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Program teaches zero tolerance for poor performers
Teaches strategies for dealing with troublemakers
Hospice leaders know very well who are their high, middle, and low performers, but they may not take the time to identify employees this way or deal with the conflicts posed by the low performers, and this can lead to systemic and long-term problems in the organization.
According to the training techniques of a Florida leadership training program, there are some very specific ways managers can improve the entire hospice's performance, partly through dealing with low performers and boosting the morale of middle and high performers.
Once hospice managers learn how to improve responses to employees' positive and negative behaviors, then they'll start to get more reinforcement and honesty out of their staff, says Dale O. Knee, MHCA, president and chief executive officer of Covenant Hospice in Pensacola, FL. Covenant has an alliance with the Studer Group of Gulf Breeze, FL, to provide managerial training through a leadership academy.
"Once people know you're sincere, and you have an honest relationship with them, then they'll sincerely want to know what they can do for you," Knee says.
The leadership training program provides various tools, examples, and strategies for improving end-of-life organizations from the top down. But here are Knee's examples of how an organization can solve the ever present problem of improving low performers while not driving out high and middle performers:
1. Have a conversation with the low performer.
For example, a manager should set an appointment with the low performer, call the person in and have him or her sit down, dispensing with all pleasantries, Knee says.
"You can say, 'Thank you very much for coming to this appointment on time. I have some things I want to discuss with you,'" Knee says.
Then the manager should immediately tell the person about the behaviors that have identified the person as a low performer, including a bad attitude, if applicable, Knee says.
"Say how you expect that behavior to be corrected, and tell them very specifically that you expect this behavior to be corrected quickly," Knee advises. "Tell them you will meet with them on a weekly basis, and you would expect to see significant improvement immediately, or you will then have to take more definitive action."
The manager should also tell the employee that he or she will document this conversation and will continue to document further meetings so there will be a clear record of understanding what the expectations are, Knee adds.
"One of the techniques would be to not allow the employee to redirect the conversation or to point fingers at someone else, or direct the conversation back to you," Knee says. "They might say, 'You haven't spent enough time with me, or whatever.'"
If the employee tries to redirect the conversation, then the manager should say, "Look John or Jane, we're not here to talk about someone else today, we're here to talk about you," Knee says.
If the low performer goes away from the office thinking the manager is serious and that there will be some consequences, then it won't take long for word to get around, and the manager must follow through, Knee says.
2. Follow-up on low performer meeting.
"That's the next key ingredient: you must absolutely follow-through," Knee says. "It can't be a vacant threat; it has to be kept, and the staff will learn that someone is being scrutinized, and they'll expect some action to be taken."
Low performance needs to be corrected quickly, and it cannot be allowed to continue for months or years, Knee says.
"You don't call someone in and say, 'You got to change your attitude, and the next time I do an annual performance review, there will be consequences,'" Knee explains. "If I'm having a low performer conversation with someone I tell them that they must make the change the minute they walk out of my office."
And why shouldn't this be expected of employees? he asks.
"Why should we be at the mercy of low performers?" Knee says. "The organization should not be held hostage to low performers, and there's no reason for it."
Monitoring the low performer will take some time and effort.
For instance, if the employee's problem has been documented, then the manager might need to enlist help from other staff to review the employee's medical records and document problems, Knee says.
"If it's an attitudinal problem, then you have to observe the employee," Knee says. "That period of evaluation takes an investment on your part, and the pay-off is that you either improve the person and move them up to a middle performer category, or you rid the organization of the low performer."
The leadership training includes instruction on what is an appropriate disciplinary action and what isn't; a hospice manager who is uncomfortable that there may be side issues, such as claims of discrimination, can contact a labor attorney used by the hospice, Knee says.
"One thing we don't do, and I think it would be a vital mistake, is to be afraid of doing anything," Knee says.
"We give leaders the tools and resources to help them deal with low performers, so they shouldn't be like deer staring in the headlights, thinking their hospice will be sued," Knee says. "We don't run scared of a potential lawsuit just because we're afraid of it."
When Knee explains these leadership concepts at seminars and conferences, he often hears from leaders that they can't take this kind of action because their human resources department wouldn't let them do it.
"If I hear a leader at a hospice organization say that their human resources department won't let them do it, and I'm consulting with the hospice, then I'll have a frank conversation with the CEO, and say, 'Before you can do anything else, you need to take a hard look at the HR department,'" Knee says. "The HR department should be a service department, and through improved personnel administration, you improve the entire organization."
In about 20 to 25 percent of cases, the low performing employee will quit, which is good because those likely would be the most difficult ones to deal with, Knee says.
3. Continue to monitor if employee improves.
Leaders are taught to set 90-day goals for all employees, and the more general goals, omitting specific names, are shared on an Intranet site so everyone can see them, Knee says.
One of these goals is for the front-line supervisor to continue monitoring the low performer.
For example, suppose a registered nurse is the leader of the team, and she has on the team an LPN who has serious documentation and timing issues. The low performer conversation has been held, and the LPN's performance has improved vastly within the first two weeks to a month, Knee says.
