Terminating an employee is never pleasant but you can ease the transition and safeguard your practice in the process. This author speaks to practice management experts about recognizing significant offenses, the best methods of letting employees go and how to protect yourself from potential legal issues.
You are stunned when it happens. An employee has been stealing from your practice. At first, when another employee tipped you off, you were not sure. After all, the daily amount she was taking was so small the theft was easy to miss. But you started digging and you have pieced together documentation and unrecorded patient payments that prove her guilt. Not to mention, you find yourself out thousands of dollars. Now what?
In this actual scenario, management confronted the employee. She cried and insisted she would never steal from the practice. When faced with the paperwork proving her guilt, her crying turned to anger and she blamed co-workers. Fired on the spot, she threw her key at the practice’s physician-owner and left in an emotionally volatile state. Her husband phoned the office later to call the staff and physicians “liars” who had “falsely accused” his wife.
It is not a pleasant situation for anyone — manager, employee or other staff. Without a doubt, this case necessitated immediate action. However, there are ways to smooth the process of confronting an employee or terminating employment, even when the potential for fallout is huge.
There is a great range of behaviors for which an employee could be fired. Minor offenses generally are not a problem on their own but if there is an accumulation of these offenses over time, they may present a major issue. According to practice management experts, these offenses include habitual absenteeism, tardiness, insubordination, inappropriate language/verbal abuse, incompetence, disregard for policies and procedures and carelessness.
“If, after being counseled multiple times, the employee does not improve job performance in ‘minor’ areas,” firing may be appropriate action, says Bruce Werber, DPM, a Fellow and Past President of the American College of Foot and Ankle Surgeons, who practices in Scottsdale, Ariz.
Major acts include lying, stealing, doctoring timecards (paper or computerized), verbal abuse of a patient, forgery of prescriptions, sexual harassment, carrying a weapon, using or being in possession of illegal drugs, and fraternizing with patients, according to practice management experts. In many cases, these types of offenses require immediate action.
“In an at-will-employment state, theoretically, an employee can be fired based on lack of performance, because of a ‘challenging’ personality or because he or she does not fit well in the job,” says Lynn Homisak, PRT, the president of SOS Healthcare Management Solutions and Fellow of the American Academy of Podiatric Practice Management. “However, that doesn’t stop the employee from claiming he or she was fired unfairly.”
Indeed, how you handle the hours, days or weeks leading up to a firing can be very important.
There are a variety of routes by which you can learn of inappropriate employee behavior.
• Let staff know that if they see an issue, you will listen. “When we had an employee who was stealing, I found out from another employee,” says Eric Feit, DPM, a Fellow of the American College of Foot and Ankle Surgeons who practices in San Pedro and Torrance, Calif. “We emphasize that employees are the eyes and ears of this office and that, if they see something inappropriate, they should communicate.”
Homisak recommends that you create a formal grievance system for filing complaints in case employees are not comfortable talking about potentially sensitive information or are nervous about being blamed for “ratting out” a colleague.
• Make yourself aware. Dr. Werber has an open-door policy with all staff but also cautions you cannot rely solely on hearsay.
“All the partners need to walk around, look in treatment rooms, see if things are clean, listen and pay attention to how front office staff speak to the patients and answer the telephone,” he says. “Most practices are small and there is no reason you cannot keep your awareness level high.”
• Talk directly to patients. “I ask patients,” says Dr. Werber. “How was your experience when you called? Did you have problems with the voice mail? Issues with the staff during your visit?” By letting patients know he wants their experience in his office to be the best possible, Dr. Werber says he “gets patients to tell me what they are feeling.”
• Look for operational red flags. “For example, if the financial records are not balancing, you might detect some lack of regard for the practice’s policies and procedures,” says Kristin Titko, DPM, MBA, a Trustee of the American Academy of Podiatric Practice Management and Fellow of the American College of Foot and Ankle Surgeons.
Homisak agrees. “Have operational system checks in place — for example, to check whether money proves at the end of the day,” suggests Homisak. She says other examples may include restricting certain computer passwords and the timecard system to employees for whom access is a job necessity.
