed. In retrospect, these employees often become happier in new jobs in which they have another chance to become successful. Many experienced supervisors have received a call or message from a terminated staffer months or years later to say “thank you” for firing them. OM

Corinne Z. Wohl, MHSA, COE, is president of C. Wohl & Associates, Inc., a practice management consulting firm. Corinne earned her Masters of Health Services Administration degree at The George Washington University and has over 30 years of hospital and physician practice management experience. She can be reached at czwohl@gmail.com or 609-410-2932.

John B. Pinto is president of J. Pinto & Associates, Inc., an ophthalmic practice management consulting firm established in 1979. He is the leading author in America on the business of ophthalmology. His latest book, “Simple: The Inner Game of Ophthalmic Practice Success,” is now available at www.asoa.org . He can be contacted at pintoinc@aol.com or 619-223-2233.