Then, the leader needs to continue to sample the employee's documentation and medical reports to make certain the person doesn't fall back into being a low performer, Knee explains.
"If the person does fall back then that's grounds for termination, and the employee would need to be told that up front," he says.
"If I had a low performer who corrected his or her behavior within 30 days, then I'd call him or her in and have a good conversation," Knee says. "I'd say, 'You've done a good job, and I hope you understand now what you need to do to keep your documentation up. Documentation is critical in health care, and I hope you know that I don't expect you to fall back, and I don't expect to have another low performer conversation with you because, at that point, I'd have to seriously question your dedication to our organization.'"
Low performers are survivors, who know what to do to get by in an organization, Knee notes.
"They've outlived several supervisors, so they know they can play the yo-yo game and think, 'I can clean up my act until they're not looking, and then I can fall back,'" Knee says. "So you have to let it be known that there will be no falling back."
4. Be direct when firing an employee.
"Assuming you have the documentation you need, you call in the employee, and the conversation should be short," Knee says. "You basically say, 'As you know, I've had conversations with you, and I've put you on corrective behavior, and we've attempted to correct what's lacking, but since there has been no improvement in these areas, we're terminating your employment with us."
That's the end of the conversation, Knee says.
"Obviously you don't want them going away feeling terribly put-upon, but keep in mind that they're low performers, and they have not been doing the organization any good," Knee says.
5. Reinforce middle performers.
Middle performers should be called into the supervisor's office periodically and on an individual basis, Knee advises.
"I'd say, 'Thank you, John, for coming in today. How's your family doing?' etc., etc.," Knee says. "And I'd have a list of things in mind that are written down."
For instance, the manager will praise the middle performer for his or her good work, saying, perhaps, "I'm extremely pleased with the feedback I'm getting from patients about you," Knee suggests.
"Then you transition into an area where you are becoming the employee's mentor and coach in helping him or her improve," he says. "I might say, 'There is one thing that I would like to talk with you about where there is more room for improvement: I've noticed that occasionally your documentation is a little bit late; John, I'd really like you to work on that, and if you do, then it would be wonderful for you and wonderful for the team.'"
Then the supervisor can suggest the employee meet with someone else to learn how to improve his or her skills.
"The key thing is to ask John, 'What can I do for you? Do you have all the tools you need to do your job?'" Knee says.
"John might say, 'I have X number of patients, and I'm doing documentation and sometimes I'm working on my kitchen table doing it. Is there any way our team could get laptops?'" Knee says. "So you make the employee part of the solution, and have him go away feeling that he's been complimented, and you're interested in his career and helping him improve."
If a manager does all of this well, then the employee is re-recruited.
The key is 100 percent honesty, Knee says.
If the employee's solution cannot be done because of the organization's budget, then the manager should say that it's a great idea and the managers will look very hard at how they can do this, but since it would be a challenge to find money in the budget for it, then the key is for the staff to promote hospice each day and bring in more patients, Knee says.
"You can say, 'If we increase the size of our organization, then we'll have more money to make other investments, and you can be a part of that solution,'" Knee says. "Don't make promises you can't keep, but get them to be part of the solution, which is critical because an organization's efficiency and effectiveness occurs at the middle level."
The high performers are the thinkers, innovators, and people way out there with big ideas," Knee says. "But the efficiency, effectiveness, and productivity occur within the middle performer levels, and that's where you want to encourage it."
6. Motivate high performers.
"High performers must be challenged, and they constantly want to feel they are achieving," Knee says. "They want to take on more responsibility, and so it behooves a high performer supervisor to frankly take advantage of that and recognize that they have someone who is a high performer and who has a high capacity for producing a lot of work."
A high performer conversation with a manager might go like this: "You say, 'I want to know not only what I can do to help you, but what would you like to do, Judi?'" Knee suggests. "Do you know something we're involved in that you'd like to be involved in, and what would excite you?"
With a high performer, it's a more personal conversation and the manager is really getting to know them, Knee says.
"You want them to know that they are really a major contributing factor in the success of the organization," Knee says. "You do anything you can to promote them, and, once again, it's a constant rehiring process."
Usually when people are called into the supervisor's office they wonder what they've done wrong now. So with high performers, the manager should give the person a call or drop off a note and say, "Sometime this week, please drop by and see me," Knee says.
"I say, 'I just wanted to take this opportunity to ask how you are doing,'" he adds. "Or, I'll go to their office and knock on the door, go in, and say, 'I just wanted to stop by and say how much I appreciate you.'"
Leaders should constantly reinforce their appreciation of the high performers, and this has the added benefit of the staff witnessing this appreciation, which might motivate some of the middle performers to move into the high performer category, Knee adds.
"I don't want to say we're the most wonderful and all-knowing hospice, but this is a journey that we continue to be on, and no organization ever reaches the end of it," Knee says. "For all of the great things going on, we still have issues and things we need to deal with, but we deal with them in a different, more effective manner than we did five years ago."