However you learn of an employee’s ill behavior, it is imperative that you document everything from the moment you get an inkling something may be wrong. If you have observed the inappropriate behavior, write a summary, including the time and date, and place it in the employee’s file. The same goes if an employee has filed a written or oral complaint.
“Documentation could be invaluable to supporting your decision so it is especially important to honestly recount any incidents based on fact and free of opinion, including what efforts were made to correct poor performance and the outcomes of those efforts,” says Homisak.
She recommends that, unless the offense requires immediate termination, you take a more methodical, ameliorative approach.
• Discuss the situation before it escalates. In the case of more minor transgressions or changes in behaviors or attitudes, it is best to approach the issue or issues head-on. Many times, you can head off or correct problems, according to Drs. Titko and Werber.
“We do a verbal communication first with the employee in which we discuss the details of the situation, ask the employee the reasoning of his or her behavior, and discuss corrective measures,” says Dr. Titko.
Dr. Titko’s practice uses a standard form of acknowledgment that employees sign. “It basically says that they have received the verbal warning — not that they necessarily admit to wrongdoing, but rather that they have had the discussion and are aware of the situation” presented by management, according to Dr. Titko.
Dr. Werber suggests that the form also remind the employee that the issue could be grounds for termination and present the steps that may follow. This may include the timeframe for resolving the issue and, should the timeframe go unmet, potential intermediary repercussions, such as probation or time off without pay.
The form — signed by the employee, yourself and perhaps a third-party observer such as the office manager — then goes in the employee’s file.
• Review annually or semiannually. A review is a good time to discuss performance objectives as a whole and does not come as a surprise to employees if you are consistent about it.
“We sit down with each employee every six months for performance reviews,” says Dr. Feit. “We discuss their strengths and weaknesses, and encourage them to work on the weaknesses between that time and the next review. This is for all employees because everyone has room for improvement.”
This way, if there is a new issue, you have the opportunity to address it in what should already be viewed as a neutral kind of meeting.
Homisak does caution podiatrists about sending contradictory messages.
“It’s important to not praise or reward poor performance with a raise just to avoid confrontation with the employee because it totally contradicts any decisions to fire if there is no improvement,” says Homisak.
• Address second/repeated offenses immediately. This sit-down should go much like the initial discussion in terms of documentation and temperament, but this time, there should be appropriate, proportional repercussions as outlined previously. Remember to maintain a calm focus on the employee’s actions.
“When employees get in trouble, they look to blame someone else,” says Dr. Feit. “What happens is, they start guessing who ‘told on’ them, so it is very important to defuse that problem, particularly if you are going to reprimand and not fire the employee. Do not let the situation become a blame game.”
• Document everything. Anything that is written should be discussed and anything that is discussed should be written. “Anything worth remembering is worth writing down,” says Homisak. “Do not be skimpy. Write the details as they occurred.”
• Take a moment to consider other options. “Keep in mind there are alternatives to termination if appropriate in cases of poor performance,” says Homisak. “For example, if an employee is doing a poor job, it could be because she isn’t a good fit for the position’s strengths/skills and moving her to another position may be the better move than firing.”
You have given the employee the opportunity to correct the inappropriate actions and behaviors. The employee has not followed the discussed improvement steps despite your best attempts to counsel him or her. You know your documentation is in order and you have decided firing is the next course of action. Homisak recommends the following 10 steps for proceeding with terminating employment.
1. Meet privately away from other employees. However, Dr. Werber notes that it may be a good idea to have a member of staff in a supervisory position on hand as a witness. “I do not want anyone coming back and filing a complaint with the labor board,” he says. “A false allegation is still an expensive allegation.”
2. Be brief — terminate in the first seven to 10 minutes. “Don’t chit chat,” says Homisak. “Be direct and do not postpone the inevitable.”
3. Be prepared for emotional outbreaks (anger, crying, etc.). “Usually, they cry or become angry,” says Dr. Titko. “If they become offensive, it is a matter of getting them off the property.”
