Practice Consequences

For all the marbles, here is your final question: What is Truth or Consequences? a. A small town in New Mexico b. An old TV game show c. A fact many practice managers just can’t face d. All of the above

If you guessed “d,” congratulations you are our new champion! In fact, the answer is all of the above. In 1950, Ralph Edwards hosted the wildly popular radio game show Truth or Consequences, and he announced on the air that he would air his program from the first city in America that renamed itself after his show. Hot Springs – a small spa city in New Mexico actually took him up on his offer, and renamed itself Truth or Consequences. Additionally, after 17 years (1940-1957) the radio program evolved into several different TV shows, the most popular incarnation hosted by Bob Barker from 1956-1975. Of most interest to us though is the fact that truth and/or consequences is indeed a fact many practice managers and eye care professionals in ownership, leadership, and supervisory roles simply cannot face. Allow me to explain.

As an adjunct instructor for Rockhurst University and National Seminars Group, I frequently teach a 2-day seminar entitled Leadership Skills for Managers and Supervisors. It is a very popular class (for information when this seminar is coming to your town, call 800-258-7246) that is attended by managers and business owners from all walks of life. Early during the first day, I ask the attendees to share with the rest of the class their challenges – areas of frustration and concern in their supervisory roles. As you can imagine, the challenges are numerous and varied. Some complain about a lack of resources, dealing with difficult people, managing a bullying or clueless boss, time management, delegation, finding good people, getting employees to embrace change, and on and on…Often though I’ll start to hear very specific challenges; for example, employees who:

Make too many personal phone calls

Conduct personal business on the phone

Send text messages during business hours

Are guilty of email or Internet misuse

Treat patients or co-workers rudely

Do not follow the practice dress code

Arrive late for work

Perform their job duties below acceptable standards

Call in sick – even though all their sick time has been used. And on and on…

Those specific challenges could all fall under the headings of “Substandard Work Performance” or “Inappropriate Behavior.” Sometimes when these challenges are verbalized, if I’m feeling a little frisky or sarcastic, I’ll ask the attendee, “Why do you think that happens? Why are they late all the time?” Some of the answers that are offered include: She’s a single mother, traffic jams, personal problems, had to get the kids ready for school, illness, or she knows that her co-workers are there to cover for her. Those are all possible explanations for the tardiness (or for any of the other transgressions listed above) on any given day, but I didn’t ask for an explanation. I asked why.

A 2008 Harris survey revealed employees call in sick for the following reasons:

This study shows that nearly two-thirds of all absences are for reasons other than illness! A manager needs to be sensitive to the stress of mere day-to-day survival in the challenging, complex world in which we live. Managers who truly are sensitive to those needs, and are able to communicate that sensitivity by their day-to-day actions will have less absenteeism to deal with.

Additionally and anecdotally, I believe 90% of your employees will respond positively to your caring concern, and when appropriate, counseling and coaching. Behaviors will change and life will go on. But with some people (the other 10%) the TRUTH of the matter is that the only thing they understand is real CONSEQUENCE. In fact, I also believe that many managers are blind to another truism: The people who are in most need of change will not change until they feel uncomfortable. May I humbly suggest that the reason why those people whose behavior is in most need of change never change is simply because nothing bad ever happens to them! There is no real (say it together) consequence for not changing.

By the way, writing them up…again, setting up a meeting with you, them and the doctor…again, talking to them, asking them to change, idle threats, cajoling, ignoring, looking the other way, holding a meeting with the entire staff to discuss expectations, rewarding other employees, etc….all of those things may or may not be appropriate actions. But guess what? They all lack any real…consequence!

Once during a conference, one of the attendees raised her hand to ask a question. “Anthony…I got this one employee…the doctor said I can’t ever fire her…and I done wrote her up twenty-three times…what can I do?” Her frustration was palpable. When she said that she had written her up twenty-three times, I thought she said that in the same way I might say, “I wrote her up a million times.” So I asked her, how many times have you actually written her up. Her response was astounding. “I done told you Mr. Anthony – twenty-three times!” You see, the young lady asking the question could not fathom that her employee had not responded to twenty-three write-ups. Why? Because the woman at my seminar was a normal, decent, kind human being who would have responded to the first write up. I was left with the daunting task of answering her question by saying there is nothing she can do. Her “Problem Child” is simply waiting for twenty-four. Her real problem is not with her employee, it is with the owner/doctor who has decreed he will never fire the offensive employee. He is trying to hold his practice manager accountable for not being able to change the employee’s behavior, yet he has not given the manager any real authority to accomplish it. Because I’ve got news for you: That employee knows the doctor will never fire her. The only effective tool: consequence.

Which begs the question: Why does that doctor refuse to fire the offensive employee? There could be dozens of specific reasons. Let’s examine a few.

She has a family. The economy is so bad. Really? If that employee cared as much about her family as apparently the doctor does, and actually valued her job, perhaps she would respond to the real consequence of potentially losing her job.

Trying to be a “nice guy.” Really? Why not think about being a “nice guy” for all your other employees who strive to do a good job and have a positive influence on your practice.

She may sue me if I fire her. Possible? Yes. Likely? No. And if you document your conversations, and keep good records you have nothing to fear on this front.

It’s so hard to find employees these days. When did being vertical and having a heart beat become the only requirements to keep a job?

I don’t like confrontation. I wouldn’t want to fire her myself. Nobody likes confrontation…grow a backbone. Better yet, learn how to handle conflict, appropriately counsel, and if necessary, how to legally and professionally terminate an employee.

No question about it…sadly…sometimes…the truth is: all we have is consequences.