Act quickly, before one bad staff member poisons the practice.

Much has been written and said about the Toxic Employee in medical practices. While human resource (HR) issues are typically the most difficult to reconcile in general (and most time-consuming), the toxic employee is perhaps the most challenging of all. Much is at stake, and the impact on long-term morale can take months or even years to turn around as a result of the metastatic influence of a single toxic employee.

Though we often fool ourselves into denying that such a situation exits in our practices, it is critical to identify and address the toxic employee immediately. This difficulty is often compounded by the fact that many toxic employees are quite skilled in their respective positions and make us aware of our dependency upon them. It is likely that the behavior is not novel to your practice (i.e., similar issues have arisen in the employee’s former jobs), and related behaviors usually occur outside the workplace as well.

THE TELL-TALE SIGNS

Here are the behaviors and phenomena that help identify the Toxic Employee:

• The Toxic Employee is often argumentive in staff meetings.
• The Toxic Employee is highly critical of the work product of other staff.
• There is an increase in incidents involving other employees’ negative behavior.
• Productivity of other staff could be negatively affected.
• Absenteeism and poorly explained staffing-turnover rise.
• Tension, discontent and negative energy are palpable.

THE ENABLING FACTORS

Sadly, the Toxic Employee is an all-too-common problem because many of them, with exemplary experience and skill sets, are passed around unknowingly from practice to practice. Often, management is concerned about violating an employee’s rights by calling attention to such problems, which are then allowed to persist far too long. Sometimes, the Toxic Employee is unaware of the manifestations of his or her behavior and is hurt or angered by such accusations.

As a result of staff’s attempt to insulate the doctor(s) from the growing problems surrounding the Toxic Employee, physicians are usually unaware of the issues brewing.

By the time things rise to our level of awareness, containment of the situation is exceptionally difficult. The manager of the employee’s department often has become overwhelmed, and the other department managers and practice administrator become involved, slowing normal practice operation. Patient care may be affected. Staff who are willing to come forward are frequently angry, accusing the manager(s) of ignoring or inadequately addressing the Toxic Employee. It can become paralyzing to the practice.

SOLUTIONS FOR A TOXIC SITUATION

Once you have recognized the problem, it’s critical that you act quickly to combat it. I advise the following steps:

• Recognize and identify the problem, and own it immediately.
• Set up regular meetings with your Toxic Employee. Explain the issues surrounding his/her behavior.
• Create a paper trail of your conversations, as well as efforts to resolve the perceived conflicts.
• Establish a course of action with milestones to achieve, and provide regular feedback to the employee, especially when there is a positive shift in behavior. Such positive reinforcement is a powerful tool.
• Play to the employee’s strengths. Often a reassignment of tasks or job position quickly alleviates employee stress, and allows the employee to demonstrate to management and coworkers that he or she is indeed a valuable team member.

FINAL THOUGHTS

To quote a former practice administrator, Mr. Lew McBee, “Dealing with a toxic employee is not easy. Frustration is inevitable. When you are working with a toxic employee, patience is more than a virtue — it is a necessity.”

Behavior modification is a gradual process, and for any of us, converting bad behavior into good behavior can be exceptionally challenging. There often is an urge to terminate the Toxic Employee as an immediate pressure release, and to make an example of the employee to other staff. This is not always the best course of action, though sometimes it is the inevitable outcome, which makes the above-mentioned meetings and documentation essential.

Yet, when you turn around the Toxic Employee, the staff recognizes that management listened and addressed their concerns, and the employee will likely benefit from the experience in outside life relationships; the ultimate reward is when the Toxic Employee is rescued and becomes an integral member and roll model for the team. OM

Steven M. Silverstein, MD, FACS, is a cornea-trained comprehensive ophthalmologist in practice at Silverstein Eye Centers in Kansas City, Mo. He invites comments. His e-mail is ssilverstein@silversteineyecenters.com.