4. Listen. Do not respond by becoming defensive or argumentative. Whatever you do — even if it is your emotional style — “Don’t attempt humor,” says Homisak. “It’s not funny to them” and won’t ease the situation.
5. Stay focused, hold your ground and repeat the main message. “We present to the employee the fully informed reasoning of the dismissal and what it is based on,” says Dr. Titko. “It is short and to the point, and we do not make them any promises such as a letter of recommendation.”
6. Don’t blame the employee. What’s done is done. “It is a lot like breaking up with a partner,” says Dr. Werber. “Simply outline the reasons and try not to be accusatory.”
7. Don’t say you understand. Sympathize but don’t empathize. “It is not a time to make excuses,” says Dr. Titko. “The supervisor doesn’t say, ‘We are sorry we have to let you go.’”
8. Let the employee know your decision is firm. Do not agree to think about it. Make a clean break. “Unless it’s a grievous offense, I’ll often help to ease the transition by giving the employee another week’s pay or continuing benefits for a month,” says Dr. Werber.
9. Do not refer to age, sex or race, even casually.
10. Write a factual record of the interview and give the employee a copy. “Everything needs to be documented,” says Dr. Werber. “And everyone who was in the room should sign the document.”
Always speak to an employment law attorney if you have questions about an action you are about to take. Homisak recommends that, after the firing, you escort the employee out the door, take any keys (although changing the locks is a good idea) or office property, and obtain/change any passwords to office equipment.
“Sometimes, in exchange for severance (such as Dr. Werber mentioned above), you can ask the employee to sign a document forfeiting her right to sue for wrongful termination,” notes Homisak. “Depending on the situation, you might let the terminated person submit a letter of resignation, which makes it easier for him or her to find other work.”
In this age of social media, do not give into the temptation to post to your personal — and certainly not professional — Facebook, Twitter or other site. Avoid this temptation even if you just wish to “set the record straight.”
“There’s really little you can do” that won’t look like retaliation, points out Homisak. “The only thing you can do is prevent the terminated employee from posting on your business page.”
Do not pretend the firing did not happen. Hold a meeting that day or the next day to provide an official explanation. Resist the temptation to go into details, says Homisak. She suggests simply saying, “Out of respect for the employee’s privacy, I would rather not discuss the details. However, despite repeated warnings, so-and-so will not be working here anymore.” This kind of evenhanded disclosure avoids making employees fear they could be next while stressing that breaking rules poses consequences.
“The staff almost always know already,” says Dr. Feit. “Not because there has been discussions among employees but if there are problems, staff have been telling me about them. It is often a relief and they feel happy I did not ignore their concerns and fairly acted on them.”
Another way to ensure employee morale doesn’t dip after a firing is to have a plan for handling the new workload in place, even before you carry out the firing. This communicates to staff that you have thought about them and want to be as fair as possible until a replacement can be found.
“It leaves a void that the remaining staff have to pick up,” says Dr. Titko. “It helps to have cross-training within the practice at all times so you are prepared to cover the loss of an employee under any circumstances.”
Let remaining staff know that it is okay to maintain friendships but that it is not appropriate to use office time for that purpose. “It is disruptive to patients, doesn’t represent the practice well and looks unprofessional,” says Dr. Feit.
“No one getting fired for breaking the law or even for poor performance should be ‘surprised’ when the time comes,” says Homisak. “If the employee is performing criminal acts, it is just a matter of time until he or she is caught and if work performance is not up to par, there should be enough evidence that the ‘firing moment’ is coming.”
Following prescribed steps makes the experience psychologically easier for the person doing the firing, says Dr. Werber, because it lets him or her build his or her own expectations of what is to come.
Moving forward, exit interviews can “be very revealing about the work experience itself and, if agreeable with the terminated employee,” it might be helpful to conduct, suggests Homisak. In addition, if you have had to fire an employee, it is a reminder to look at your hiring practices, according to Dr. Werber.
“It all goes back to listening and being involved in hiring,” he says. “Preventive care is always better than a surgical excision.”
For further reading, see “When You Have To Fire An Employee” in the July 2002 issue of Podiatry Today.